Organisation mondiale de la santé (OMS) · Technical Documents

Programme budget 2008-2009: budget performance (final report)

31 décembre 2010 Organisation mondiale de la santé

Retour à la vue par article

Texte intégral

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMITTEE Sixty-first session Putrajaya, Malaysia 11-15 October 2010

WPRlRC61/3

6 August 2010 ORIGINAL: ENGLISH

Provisional agenda item 8

•

PROGRAMME BUDGET 2008-2009: BUDGET PERFORMANCE (FINAL REPORT)

This document presents the final reports on the implementation of assessed and voluntary contributions for the 2008-2009 biennium by source of funding, strategic objective and category of expenditure. In monetary terms, the implementation of assessed contributions amounted to

US$ 79.2 million or 99.8% of the final working allocation (US$ 79.4 million) for the period I January 2008 to 31 December 2009 (Tables 1 and 3). In addition, the activities

implemented utilizing voluntary contributions amounted to US$ 150.8 million as of 31 December 2009. The total implementation for all funds was US$ 230.0 million as of 31 December 2009 (Table 3). The implementation of all funds by strategic objective is

•

shown in Table 4 and the implementation by category of expenditure is reflected in Table 5 . Information on outputs and results is provided in Annex 1 of this report. The information is based on an end-of-biennium assessment exercise and covers the period 1 January 2008 to 31 December 2009. Annex 2 provides details of improved ways of

working, which were introduced at the end of 2009, including the innovative country strategic frameworks and technical strategic frameworks. An interim report on the implementation of assessed contributions and voluntary

contributions for 2008-2009 was presented to the sixtieth session of the Regional Committee. The Regional Committee may now wish to review and discuss the fmal implementation figures.

WPRlRC6113 page 2

IMPLEMENTATION OF PROGRAMME BUDGET 2008-2009

This document presents the final reports on the implementation of. assessed and voluntary contributions for the 2008-2009 biennium by source of funding, strategic objective and category of expenditure.

Structure of this document With the aim of achieving coordinated reporting in uniform formats, this paper draws its information from the financial report and audited fmancial statements for the period 1 January 2008-31 December 2009 (document A63/32), which was discussed at the Sixtythird World Health Assembly in May 2010.

•

Level of programme budget The Proposed Programme Budget 2008-2009 was presented to the Regional Committee of the Western Pacific at its fifty-seventh session in September 2006. The Global Programme Budget 2008-2009 was approved at the Sixtieth World Health Assembly in May 2007. The assessed contributions approved by the World Health Assembly for the Region amounted to US$ 80.2 million (a 4.8% increase from the US$ 76.5 million approved for 2006-2007). Table 1. Financing sources summary: 2008-2009 and 2006-2007 (US$ million)

Programme budget 2008-2009 Source of financing Assessed contributions Voluntary contributions Approved budget 80.2 256.7 Final working allocation 79.4 277.7

Programme budget 2006-2007 Source of financing Assessed contributions Voluntary contributions Approved budget 76.5 156.4 Final working allocation 74.7 156.4

• 231.1

Total

336.9

357.1

Total

232.9

WPRlRC6113 page 3

Owing to continuing uncertainties with regard to the payment of contributions from Member States, the WHO Director-General initially decided to establish the working allocation at 98%, hence temporarily reducing the Western Pacific Region's assessed contributions to US$ 78.5 million. The subsequent release of an additional 1% resulted in the final working allocation ofUS$ 79.4 million for 2008-2009. During the biennium, the WHO Regional Office and Headquarters mobilized US$ 214.3 million in voluntary contributions (Table 2). Table 2 reveals the gaps in fmancing for the 2008-2009 biennium. While the Region was able to mobilize adequate resources under strategic objective 2 - HIV/AIDS, tuberculosis

•

and malaria, gaps were identified in other strategic objectives during the implementation stage.

Table 2: Gaps in financing for 2008-2009 by strategic objective - all funds (US$ million)

Total Strategic objective 1 Communicable diseases 2 HIV/AIDS, tuberculosis and malaria Final working allocation 85.6 56.3 18.0 25.6 13.5 22.4 2.9 13.8 14.6 41.4 14.7 partnerships 15.2 33.1 357.1 Income AC 8.0 5.7 5.6 4.4 1.4 4.2 0.2 2.9 2.5 17.8 3.6 8.4 14.7 79.4 VC 67.3 51.6 7.5 7.1 10.4 8.7 1.1 5.4 2.9 21.0 9.8 6.7 14.8 214.3 Total 75.3 57.3 13.1 11.5 11.8 12.9 1.3 8.3 5.4 38.8 13.4 15.1 29.5 293.7 Gap (10.3) 1.0 (4.9) (14.1) (1.7) (9.5) (1.6) (5.5) (9.2) (2.6) (1.3) (0.1) (3.6) (63.4)

3 Chronic noncommunicable conditions 4 Child, adolescent, maternal, sexual and reproductive health and ageing 5 Emergencies and disasters 6 Risk factors for health 7 Social and economic determinants of health 8 Healthier environment 9 Nutrition and food safety 10 Health systems and services 11 Medical products and technologies 12 WHO leadership, governance and 13 Enabling and support functions

•

Total AC-assessed contnbutions; VC-voluntary contnbutlons.

WPR/RC6113 page 4

1m plementation

In monetary terms, the implementation of assessed contributions amounted to US$ 79.2 million or 98.8% of the approved budget and 99.8% of the final working allocation for the period I January 2008 to 31 December 2009. In addition, the activities implemented utilizing voluntary contributions as of 31 December 2009 amounted to US$ 150.8 million or 54.3% of the final working allocation and 70.4% of the available resources

(US$ 214.3 million), respectively. Table 3a compares the implementation of all funds for 2008-2009, which totalled US$ 230 million as of 31 December 2009, with the implementation of all funds in 2006-2007. Table 3b presents a comparison of implementation by country office and Regional Office for the 2008-2009 and 2006-2007 bienniums.

• %

Table 3a. Implementation of all funds (US$ million)

Implementation 2008-2009 Fund Assessed contribution Voluntary contribution Total Income Expenditure Encumbrances Total

Implementation 2006-2007

Fund Assessed contribution Voluntary contribution Total

Income

Implementation

79.4 214.3 293.7

75.4 137.6 213.0

3.8 13.2 17.0

79.2 150.8 230.0

99.8 70.4 78.3

74.7 156.8 231.5

74.7 101.4 176.1

100.0 64.7 76.1

*Implementatton In 2006-2007 is equal to expenditure and encumbrances.

Table 3b. Implementation by country office and Regional Office (US$ million)

•

Implementation 2008-2009 Level Country Regional Total Assessed contribution Voluntary contribution Total Level Country Regional Total

Implementation 2006-2007 Assessed contribution Voluntary contribution Total

44.5 34.7 79.2

84.9 65.9 150.8

129.4 100.6 230.0

42.3 32.4 74.7

39.2 62.2 101.4

81.5 94.6 176.1

WPR/RC6113 page 5

Table 4 shows the implementation of all funds (expenditure plus encumbrances) for the 2008-2009 biennium by strategic objective.

Table 4: Implementation by strategic objective (US$ million)

Strategic objective

Expenditure AC VC

Encumbrances AC 0.5 0.2 0.3 0.3 0.1 0.3 VC

Total AC 8.0 5.7 5.6 4.4 1.5 4.3 0.2 2.9 2.5 17.7 3.6 8.3 14.5 79.2 .

Total VC

1 Communicable diseases 2 HIVIAIDS, tuberculosis and malaria

7.5 5.5 5.3 4.1 1.4 4.0 0.2 2.7 2.4 16.7 3.4 8.2 14.0 75.4

43.5 32.7 4.6 4.5 5.7 6.3 0.5 3.2 2.0 12.1 5.6 5.7 11.2 137.6

4.4 3.2 0.4 0.2 0.8 0.4 0.1 0.6 0.1 1.0 0.4 0.1 1.5 13.2

47.9 35.9 5.0 4.7 6.5 6.7 0.6 3.8 2.1 13.1 6.0 5.8 12.7 150.8

55.9 41.6 10.6 9.1 8.0 11.0 0.8 6.7 4.6 30.8 9.6 14.1 27.2 230.0

•

0.2 0.1 1.0 0.2 0.1 0.5 3.8

8 Healthier environment 9 Nutrition and food safety 10 Health systems and services 11 Medical products and technologies 12 WHO leadership, governance and partnerships 13 Enabling and support functions Total AC-assessed contnbullons; VC-voluntary contnbutlons.

•

As in previous years, dependency on voluntary contributions remained high in 2008-2009. In fact, the total amount of voluntary contributions mobilized in 2008-2009 was 36.7% higher than in the previous biennium. Due to the change in the financial rules and regulations of the Organization, the fmancial reports for 2008-2009, presented and approved by the World Health Assembly, reflect the total expenditures only. The implementation figures for the 2006-2007 biennium include both the expenditure and encumbrances. The implementation of assessed and voluntary contributions in 2008-2009, broken down by category of expenditure, is shown below in Table 5.

WPRlRC6113 page 6

Table 5: Implementation by category of expenditure (encumbrances not included) (US$ million)

Category Staff cost Contractual services Direct financial cooperation Travel Medical supplies and literature General operating costs Others" Total

Amount spent

95.8 30.1 26.2 22.0 9.8 9.6 19.5 213.0

45.0 14.1 12.3 10.3 4.6 4.5 9.2 100.0

"Others include equipment, fumiture and vehicles, training, consulting, research services, telecommunications and fellowships

•

During the 2008-2009 biennium, the largest percentage of expenditure was attributed to staff costs (45%), followed by contractual services (14.1%), direct financial cooperation (12.3%) and travel (10.3%). Travel costs include national and international group training activities and meetings convened and/or supported by WHO. Recognizing the substantial expenditure under the travel category, the Secretariat implemented several cost-containment measures, such as better travel management, negotiation with the travel agents, and use of video conferences wherever possible. Expenditure on travel is being closely monitored by the Regional Office.

Outputs and results Annex 1 contains the end-of-biennium performance report on outputs and results, summarizing progress made towards the strategic objectives and regional expected results identified in the Programme Budget 2008-2009. During discussions of the interim performance report for the Programme Budget 2008-2009 at the sixtieth session of the Regional Committee, some concerns were raised about the scope, description and measurement of the regional expected results. The regional expected results were fIrst documented in 2006 as part of planning the implementation of the Medium-term Strategic Plan. Earlier at the sixtieth session of the Regional Committee, the Regional Director outlined his vision for WHO in the Region and his intentions for the regional Secretariat.

•

WPRJRC6113 page 7

Importantly, the Regional Director asked the Secretariat to find improved ways of working to attain the Organization's mission. Subsequently, in late 2009 and early 2010, the Regional Director undertook systematic and detailed reviews of WHO country-level work plans and the Regional technical programmes. In the light of the discussions at the sixtieth session of the Regional Committee, the matter of expected results was given particular attention. The Regional Director's country-level and Regional-level reviews confirmed the need for improved ways of working, including strengthening the quality of performance management, measurement and monitoring, and improving the overall efficiency and

•

effectiveness of WHO operations . Since then, changes have been made to the Regional Office structure and improved work processes have been introduced, including development and adoption of a novel strategic framework to better facilitate the alignment of WHO country work with individual Member State's health goals; and to improve the oversight, monitoring and management of WHO technical work across the Region in line with Member States' collective goals. Annex 2 provides more details of these improved ways of working. Apart from helping to formulate sound performance indicators and to internally monitor progress, the strategic framework approach-using its participatory bottom-up planning process-is being used to robustly plan and link the country and regional priorities

•

of WHO to more effectively drive actions within the strategic directions set by the Mediumterm Strategic Plan. The innovative strategic framework approach within the Western Pacific Region is still being implemented and refined, but it has already generated considerable interest in other WHO regions and at Headquarters as the current and future Medium-term Strategic Plans are being considered. The successful creation of synergistic Country Strategic Frameworks and Technical Strategic Frameworks will more firmly base strategic and operational planning processes on individual countries' priorities and the agreed collective Western Pacific Regional technical agenda, and also improve measurement, monitoring and accountability for clearer results from the Secretariat within the framework of the Medium-term Strategic Plan.

WPRlRC61/3

page 8 Completion of the Country Strategic Frameworks and Technical Strategic Frameworks in the Region is expected before the end of 2010. The results of this improved way of working will benefit operations in the 2010-2011 biennium and the planning of the Proposed Programme Budget 2012-2013, which will be presented to the sixty-second session of the WHO Regional Committee for the Western Pacific in 2011.

•

WPRlRC61 13 ANNEX 1

WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION

PROGRAMME BUDGET 2008-2009 OUTPUTS AND RESULTS

Summary of progress made towards strategic objectives and regional expected results

December 2009

WPRlRC61/3 ANNEX 1

WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION

PROGRAMME BUDGET 2008-2009 OUTPUTS AND RESULTS

Summary of progress made towards strategic objectives and regional expected results

t ,

t December 2009

OVERVIEW

Overview The Programme Budget 2008-2009 performance assessment is the fi~st t~ be carried out within t~e framework of the Medium-term Strategic Plan 2008-2013. It aims to Identify the overall progress In achieving the regional expected results outlined in the Medium-term Strategic Pla~ 200.8-2013 a~d the Programme Budget 2008-2009 for the Western Pacific Region, approved at the fifty-eighth session of the Regional Committee in September 2007.' Of the 97 regional expected results, 88 were "fully achieved" and nine "partly achieved". The breakdown by strategic objective is as follows: Regional expected results Strategic Objective Fully achieved Partly achieved Total

1. Communicable diseases 2. HIV/AIDS, tuberculosis and malaria 3. Chronic noncommunicable conditions 4. Child, adolescent, maternal, sexual and reproductive health, and ageing 5. Emergencies and disasters 6. Risk factors for health 7. Social and economic determinants of health 8. Healthier environment 9. Nutrition and food safety 10. Health systems and services 11. Medical products and technologies 12. WHO leadership, governance and partnerships 13. Enabling and support functions Total .

8 9 6 7 8 6 7 5 6 13 3

1 1 1 0 2 0 0 0 0 2 0 0 2 9

9 10 7 7 10 6 7 5 6 15 3

4 6

4 8 97

At the start of the biennium, each of the 97 regional expected results had one or more indicators defined, all with baselines and targets. Experience has shown that many of the defined indicators have limitations and do not adequately represent the full scope of the expected results, or the range of WHO actions and progress in the Westem Pacific Region. Significant improvements will be made to improve the relevance of future indicators. 1 Document WPRJRC58/4

OVERVIEW

As in pr~vious bienniu~s, the pro.g~ess assessment exercise was primarily a self-assessment process. It be~an with the ~valuatlon by Individual offices (country and regional) of their performance in achieving their office-speCific expected results. All teams and units reviewed the delivery of planned products and services, tracked and updated indicator values for the expected results and provided narrative information on the achievements. The performance assessments at office level were then consolidated and synthesized into reports by the strategic objective teams at the Regional Office. The degree of success in achieving the regional expected results was assessed on the basis of the following indicator criteria: • • • Fully achieved - All indicator targets for the regional expected result were met or surpassed; Partly achieved - One or more indicator targets for the regional expected result were not met; Not achieved - No indicator targets for the regional expected result were met.

These initial assessments of the regional expected results were then reviewed and revised in the light of the reports on the contributing office-specific expected results. The achievements in countries were given particular attention and cognizance was taken of any limitations of the regional expected result indicators before a final decision on achievement status was made. In order to improve the reliability and accuracy of the assessment outcomes, a quality assurance mechanism was established. Draft reports were shared between strategic objective teams before being reviewed by peers from both technical units and the planning and performance assessment team. The reports on all 13 strategic objectives were scrutinized in order to identify inconsistencies and omissions, and to ensure that achievements and not just actions were the main focus of attention, and that the reports accurately reflected the work being carried out in countries. Systematic feedback on the quality review completed the iterative process. More detailed information on the 2008-2009 indicators and targets is available on the WHO Regional Committee for the Western Pacific web page (www.wpro.who.intlrcm/en/rc61). A narrative report on the work of WHO in the Western Pacific Region for the period 1 July 2008 to 30 June 2009 was presented to the sixtieth session of the Regional Committee in Hong Kong (China) in 2 September 2009.

Document WPRlRC60/2

STRATEGIC OBJECTIVE 1

STRATEGIC OBJECTIVE 1 To reduce the health, social and economic burden of communicable

diseases. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

Measles supplementary immunization activities (SIAs) were conducted in China, Kiribati, Papua New Guinea, Samoa, Solomon Islands, Vanuatu and Viet Nam, reaching over 100 million children with measles vaccine regardless of sex, ethnicity or socioeconomic status. Additional activities conducted during the SIAs in these countries included administration of other vaccines, such as oral polio vaccine, as well as provision of vitamin A supplements, deworming medicine to young children, and insecticidetreated bednets. All countries and areas were using hepatitis B vaccine with a birth dose, and 26 have coverage levels required to achieve the hepatitis B control goal before the scheduled target date of 2012. New and underutilized vaccines were increasingly incorporated into routine schedules in Member States. Polio-free status was maintained by strengthening routine immunization services, conducting polio SIAs in selected Member States, and improving acute flaccid paralysis surveillance. The Regional Certification Commission for Polio Eradication continued to review annual progress reports from Member States, and, with China and Japan completing containment requirements, concluded that Phase 1 laboratory containment was completed. Technical support was provided for the compilation and analysis of the 2007 and 2008 leprosy data received from countries, for efforts to sustain leprosy elimination status, for advocacy campaigns in Cambodia and China, for a review of the national leprosy programme in Papua New Guinea, and for orientation of the operational guidelines 2006-2010. A training and partners' meeting for northern Pacific island countries was organized in April 2008, and a training workshop for leprosy programme staff in the Western Pacific was held in June 2009. Development and endorsement of the Dengue Strategic Plan for the Asia Pacific Region 3 by the Regional Committee in September 2008 raised the profile of dengue throughout the WHO South-East Asia and Western Pacific Regions. The biregional plan provided a road map for national plans and for resource mobilization. Development of regional plans of action for neglected tropical diseases and regional research in communicable diseases set the base for endorsement at upcoming sessions of the Regional Committee. Member States significantly enhanced their capacity with regard to disease surveillance, monitoring and response. By the end of the biennium, all Member States were conducting case-based measles surveillance-supported by an extensive laboratory network-with monthly reports submitted to the WHO Regional Office. WHO assured the quality of the polio and measles laboratory networks through proficiency testing and site visits. WHO also assisted priority countries to establish sentinel surveillance systems for diseases targeted by new or underutilized vaccines, including Haemophilus influenzae type b, Streptococcus pneumoniae, Japanese encephalitis and rotavirus. Field epidemiology training programmes were initiated in Cambodia, the Lao People's Democratic Republic, Mongolia and Viet Nam to ensure the sustainability of proper technical staff to adequately support surveillance and response programmes. Research projects that addressed programmatic gaps were supported continuously with small-scale grants from the Special Programme for Research and Training in Tropical Diseases (TOR). All Member States adopted the Asia Pacific Strategy on Emerging Disease (APSED),4 which focuses on the strengthening of capacity in the areas of surveillance and response, laboratory, zoonoses, risk communication and infection contro/. The implementation of this Strategy supports the core capacity development required under the revised International Health Regulations (IHR) 2005, which are legally

WPRJRC59.R6 WPRJRC56.R4

STRATEGIC OBJECTIVE 1,

binding in all Member States. When IHR (2005) entered into force in June 2007, it became a WHO mandate to support Member States to develop the core capacity to fulfil obligations by 2012. National IHR Focal Points, who were designated or established in all Member States, were fully operating with appropriate procedures and protocols. Regional exercises were conducted on IHR (2005) event communications with the participation of 23 National IHR Focal Points in the Region. The exercises validated the functional accessibility of focal points and the IHR (2005) event verification process between Member States; and WHO. As a result of various workshops and technical assistance provided by the WHO Regional Office, countries strengthened their country-level IHR (2005) activities with respect to advocacy, communication,' core capacity-building, points of entry and support for legal matters. Intense efforts in data collection, data analysis and information sharing (e.g. regional database on the WHO website) attracted the attention of policy-makers, key stakeholders and donors and resulted in successful resource mobilization. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 01.001.WP01: Policy and technical support provided to Member States in order to maximize equitable access of all people to vaccines of assured quality, including new immunization products and technologies, and to integrate other essential child-health interventions with immunization • Appraisal: Fully Achieved .

Comments on achievements Measles supplementary immunization activities (SIAs) are opportunities to establish equity of life-saving interventions to prevent disease and improve health. During the 2008-2009 biennium, measles SIAs were conducted in 22 of 31 provinces in China, Kiribati, Papua New Guinea, Samoa, Solomon Islands, Vanuatu and Viet Nam, reaching over 100 million children with measles vaccine regardless of sex, ethnicity or socioeconomic status. Additional activities conducted during the SIAs in these countries included administration of other vaccines, such as oral polio vaccine, as well as provision of vitamin A supplements, deworming medicine to young children, and insecticide-treated bed nets. The WHO Regional Office provided technical, operational and/or financial support to each of these countries. Significant progress on the introduction of Haemophilus influenzae type b (Hib) vaccine was made in the last two bienniums. Twelve countries and areas introduced or decided to introduce Hib vaccine in this last biennium, bringing the total number of countries in the Region using Hib vaccine to 31. Most of the countries that were not currently using Hib vaccines were high-income countries, All countries and areas now use hepatitis B vaccine with a birth dose. Twenty-six countries achieved the hepatitis B control goal before the scheduled target date of 2012. Pneumococcal conjugate vaccines were introduced by three new countries and areas, namely, Macao (China), Hong Kong (China) and New Zealand, Preparatory work for the introduction of new vaccines (e.g. Hib, pneumococcal, Japanese encephalitis, human papillomavirus and rotavirus vaccines) was conducted in Cambod,ia, China, Fiji, Hong Kong (China), Kiribati, the Lao People's Democratic Republic, MongOlia, Macao (China), Solomon Islands, Vanuatu and Viet Nam, The preparatory work included setting up surveillance systems to generate disease burden data, economic and financial analysis, regional meetings for exchange of information and comparative analysiS. An expert consultation was organized in Malaysia for options for cervical cancer control, including human papillomavirus vaccine. Similarly, regional workshops were organized for Hib, Japanese encephalitis and typhoid vaccines. The preparatory work conducted in 2008-2009 will result in the actual introduction of these vaccines, where justified, in 2010-2011. Success factors included continuous advocacy and communications with countries and having enough funding to provide direct technical assistance. With the introduction of new vaccines and the current financial crisis, future implementation plans may be delayed.

STRATEGIC OBJECTIVE 1

RER 01.002.WP01: Effective coordination and support provided in order to achieve certification of poliomyelitis eradication, and destruction, or appropriate containment, of polioviruses, leading to a simultaneous cessation of oral poliomyelitis vaccination globally. Appraisal: Fully Achieved Comments on achievements Technical and financial support was provided to Member States to maintain quality surveillance for polio through training of health and laboratory staff, introduction of new laboratory testing methods, accreditation of polio laboratories, working with national certification committees, and advocacy with senior health decision-makers on continued requirements for maintaining polio-free status. Regular data analysis was performed for acute flaccid paralysis (AFP) surveillance indicators and feedback was provided to each country. Technical support also continued for strengthening routine immunization systems through the identification of special risk groups and conduct of special outreach, promotion of health centre utilization and defaulter tracking. Supplementary immunization activities against polio were supported in China and the Lao People's Democratic Republic, where they were integrated with other immunization and child survival interventions. The annual meeting of the Regional Commission for the Certification of Poliomyelitis Eradication was combined with a targeted review of the AFP surveillance system in Cambodia. This arrangement allowed commission members to review the system by themselves and provided advocacy opportunities with senior officials from the ministries of health and other relevant bodies. Ail countries were supported in preparing their annual progress reports, detailing surveillance, immunization, laboratory containment and certification activities as well as levels of preparedness for importation of wild poliovirus and emergence of vaccine-derived poliovirus. Following the completion of phase one wild poliovirus laboratory containment in December 2008, with submission of final documentation from China and Japan, technical support was provided to develop maintenance plans, to keep national laboratory lists and inventories current and to further reduce the number of laboratories retaining wild poliovirus infectious and potentially infectious materials. Work continued to ensure that all countries retained a focal point for wild poliovirus laboratory containment within the ministry of health and to ensure preparations for phase two, as requested by the Regional Commission for the Certification of Poliomyelitis Eradication. Technical support was also provided to Member States interested in shifting from oral polio vaccine to inactivated polio vaccine as part of national decisions, as eventual global oral polio vaccine cessation cannot be expected in the mid-term.

RER 01.003.WP01: Effective coordination and support provided to Member States in order to provide access for all populations to interventions for the prevention, control, elimination and eradication of neglected tropical diseases, including zoonotic diseases. Appraisal: Partially Achieved Comments on achievements A draft regional plan of action for neglected tropical diseases was prepared and a consultation process among programme managers commenced. The final version of the plan of action will be taken to the Regional Committee for endorsement. Priority actions were taken to strengthen dengue disease surveillance, such as sharing of dengue information among Member States, vector surveillance and management, case management, outbreak response, and operational research. Comprehensive data on programme progress were collected and placed on the WHO Regional Office website, attracting the attention of stakeholders and donors. Progress was also made on the implementation of the biregional dengue plan of action. Significant progress was achieved by the soil-transmitted helminthiasis and schistosomiasis preventive chemotherapy programme in the Mekong countries. Cambodia, the Lao People's Democratic Republic, Kiribati and Vanuatu managed to attain 75% deworming coverage among the at-risk school-age population. Lymphatic filariasis elimination was achieved in China and the Republic of Korea, while elimination verification is pending in three Pacific island countries. A regional dengue database was put in place in the WHO Regional Office and resources for dengue were mobilized. The leprosy elimination goal (prevalence of <1 per 10 000 population) was achieved at the regional level in 2000, and sustained thereafter. Thirty-four out of 37 countries and areas sustained the elimination target. Technical assistance and fundinq support was provided to Kiribati, the Federated States of Micronesia and the Marshall

•

j STRATEGIC OBJECTIVE 1

Islands to strengthen leprosy activities. A regional workshop was held for the countries with the highest burden of leprosy to update them on the new global strategy for leprosy control. In-country workshops were held to assist national leprosy programmes in updating knowledge and improving clinical skills on leprosy control.

RER 01.004.WP01: Policy and technical support provided to Member States in order to enhance their capacity to carry out surveillance and monitoring of all communicable diseases of public health importance. Appraisal: Fully Achieved Comments 9n achievements Member States. utilizing support from both the WHO Regional Office and country offices. continued to strengthen their capacity for surveillance and monitoring of communicable diseases of public health importance. Countries included Cambodia. China. Fiji. the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and various Pacific island countries. In December 2009, most Member States had either adequate or well-functioning surveillance systems that would permit identification of specific diseases. With outbreaks of pandemic Influenza A (H1N1) 2009, surveillance systems throughout the Region performed very well. This was an indication that surveillarnce systems were working at relatively high performance levels. With support from the WHO Regional Office, Member States strengthened their early warning and response networks and their field information management systems. Indicator-based systems, which were found in all Member States, were also strengthened. In the Lao People's Democratic Republic, there was special progress in this area as the early warning and response network was expanded to all provinces and all provincial staff received supportive training. Mongolia also made special progress in the implementation of this new routine surveillance system, which was expanded to cover a large portion of the country. Throughout the Region, event-based surveillance systems were enhanced and capacity was strengthened to rapidly capture information about unusual and unexpected events that may pose a risk to public health. The Lao People's Democratic Republic completed an extensive evaluation of their pilot event-based surveillance system and proceeded with implementation. China strengthened their existing system by adding an online event-based component. Mongolia developed country-specific event-based surveillance guidelines, conducted national training and then launched a pilot of the programme. Links between event-based surveillance and zoonoses and animal health events were improved by building closer links between the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OlE), WHO in the Western Pacific Region, and the WHO global early warning and response system. This collaboration led to more timely reporting of poultry mortality in the Lao People's Democratic Republic, Mongolia and Viet Nam, and improved reporting of unusual pig mortality in the Philippines. A very important component of efforts to strengthen surveillance and response was the capacity development of country epidemiologists. A modified field epidemiology training programme of short modules, as opposed to longterm class attendance, with an emphasis on practical field orientation was developed by WHO in the Western Pacific Region. Field epidemiology training courses based on this model but modified to- adjust to country requirements were developed and implemented in Cambodia, the Lao People's Democratic Republic and Mongolia. High-quality, case-based measles and rubella surveillance is one of the three core strategies for measles elimination and is frequently integrated with surveillance for acute flaccid paralysis and neonatal tetanus. WHO in the Western Pacific Region provided technical, operational and financial support to strengthen case-based measles surveillance integrated with surveillance for other vaccine-preventable diseases in Cambodia, Fiji, Kiribati, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines, Solomon Islands, Vanuatu and Viet Nam. Integrated training for case-based measles, acute flaccid paralysis and influenza-like illness was conducted in several Member States. Completeness of national measles reporting to the WHO Regional Office increased from 51% to 82%, and timeliness of reporting increased from 19% to 57% during the biennium. National measles laboratories and regional reference laboratories were strengthened through direct technical and financial support, including hands-on training; .

STRATEGIC OBJECTIVE 1

RER 01.005.WP01: New knowledge, intervention tools and strategies that meet priority needs for the prevention and control of communicable diseases developed and validated, with scientists from developing countries increasingly taking the lead in this research. Appraisal: Fully achieved Comments on achievements Significant progress was made in developing a regional plan of action for research on neglected tropical diseases, malaria and tuberculosis. The draft plan of action was prepared to strengthen the capacity of diseaseendemic countries in the Region to undertake research on neglected tropical diseases, and to strategically link research with disease control activities. The draft plan of action was refined via regional consultations with strong input from leading researchers, research institutes, WHO collaborating centres and research networks, such as the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+). The plan of action is expected to encourage increased political commitment and allocation of resources. Research projects that addressed programmatic gaps were funded by small-scale grants awarded by the Special Programme for Research and Training in Tropical Diseases (TOR) and administered by the WHO Regional Office. In administering the TOR small grants, WHO not only provided research grants to less-developed, resource-constrained Member States, but also provided capacity-building through intense mentoring to improve the proposals. Additionally, two operational research studies were supported by the Asian Development Bank. A follow-up survey of a 2007 scientific writing workshop demonstrated that the partiCipants continued to produce peer-reviewed SCientific articles in 2008 and 2009. WHO in the Westem Pacific Region continued to support regional research networks as they play an important. role in the development of knowledge, tools and strategies to control communicable diseases. In 2009, WHO provided financial and administrative support to the ninth RNAS+ meeting. TOR also strengthened its support to the Region via a regional stakeholder consultation on infectious diseases of poverty, a thematic reference group, and a fulltime support staff person in the WHO Regional Office.

RER 01.006.WP01: Support provided to Member States in order to achieve the minimum core capacities required by the International Health Regulations (IHR) (2005) for the establishment and strengthening of alert and response systems for use in epidemics and other public health emergenCies of international concern. Appraisal: Fully Achieved Comments on achievements All Member States continued to give high priority to the implementation of the Asia Pacific Strategy for Emerging Diseases (APSED). Endorsed by the Regional Committee for the Western Pacific in September 2005, APSED serves as an effective regional tool for countries to meet the surveillance and response core capacity obligations under the IHR (2005). All Member States had an operational NationallHR Focal Point in place. National plans of action (or equivalent) and national preparedness plans (or equivalent) were developed. Member States attended several key regional and national meetings and workshops, including the annual meetings of the Asia Pacific Technical Advisory Group on Emerging Infectious Diseases and a meeting of the Pacific National IHR Focal Points to further strengthen their IHR (2005) systems. A regional exercise on IHR (2005) event communication was conducted with the participation of 23 National IHR Focal Points in the Region. The purpose of the exercise was to test and assess the functional accessibility of country focal pOints and to validate the IHR (2005) event verification process between Member States and WHO. The results of the assessment were very positive. Operationally, National IHR Focal Points played a very important role in the completion of the 2008 and 2009 State Parties' reports on IHR (2005) implementation, which were required by the World Health Assembly. The National IHR Focal Points also played an invaluable role in providing timely and accurate information on pandemic (H1N1) 2009 to the Western Pacific Region. WHO assisted in the sharing of information on pandemic (H1 N1) 2009 among Member States through the IHR (2005) event information site. Countries made progress in strengthening public health measures and emergency response capacities at designated points of entry. A majority of countries conducted a capacity assessment of deSignated points of entry as well as developed a plan to ensure that the IHR (2005) capacity of designated points of entry will be

STRATEGIC OBJECTIVE 1

developed by 2012. Finally, a joint meeting was conducted between WHO and the Association of South-East Asian Nations (ASEAN) on' public health measures at international points of entry, giving countries an opportunity to share experiences and practices as well as to identify new roles for pOints of entry. Further, working relationships with other regional and international organizations and agencies (including but not limited to ASEAN, Secretariat of the Pacific Community, and International Civil Aviation Association) were developed or further enhanced with the purpose of facilitating application of IHR (2005).

RER 01.007.WP01: Member States and the international community equipped to detect, assess, respond to and cope with major epidemic and pandemic-prone diseases (e.g. influenza, meningitis, yellow fever, haemorrhagic fevers, plague and smallpox) through the development and implementation of tools, methodologies, practices, networks and partnerships for prevention, detection, preparedness and intervention. Appraisal: Fully Achieved Comments on achievements Member States continued to rely on APSED as a tool to develop the core capacities required under IHR (2005). The Strategy's five focus areas-surveillance and response, laboratory, zoonoses, infection control and risk communication-all support the development of capacities with reference to preparedness, detection of and response to emerging diseases, inclusive of major epidemic and pandemic-prone diseases. Progress was made in the implementation of APSED and pandemic planning, national laboratory networking, and development of country core capacities in response to emerging and re-emerging diseases. Most countries increased their readiness by carrying out actions specifiC for emergencies and actions based on routine situations, building on their core capacities to respond to outbreak situations as part of their APSED workplan. All countries compiled an assessment of their existing system and core capacities. More than 251 countries used the APSED baseline data collection checklists to assess the national capacities to identify gaps and facilitate national planning. Most countries initiated or completed their draft national plans of action for emerging and epidemiC-prone infectious disease or the core capacity strengthening using the APSED approach. With regard to laboratory capacity, the demonstrated ability of laboratories in the Region to detect the novel strain of pandemic influenza A (H1 N1) 2009 highlighted recent improvements in laboratory capacity. Significant progress was made in strengthening the Biosafety Consortium as an independent, regional source of expertise. Further, various training courses were provided to enhance country capacity. With regard to zoonoses, a communication channel at the regional level was formally establiShed between FAO, OlE and WHO, with all three organizations agreeing to support the development and/or strengthening of a coordination mechanism between human and animal sectors at country level. Countries strengthened their surveillance and response capacities as well as capacity to deal with specific zoonotic diseases including leptospirosis control, rabies control, brucellosis control, and emergency response to Ebola Reston. Efforts were made to conduct infection prevention and control (ICP) training, develop and implement ICP poliCies and guidelines, and develop information, education and communication materials. These achievements helped reduce the risk of hospital-acquired infections and promote universal ICP practices at health care facilities. With regard to risk communication, countries strengthened their risk communication capacity, particularly for pandemic (H1N1) 2009, through the participation of government health officials and staff in a number of workshops and training courses that fOCUSed on the core capacities required tor strengthening risk communication. Most Member States adopted a risk communication training strategy developed by WHO that that includes basic, advanced and specialist training modules. Further, most countries developed pandemic (H1 N1) 2009 risk communication materials based on a package of materials developed by WHO.

Of special interest was the recent development of the Pacific risk communication tirade. This informal partnership between the United Nations Children's Fund (UNICEF), the Secretariat of the Pacific Community and WHO aimed to develop risk communication capacity with emphasis on pandemic (H1 N1) 2009 in the Pacific. The partnership was focused on developing common and consistent approaches, complementing each others' activities and decreasing redundancy. Extensive risk training in the Pacific took place under the partnership.

STRATEGIC OBJECTIVE 1

RER 01.008.WP01: Regional and global capacity coordinated and made rapidly available to Member States for detection, verification, risk assessment and response to epidemics and other public health emergencies of international concern.

Appraisal: Fully Achieved Comments on achievements Coordinated regional capacity for outbreak response was made rapidly available to Member States through the Global Outbreak Alert and Response Network (GOARN). Specifically, GOARN was used during outbreaks in Pacific island countries, Papua New Guinea and the Philippines. Requests for assistance in emergency outbreak situations were responded to on a timely basis. An events management system was established and put into operation in the WHO Regional Office. Procedures supporting rapid response were developed and put in place. To meet an IHR (2005) requirement, a regional IHR communication and duty officer system was established and put into operation. This system insures rapid communication between Member States and WHO as well as among countries in the Region with respect to sharing of information regarding disease outbreaks. This system was thoroughly tested during the pandemic (H1 N1) 2009 outbreak and functioned exceptionally well. GOARN continued to be strengthened in the Region with seven new members joining the network during the biennium. Further, two very successful regional GOARN meetings were conducted in the Region, one in China and one in Australia, with the purpose of strengthening the network . .

RER 01.009.WP01: Effective operations and response by Member States and the international community to declared emergencies situations due to epidemic and pandemic prone diseases.

Appraisal: Fully Achieved Comments on achievements A number of Member States strengthened their national capacity in public health emergency preparedness and response in 2009. WHO advocates a "two-tiered approach" for Member States to strengthen their capacities in pandemic influenza preparedness: (1) pandemic planning, and (2) improving readiness. The first step involves developing, exercising, evaluating and revising national pandemic plans. All Member States in the Western Pacific Region have developed national pandemic plans, and nearly all have carried out trial executions of their plans and were involved in continuous development and maintenance of pandemic response plan. The Western Pacific Region was the first region to introduce the revised Pandemic Influenza Preparedness and Response: A WHO Guidance Document' to Member States in March 2009, just before the discovery of pandemic (H1 NI) 2009 in April 2009. The WHO Director-General later decided to raise the level of influenza pandemic alert to phase 5-6 according to the revised WHO guidelines. Member States in the Western Pacific Region were better prepared in their capacities for pandemic response when pandemic (H1 N1) 2009 spread around the world at rapid speed. Notable progress in the Lao People's Democratic Republic (general APSED) as well as in Mongolia (field epidemiology training programme) led to a significant strengthening of national capacity for sustainable operations. The comprehensive approach in the Lao People's Democratic Republic saw a significant improvement in the overall strengthening of sustainable operations of APSED activities, especially in the area of surveillance and response. Although WHO will continue to support surveillance and response capacity development, it is clear that the Lao People's Democratic Republic is establishing a sustainable programme. Further, in Mongolia, a strong field epidemiology programme was developed and was being implemented. Extensive training will begin in 2010; however, the groundwork for this project was established throughout the 2008--2009 biennium.

5 ISBN 9789241547680

STRATEGIC OBJECTIVE 2

STRATEGIC OBJECTIVE 2 To combat HIV/AIDS, tuberculosis and malaria. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE OVERALL

Efforts to combat HIV/AIDS, tuberculosis and malaria, through the scaling up of programmes and the mobilization of resources, were made possible with financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria and technical support provided by WHO in the Western Pacific Region. HIV

Capacity-building support was provided to nine key countries (Cambodia, China, the Lao People's Democratic Republic, Fiji, Malaysia, Mongolia, the Philippines, Papua New Guinea and Viet Nam) through normative guidelines, meetings, on-site technical support (country reviews and missions) to expand prevention, treatment and care intervention for HIV/AIDS and sexually transmitted infections (STI), especially to the most-at-risk populations. Support was focused on interventions for injecting drug users, HIV testing and cQunselling, antiretroviral therapy access, STI prevention and control, prevention of parent-to-child transmission, enhancing tuberculosis and HIV service collaboration, enhancing sexual and reproductive health services linkages, and strengthening strategic information. The following outcomes were evident: • A decline in new infections in one country with generalized epidemic (Papua New Guinea); a shift from generalized epidemic to concentrated epidemic (Cambodia); the number of HIV infections stabilized in a majority of countries, especially countries with concentrated epidemics (Cambodia, China, Malaysia and Viet Nam); the rest of the countries remain at lOW-level epidemic. • An eight-fold increase in the number of people receiving antiretroviral therapy between 2004 and 2008 in the Western Pacific Region, with an increase of 37% between 2007 and 2008, and coverage reaching 31% in 2008. • Steady expansion of HIV testing and counselling services in several countries (e.g. in Cambodia, from 190 sites testing 176 171 persons in 2007 to 212 sites testing 296 510 persons in 2008; and in particular, an almost four-fold increase in Papua New Guinea during the same time period). • Increased coverage of interventions for most-at-risk populations (e.g. in China, from 503 methadone maintenance clinics for people who inject drugs in 2007 to 600 clinics in 2008; and increased use of a condom with the most recent client by sex workers reaching 99% in Cambodia, 85% in China, 95% in the Lao People's Democratic Republic, and 94% in Mongolia and Viet Nam). • Implementation of HIV and tuberculosis collaborative activities (e.g. in Papua New Guinea, screening among HIV patients up from 38% in 2007 to 67% in 2008). • Scale-up of prevention of mother-to-child transmission with an increase in coverage from 13% in 2007 to 23% in 2008. Countries started to operationalize the linkages between HIV and sexual and reproductive health, which resulted to increase coverage of prevention of motherto-child transmission. • Increased coverage of antiretroviral therapy among children living with HIV (74% in 2008). TUBERCULOSIS

Support was given to countries for the development of tuberculosis guidelines, policies and strategies; partnership and resource mobilization; laboratory services for multidrug-resistant tuberculosis (MDRTB); advocacy, communication and social mobilization; infection control; public-private mix initiatives; expansion of directly observed treatment, short-course (DOTS); and implementation of projects funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

STRATEGIC OBJECTIVE 2

The following results were achieved: • Tuberculosis prevalence and mortality in the Region declined steadily from 25% in 2004 to 19% in 2009. • Case detection and treatment rates were maintained beyond the global targets in several countries (China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam). • National strategic plans were developed in five priority countries. 6 • A Revised Framework to Address TB-HIV Co-infection in the Western Pacific Region was published after being reviewed at a consultation meeting in February 2008 and a Joint Pacific TB and HIV/AIDS Managers' Meeting in May 2009. • The Sixth Stop TB Technical Advisory Group Meeting and Regional Inter-agency Coordinating Committee Meeting were organized in July 2008. • The Fourth Stop TB Meeting in the Pacific Islands, with roundtable discussion among partners, was organized in March 2008. • National tuberculosis programme staff participated in international tuberculosis training courses organized by the International Union against Tuberculosis and Lung Diseases, the Tuberculosis Coalition for Technical Assistance, the Korean Institute of Tuberculosis, and the Research Institute of Tuberculosis. • The regional model tuberculosis centre for MDR-TB was launched in April 2009. MALARIA

Substantial technical support was provided to eight malaria-endemic countries in the Region for the development of grant proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria. With these grants, all countries in the Region had sufficient resources to scale up their national malaria programmes based on sound strategies. The subsequent steep decline of malaria in the Region, together with WHO's declaration of malaria elimination as a global goal and its strong promotion by donors and partners, led most countries in the Region to change their programme goal from "malaria control" to progressive "malaria elimination". At the sixtieth session of the Regional Committee, Member States endorsed a Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010-2015).7 The emergence of artemisinin resistance along the Cambodia-Thailand border was discovered through high-quality monitoring of antimalarial drug efficacy data (supported by WHO in the Western Pacific Region since 2000), and was confirmed by a WHO-supported clinical trial in 2007. WHO led the development of the artemisinin resistance containment strategy, jointly with partners mobilized US$ 22 million from the Bill & Melinda Gates Foundation, and continued executing the containment effort along the Cambodia-Thailand border. An additional US$ 100 million was mobilized from the Global Fund to continue the artemisinin resistance containment initiative in Cambodia beyond 2009. Thanks to intensified WHO-led antimalarial drug efficacy monitoring in the Mekong region, further suspected foci of artemisinin resistance were discovered in China, Myanmar and Viet Nam. Since early 2000, WHO in the Western Pacific Region has advocated to focus malaria control on vulnerable, poor and/or marginalized populations. In the years that followed, WHO mobilized funds from the Asian Development Bank for two projects focusing on ethnic minorities, which led to the inclusion of interventions targeting ethnic minority groups in country proposals to the Global Fund. During this biennium, WHO continued to work on a strategy for the prevention and control of malaria in pregnant women based on operational research, continued to work with the Integrated Management of Childhood Illness (IMCI) initiative to improve malaria interventions for children, and started interventions targeting mobile populations and migrants in the context of the artemisinin resistance containment effort.

6 ISBN 978 929 061387 7 WPRlRC60.R5

STRATEGIC OBJECTIVE 2

ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 02.001.WP01: Regional guidelines, policies, strategies and other tools developed (adapting global ones, as appropriate) for prevention, treatment and care for HIVlAlDS/STI, malaria and tuberculosis (including Innovative approaches for increasing coverage of the interventions among the poor hard to reach and vulnerable populations). ' Appraisal: Fully Achieved

Comments on achievements YVHO .was actively engaged in normative work and made good progress in the following areas: HIV prevention Includl~g STI control and care. HIV and tuberculosis co-infection, multidrug-resistant tuberculosis and malaria, Improving access of poor and vulnerable populations to malaria prevention and control, quality assurance of malaria diagnostics, and engaging the private sector.

HIV Seven regional meetings and consultations were organized to guide the development and updating of pOliCies, strategies and tools for prevention, care and treatment interventions for HIVIAIDS and STI. Fourteen regional guidelines, frameworks and tools were developed to assist countries to prioritize evidence-based interventions and scale up effective HIV ~esponses (exceeding the target). A majority of the guidelines, str~tegies and tools were adapted in nine key countries after extensive consultation with technical experts and country representatives. Therefore, the nine key countries have national HIVIAIDS strategic plans and guidelines in line with WHO health sector response guidelines.

Tuberculosis Regional meetings were held in support of rolling out policies and guidelines to countries, including the Fourth Stop TB Meeting in the Pacific Islands in March 2008, the tuberculosis and HIV co-infection meeting in February 2008 and the Joint Pacific TB and HIVIAIDS Managers' Meeting in May 2009. In addition, a number of Stop TB planning exercises were held. As a result, during the biennium, essential tuberculosis guidelines and publications were developed, published . and distributed. MDR-TB and infection control policies and guidelines were developed in China, Viet Nam and the Philippines; tuberculosis and HIV co-infection policy guidelines were developed or were in progress in Cambodia and Papua New Guinea; and paediatric guidelines were completed in Papua New Guinea. Support provided by WHO in strategic planning and guidance strategies was strengthened through several initiatives. Consultations with countries were held in connection with the development of a regional strategic plan for tuberculosis control for 2011-2015. PartiCipants from the seven countries with a high burden of tuberculosis were supported in various international training courses organized by the International Union against Tuberculosis and Lung Diseases and by the Asian regional training centre of the Tuberculosis Coalition for Technical Assistance. Additional laboratory guidelines, including those for MDR-TB management, were planned for discussion at the sixth national tuberculosis and laboratory managers meeting in December 2009. All high-burden countries and Pacific island countries and areas received technical assistance for developing and implementing national tuberculosis strategic plans for 2006-2010, particularly in priority areas, including MDRTB, laboratory strengthening, public-private collaboration, tuberculosis and HIV co-infection, and information systems. To date, Cambodia, Mongolia and the Philippines have developed new national tuberculosis strategic plans for 2010-2015, China has nearly completed its plan, and Viet Nam will conduct a mid-term evaluation of its plan in January 2010.

Malaria WHO in the Western Pacific Region very successfully coordinated WHO's global evaluation of malaria rapid diagnostic tests (RDTs) and the development of a malaria RDT prequalification system. In addition, malaria diagnostic quality assurance systems were further developed through a series of international consultations, guidelines published on RDT and microscopy, and support provided to countries in and beyond the Region. Country support for malaria diagnostic quality assurance continued together with the maintenance and improvement of the regional slide bank at the Research Institute for Tropical MediCine in the Philippines. A regional policy for malaria control among ethnic minority groups was developed. Furthermore, countries began to address poor ethnic minorities in their Global Fund proposals. Major steps were taken to advance a strategy

STRATEGIC OBJECTIVE 2

on malaria prevention and control in pregnancy and a regional framework to engage the private sector in malaria diagnosis and treatment. WHO in the Western Pacific Region was strongly involved in strategy development to contain artemisinin resistance in the greater Mekong subregion. A Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010-2015) was developed in a series of meetings and endorsed at the sixtieth session of the Regional Committee in September 2009. 8 It includes a revised regional malaria indicator framework. Several countries have started to update their national strategies based on this Regional Action Plan.

RER 02.001.WP02: Regional guidelines, poliCies, strategies and other tools developed for the development of priority essential health technology programmes for prevention, treatment and care for patients with HIVIAlDS, tuberculosis and malaria (including innovative approaches for increasing coverage of the interventions among the poor, hard-to-reach and vulnerable populations). Appraisal: Fully Achieved Comments on achievements Support was provided to Cambodia to develop and finalize a national policy for medical laboratory services, to strengthen the implementation of policy and regulation of national blood transfusion services, and to facilitate the implementation of a strategiC plan for national blood transfusion services for 2007-2011. Support was provided to Fiji to develop and finali·ze the national blood service legislation and policy and to strengthen the quality assurance system for the national blood programme. A follow-up meeting was planned for national laboratory focal points to finalize the Asia Pacific Strategy for Strengthening Health Laboratory Services (2010-2015).9

RER 02.002.WP01: Policy, technical and coordination support provided to countries and areas for the implementation of prevention, treatment and care interventions for HIVIAIDSISTI, malaria and tuberculosis and their scaling-up to reach the populations most in need (including integrated training and service delivery; wider service provider networks; strengthened laboratory capacities and better linkages with other health services). Appraisal: Fully Achieved Comments on achievements HIV, malaria and tuberculosis programmes provided intense support to country programmes to address the increasing demand for technical support from countries. Technical support to countries resulted in the scaling up of interventions with increased coverage of the populations most in need, in line with the WHO guidelines and recommendations. All three programmes pioneered work in accelerating responses on drug resistance issues, and increased support in laboratory strengthening, especially in supporting countries in laboratory quality assurance. There was also increasing coordination between HIV/AIDS/STI, tuberculosis and malaria action in countries. HIV WHO continued to prioritize support to nine key countries in line with its five strategic directions (HIV testing and counselling, prevention, treatment and care, strategic information and health systems strengthening), resulting in the scaling up of interventions to the most-at-risk populations. Technical support was provided through in-country assessment, review and on-site technical support conducted in Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the PhilippineS, Viet Nam and Pacific island countries. Progress of countries towards achievement of universal access to HIV prevention, care and treatment was documented in the publication, Towards universal access: Scaling up priority HIVIAIDS intervention in the health sector, September 2009. 10 8 9

WPRJRC60.R5

WPRJRC60.R6 10 ISBN 9789241599030

STRATEGIC OBJECTIVE 2

Regional and international meetings served as forums for imparting and receiving technical inputs related to HIV, for disseminating technical guidance on the health sector response, and for strengthening networks and empowering communities towards universal access to prevention, care, support and treatment. Tuberculosis WHO in the Western Pacific Region continued to support the implementation of the national tuberculosis control plans (e.g. MDR-TB, laboratory, drug management, public-private mix, advocacy, communication and social mobilization, tuberculosis in children), including programme monitoring, reviews and evaluation. During the biennium, the Organization successfully supported more than 40 technical assistance missions and consultancies for national tuberculosis programmes due to good coordination between the Regional Office and country offices, as well as strong collaboration among technical partners. External reviews of the national tuberculosis control programmes in China, Fiji, Papua New Guinea, the Philippines, Mongolia, Solomon Islands, and Viet Nam were conducted, and technical assessments were carried out in Cambodia, the Federated States of Micronesia and the Lao People's Democratic Republic. Key focus areas of the Region, such as MDR-TB, drug management, increased case detection and laboratory strengthening, were emphasized and interventions expanded. There was an expansion of public-private mix approaches in Cambodia, China, Mongolia, the Philippines and Viet Nam. In China and the Philippines, the public-private mix appro<llch contributed significantly to tuberculosis case detection and improvement of the quality of tuberculosis services outside of the national tuberculosis programme facilities. High-level advocacy for accelerating a response to MDR-TB and extenSively drug-resistant tuberculosis (XDRTB) was apparent at the global ministerial meeting on MDR-TB andXDR-TB in Beijing in April 2009, which the WHO Regional Office supported. The launch of the first model tuberculosis centre for MDR-TB in the Western Pacific took place in April 2009, and a workshop for MDR-TB training and needs assessment was conducted with participants from five high-burden countries in November 2009. WHO continued to provide technical support to countries to carry out Global Fund-related work. An assessment of WHO's engagement with Global Fund-related work was completed, and support was provided to Pacific island countries for the monitoring and evaluation of Global Fund grant implementation. Proposals for Round 8, Rolling Continuation Channel and Round 9 grants were approved in China, Fiji, Mongolia, the Philippines, Solomon Islands and Viet Nam during 2008-2009, with total grants amounting to US$ 598 million. Support was provided for strengthening capacity and improving access to high-quality DOTS services for tuberculosis patients, including support for several public-private mix DOTS activities in Cambodia, the Lao People's Democratic Republic, Mongolia and Papua New Guinea. Support was also provided in other priority areas, including tuberculosis in children, tuberculosis and poverty, health systems strengthening and TB-HIV coinfection. A trial case-based payment for tuberculosis diagnosis and treatment in China was developed as a pilot. Malaria Intensified support was provided to eight malaria-endemic countries for scaling up vector control, improving access to diagnosis and treatment, and strengthening human capacity. None of this would have been possible without the strong commitment of existing human resources and increased staff recruitment. Vector control is the most expensive component of a country's malaria control and elimination budget. With support from WHO in the Western Pacific Region, all eight low- and middle-income malaria-endemic countries in the Region successfully mobilized Global Fund grants, thus contributing to a massive and still ongoing vector control scale-up in the Region. WHO in the Western Pacific Region also provided technical assistance to countries on specific vector control issues. Because antimalarial drug resistance was a priority in the Region, WHO strongly supported countries in efforts to improve diagnosis and treatment. This included technical support for national malaria treatment policy reviews and updates; support for artemisinin resistance containment and procurement issues; emergency support in case of stock-outs; support for diagnostic quality assurance and provision of rapid diagnostic testing training materials and bench aids; and massive resource mobilization (e.g. from the Global Fund, the United States Agency for International Development [USAID], the Bill & Melinda Gates Foundation, and the Australian Agency for International Development [AusAID]). Hard-to-reach mobile and migrant populations, especially populations crossing borders, were a key focus of attention under this initiative. A strong WHO network of country offices in the Western Pacific Region continued to provide support to the manaQement of national malaria proQrammes in all 10 malaria-endemic countries, most of which cha~ed their

STRATEGIC OBJECTIVE 2

programme goal to malaria elimination. The new Regional Action ~Ian fo~ Malaria Co~trol a.nd Elimination in the Western Pacific (2010-2015) provided a template for comprehensive national plans, Including a monitoring and evaluation framework. The Asian Collaborative Training Network for Malaria (ACTMalaria) expanded membership and activities and had become an international model for other regions.

RER 02.002.WP02: Policy, technical and coordination support provided to countries and areas for the implementation of child and adolescent health interventions related to HIVIAIDS, malaria and tuberculosis. Appraisal: Fully Achieved Comments on achievements With the support of the WHO Collaborating Centre for International Child Health and the Medical Society of Papua New Guinea, updated guidelines on the prevention, treatment and care of HIV/AIDS, malaria and tuberculosis were presented for discussion. A proposed IMCI algorithm for malaria was developed, and an HIV/AIDS algorithm was under development. Paediatric tuberculosis was reviewed, and improved case management using fixed-dose combinations and improved diagnosis was proposed. Viet Nam was supported in applying lessons learnt and implementing interventions targeting most-at-risk adolescents to reduce the incidence of HIV/AIDS in adolescents and young people who were injecting drug users. Support was also provided to strengthen the links between HIV/AIDS and adolescent-friendly health services through an intercountry meeting held in Cambodia. The Philippines was supported to develop standards for adolescent-friendly health services, including prevention and management of HIV, malaria and tuberculosis in adolescents, and for increasing the capacity of health care providers in providing adequate services to adolescents. Hong Kong (China) and Malaysia were supported to improve the capacity of health workers to respond to the needs of adolescents, including those leading to reducing HIV transmission among young people.

RER 02.003.WP01: Guidance and technical support provided on pOlicies and programmes to promote equitable access to essential medicines of assured quality for the prevention and treatment of HIV/AIDS/STI, malaria and tuberculoSiS, and their rational use by prescribers and consumers; and on uninterrupted supply of quality diagnostics, safe blood and other essential commodities. Appraisal: Partially achieved Comments on achievements All three programmes were engaged in quality assurance of medicines and diagnostics and other essential commodities (e.g. mosquito nets). Support was provided to countries to increase access to essential medicines and diagnostics and other commodities, quantification, rational medicines use and supply management. More coordination and cooperation was seen to be needed with related WHO programmes in the Western Pacific Region in order to address these major issues with a health systems approach. HIV Guidance and technical support were provided to Cambodia, China, Fiji, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, and Pacific island countries to ensure the quality of HIV/STI laboratory testing, STI testing and treatment, antiretroviral therapy (ART) and prevention of drug resistance. Support was provided to Cambodia on the availability of HIV testing and rapid syphilis testing for pregnant women to prevent mother-to-child transmission; China on ART guideline development; Fiji on ART patient monitoring; the Lao People's Democratic Republic on ART treatment; MongOlia on STI testing and treatment; Papua New Guinea on ART guideline development; Pacific island countries on STI testing and treatment, validating HIV testing strategies and STI and ART drug procurement; and Viet Nam on validation of HIV testing. Activities were ongoing and support was provided to assure the quality of ART and STI drugs, and to monitor patients' antiretroviral therapy use in selected countries. Tuberculosis All countries with a high burden of tuberculosis and the majority of Pacific island countries received technical and capacity support for drug management strengthening. To scale up the response to MDR-TB, especially its diagnosis, treatment and drug management, regional MDR-TB training was conducted in 2008 and 2009.

STRATEGIC OBJECTIVE 2

Tec~nical. assistance was ~rovided by consultants in laboratory and drug management and capacity support was provided In Cambodia, China., the Federated States of Micronesia, Fiji, the Lao People's Democratic Republic, the Marshall 1~lan?s, Mongolla~ Papua New Guinea, the Philippines, Solomon Islands and Viet Nam, together with other Pacific Island countries. Quality-assured and Green Light Committee (GLC) approved programmatic management of MDR-TB was being implemented in five countries (Cambodia, China, Mongolia, the ·Philippines and Viet Nam). Specific activities in capacity support for management of drug supply included: • national workshops on rational pharmaceutical management for drug-reSistant tuberculosis conducted in Mongolia, the Philippines and Viet Nam; • technical support provided to GLC missions undertaken in Cambodia, the Federated States of Micronesia and Viet Nam; and • a tuberculosis drug management workshop held in Suva, Fiji in November 2009 to provide information and tools for improving the basic pharmaceutical supply methods needed by successful DOTS and programmatic management of drug-reSistant tuberculosis programmes in the Pacific. Technical support was provided on laboratory capacity and quality strengthening in partnership with supranational reference laboratories. Extensive hands-on training on advance laboratory techniques (culture and drug susceptibility testing) was supported in Cambodia, China, the Lao People's Democratic Republic, Mongolia, the Philippines, Papua New Guinea and Viet Nam, as well as in 13 Pacific island countries and areas through the Pacific Tuberculosis Laboratory. All high-burden countries and Pacific island countries had quality assurance mechanisms in place for laboratories and were reporting quality assurance activities annually. Specific activities in laboratory strengthening included: • a workshop on tuberculosis laboratory strengthening held in Hong Kong (China); • external quality assessment services (panel testing, blinded re-checking on acid-fast smears, on-site evaluations) and drug susceptibility testing provided by supranational reference laboratories (Institute of Medical and Veterinary Science and the Queensland Mycobacterium Reference Laboratory in Australia and the Pacific Paramedical Training Centre in New Zealand) to national laboratories in the Pacific island countries; • laboratory staff from Mongolia and Viet Nam trained at the Research Institute for Tuberculosis in Tokyo, Japan; • a meeting with laboratory experts held in Hokkaido, Japan to develop a training programme on advanced laboratory techniques; and • a workshop with heads of supranational reference laboratories for the Pacific held in December 2009 in Shanghai, China to improve and strengthen support to national tuberculosis laboratories in the Pacific. Malaria Monitoring antimalarial drug quality and combating counterfeit antimalarial and other anti-infective medicines were advanced.

The antimalarial drug quality monitoring work in the greater Mekong subregion exposed the public health threat posed by counterfeit and substandard antimalarial medicines. The work was coordinated jOintly by the WHO Regional Office and the WHO Mekong Malaria Programme and supported by USAID and US Pharmacopeia as the main technical partner . The sentinel site monitoring activities continued in Cambodia, the Lao People's Democratic Republic, Thailand and Viet Nam, and, in some countries, the number of sentinel sites was expanded with Global Fund budget. In Yunnan, China, these activities were, after an interruption, resumed with support from WHO in the Western Pacific Region in 2008. In addition, a large-scale survey was carried out in 2009 by US Pharmacopeia along the Cambodia-Thailand border under the artemisinin resistance containment grant from the Bill & Melinda Gates Foundation. WHO continued working with the International Criminal Police Organization (INTERPOL) on combating counterfeit medicines through 'Operation Storm' in 2008 and 'Operation Storm 2' in 2009. The coordinated raids of retail shops and warehouses were part of a multi-country effort to disrupt the sale and distribution of counterfeit pharmaceuticals in Asia. The operations brought about a unique cooperation of customs agents, police and drug regulatory authorities in the six greater Mekong subregion countries and Indonesia. The Singapore Public Health Laboratory conducted and financed the laboratory analyses of the samples, INTERPOL managed the operations, and WHO financed the planning and final meetings. Research on new laboratory analytical methods to detect counterfeit drugs was supported and published at the US Georgia Institute of Technology.

STRATEGIC OBJECTIVE 2

Support for malaria supply management was ongoing in selec((3d countries. ~or the huge malaria programm.e scale-up, malaria supply management was a maJ~r bottleneck In mos! countnes. WHO .In the Western Pacific Region facilitated and worked with Management SCiences for Health to Improve antimalarial supply ~anagement in the Lao People's Democratic Republic, where a successful Global Fund proposal will address this on a larger scale. WHO supported the writing of Global Fund proposals for malaria in other countries (Papua New Guinea, Solomon Islands and Vanuatu) to ensure that they adequately addressed supply management. The WHO Regional Office worked closely with the Representative Offic~ in Papua N~w Guinea to. re-establish the ~~ug supply system to the Papua New Guinea peripheral health umts through a kit system-thiS Will be precondition for the rapid diagnostiC test, artemisinin-based combination therapy roll-out planned for 2010. To ensure the quality of malaria diagnostics, two regional laboratories in Cambodia and the Philippines continued to provide free batch testing of malaria rapid diagnostic tests before they were sent to countries in the Region. Support for the two regional laboratories, established under the WHO diagnostics initiative, was taken over by the Foundation for Innovative New Diagnostics. Testing services will continue to be available free to all countries in the Region.

RER 02.003.WP02: Embedding disease control programmes in health planning process. Appraisal: Fully Achieved Comments on achievements A workshop on maximizing synergies between global heaHh initiatives and health systems was held in the Philippines in November 2009. The workshop was co-organized by the WHO Regional Offices of South-East Asia and the Western Pacific. The workshop provided an opportunity to bring together 109 participants-Member States' technical staff from disease-specific programmes as well as policy and planning departments along with WHO country office staff from disease-control and health systems disciplines. Observers included representatives of the Global Alliance for Vaccines and Immunization, Global Fund, International Medical Center of Japan, United Nations Children'S Fund, World Bank, Asian Development Bank, Joint United Nations Programme on HIV/AIDS-Technical Support Facility for Asia and the Secretariat of the Pacific Community.

RER 02.004.WP01: Regional and national surveillance, evaluation and monitoring systems strengthened and expanded to monitor progress towards targets and resource allocations for HIV/AJDS/STI, malaria and tuberculosis control, including monitoring of drug and insecticide resistance and the impact of control efforts. Appraisal: Fully Achieved Comments on achievements Major progress was made in strengthening the regional and national surveillance and monitoring and evaluation systems for HIV, malaria and tuberculosis. Intensive technical and capacity-building support was provided to key countries. Drug resistance for HIV, malaria and tuberculosis has been a major concern in the Region and the WHO Regional Office continued to support to countries to establish monitoring systems for drug resistance for HIV, malaria and tuberculosis treatment. HIV Technical support was provided to nine countries as planned. Nine countries had surveillance systems based on WHO recommendations and reported on health sector progress towards universal access using the WHO framework. Five additional high-income countries reported on health sector progress. Four countries started surveillance and monitoring of HIV drug resistance in accordance with WHO-recommended standards. Capacitybuilding was provided to countries through WHO staff in the Western Pacific Region. WHO and national country staff were also supported through global and regional training activities and workshops on various aspects of strategic information (HIV surveillance,. HIV estimates, use of patient monitoring data, HIV drug resistance surveillance and prevention). Jointly, the Regional Offices for South-East Asia and the Western Pacific published the Toolkit for Monitoring and Evaluation of Interventions for Sex Workers." Three regional consultations were organized on monitoring health sector response and HIV drug resistance.

II ISBN 978 92 90223542

STRATEGIC OBJECTIVE 2

Tuberculosis !echnic?1 and capacity-building support was widely provided to improve monitoring and evaluation. Tuberculosis Information s~tems were reviewed during the tuberculosis programme reviews in Mongolia, Papua New Guinea and the Philippines. T echmcal support was provided for data collection and in-depth analysis in regional tuberculosis data~ets for the 2010 tuberculosis control report. Mongolia was supported to develop the Internetbased ~uberculosls Information system, use of international electronic health record standard and integration of health information database. Population-based surveys were also supported in the Lao People's Democratic Republic and the Philippines. Malaria Big advances were made in this biennium. The regional "Kunming indicator" framework was reviewed and replaced by the new regional malaria indicators, which were part of the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010-2015). The new regional malaria indicator framework was being used by countries to update their national monitoring and evaluation plans. Comprehensive malaria surveillance and programme monitoring data could be received from all countries for the 2009 World Malaria Report. Improved malaria burden of disease estimation was piloted in three countries. Antimalarial drug efficacy monitoring (therapeutic efficacy survey) was intensified in the greater Mekong subregion, and therapeutic efficacy surveys progressed in the Pacific.

RER 02.005.WP01: Political commitment sustained and mobilization of resources ensured through advocacy and nurturing of HIV/A1DS/STI, malaria and tuberculosis partnerships at country, regional and global levels; support provided to countries and areas as appropriate to develop/strengthen and Implement mechanisms for resource mobilization and utilization; and engagement of communities and affected persons increased to maximize the reach and performance of HIV/A1DS/STI, malaria and tuberculosis control. Appraisal: Fully Achieved Comments on achievements Countries were intensely supported to mobilize resources, resulting in a massive scale-up of programme activities. However, funding for WHO staff remained limited. Partnerships with key players, networks, WHO collaborating centres, academia, technical partners and agencies were strengthened. TuberculosiS and malaria programmes advanced the involvement of the private sector in key countries. HIV continued to actively participate in various regional task forces to enhance the active involvement of most-at-risk populations and people living with HIV. HIV

Nine countries were supported to mobilize Global Fund resources. In addition, partnerships with WHO collaborating centres, technical partners and networks were developed to support WHO in providing technical support. Partnerships with other key players in HIV were enhanced through active participation in various regional task forces. PartiCipation in and support of the various regional task forces enhanced community partiCipation of most-at-risk population and people living with HIV. Tuberculosis Initiatives were implemented to sustain political and donor commitment and further increase funding for tuberculosis control in the Region. Cambodia, China, the Philippines and Viet Nam increased their national tuberculosiS programme budgets during the biennium. The Lao People's Democratic Republic, Mongolia, and Papua New Guinea sustained their national budget for tuberculosis control. Advocacy activities at national and sub national levels were ongoing in Cambodia, China, Mongolia, Papua New Guinea and the Philippines. Intercountry capacity support and coordination of resource needs assessment, planning and budgeting were strengthened. Support for planning and budgeting at country level, including in the context of Global Fund grants, was provided; however, more work needs to be done on planning and budgeting for overall plans. The WHO Headquarters' planning and budgeting tool was not used in most countries. A training workshop was held in Indonesia in Dece.mber 2009 to help address this issue and 10 participants from seven countries (Fiji, the Lao PeoRle's Democratic Republic, MongOlia, Papua New Guinea, the Philippines, Vanuatu and Viet Nam) were

STRATEGIC OBJECTIVE 2

supported to attend. Technical assistance missions were conducted to support countries in advocacy, building partnerships and resource mobilization. The Philippines was finalizing its advocacy, communication and social mobilization strategy, and Mongolia was in the process of developing one. Support for activities using funds from the US President's Emergency Plan for AIDS Relief was ongoing. Among those activities supported were: technical assistance to China on tuberculosis infection control, finalization of public-private mix DOTS operational guidelines for Mongolia, and technical assistance to a Green Light Committee mission in Viet Nam. Assistance was also given to mobilize resources and technical experts for specific projects at sub national levels, such as the tuberculosis and equity project in China dealing with transport subsidy and capitation funding of health facilities. Countries were helped with proposal submissions for Global Fund applications for Round 8, Rolling Continuation Channel and Round 9. Global Fund proposals approved during 2008-2009 were for China, Fiji, Mongolia, the Philippines, Solomon Islands and Viet Nam, with total grants amounting to US$ 598 million. Malaria Ample resources were mobilized for countries, including for country staff, from the Global Fund, the Bill & Melinda Gates Foundation, AusAID, the Pacific Malaria Initiative and USAID's Mekong funding. Malaria programmes further advanced partnerships with the private sector in key countries, namely Cambodia, the Lao People's Democratic Republic, the Philippines and Solomon Islands. Partnership and cooperation were strengthened with networks for monitoring and evaluation to assess and use results, malaria consortiums, the United States Centers for Disease Control and Prevention (CDC), and academia. Cooperation and integration with other programmes was also promoted, and information exchange and communication for malaria control was supported. The first World Malaria Day, a symbolic activity deSigned to raise public awareness, to increase political commitment and to mobilize resources towards control and elimination of malaria in the Region, was commemorated on 25 April 2010.

RER 02.006.WP01 : Operational research for the prevention and control of HIV/STI, malaria and tuberculosis supported and research capacity strengthened in target countries and areas. Appraisal: Fully Achieved Comments on achievements All programmes supported operational research, largely operational research for the development of new or revised disease control strategies. However, research capacity in the developing countries of the Region was weak, making this a very intensive technical assistance process. In addition, the WHO research technical review was a longish process and the ethics review committee was only established in 2009. Engagement in research will continue to be a very time-intensive endeavour and the need to support countries in research ethics capacitybuilding and in research coordination will continue. HIV Five operational research projects were initiated and two were completed. The completed operational research projects resulted in improved HIV testing strategies and informed treatment guidelines on STI. The following were supported: • two snapshot studies on gonococcal antimicrobial susceptibility monitoring through the Department of Microbiology, Prince of Wales Hospital, Sydney and National Centre for STD Control, Nanjing, two WHO collaborating centres; • temperature stability testing of rapid HIV assays for the Region through the National Reference Laboratory, Melbourne, another WHO collaborating centre; • ongoing technical inputs in the validation study on HIV testing algorithms in Pacific island countries in collaboration with the National Serology Reference Laboratory. Australia and the Pacific Paramedical Training Centre, New Zealand; • cost-effectiveness analYSis of linking HIV services with sexual and reproductive health services in coordination with UNICEF, Economist International Unit, and the National Centre for AIDS, Dermatology and STI, Cambodia; and

STRATEGIC OBJECTIVE 2

•

collaboration with Mongolia to finalize the operational research activities on 'one-stop shop' for syphilis translated into programmatic provisions and interventions.

Tuberculosis During the 39th Union World Conference on Lung Health held in Paris, France in October 2008, China, the Philippines and Viet Nam presented three operational research papers on tuberculosis control. Further papers were presented at the 40th World Conference held in Cancun, Mexico in December 2009. Prevalence survey results in the Philippines were published, and a research grant to Mongolia from the WHO Special Programme for Research and Training In Tropical Diseases was approved. Preparations for the Lao People's Democratic Republic prevalence survey were delayed due to time constraints. In general, operational research capacity strengthening saw limited progress. Malaria WHO in the Western Pacific Region continued to be much engaged in operational research in the area of malaria case management: annual malaria drug efficacy monitoring in four greater Mekong subregion countries, nonmalarial fever study, and continuation of malaria diagnostics slide bank work. In addition, basic research was supported on artemisinin resistance along the Cambodia-Thai border (started in 2007 and extended in 2008), which led to the confirmation of artemisinin tolerance and the launching of the containment effort. A boost in basic and operational research came through the artemisinin resistance containment project funded by the BfII & Melinda Gates Foundation; this included implementation research on focused screening and treatment at the village level to eliminate artemisinin-resistant falciparum malaria parasites in Containment Zone 1 in Cambodia. No research was carried out in vector control or social research, reflecting the lack of funding and lack of staff in these areas.

RER 02.006.WP02: Review of current regional and national guidelines and strategies for the prevention and control of HIV/AlDSfTl, malaria and tuberculosis. Appraisal: Fully Achieved Comments on achievements WHO in the Western Pacific Region made progress on two relevant documents: • a joint publication with the Asian Development Bank on malaria control for ethnic minorities in the greater Mekong subregion detailing experiences and lessons learnt from two pilot projects; and • a draft biregional policy on malaria control for ethnic minorities.

STRATEGIC OBJECTIVE 3

STRATEGIC OBJECTIVE 3 To prevent and reduce disease, disability and premature death from chronic noncommunicable diseases, mental disorders, violence and injuries and visual impairment. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

During 2008-2009, WHO in the Western Pacific Region focussed its support on policy development, capacity-building for service provision, and dissemination of good practices. Policy development was supported through regional consultations on disability and rehabilitation; advocacy for noncommunicable disease policy-makers; guidance on the development of national mental health policy and legislation; development of regional frameworks for injury and violence prevention and in support of the Tobacco Free Initiative; regional road safety status reports; and initiation of national food summits in the Pacific. Capacity-building of national focal points and health care personnel was emphasized through workshops and training courses on noncommunicable disease prevention and control, communitybased rehabilitation, and suicide and drowning prevention. Collation and dissemination of good practices were enhanced by support of intervention projects and use of information technology. Member States were also supported by various other activities related to noncommunicable conditions, mental health, and violence and injury prevention. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 03.001.WP01: Advocacy and support provided to increase political, financial and technical commitment in countries and areas in order to address chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities. Appraisal: Fully Achieved Comments on achievements A regional meeting of focal points for injury and violence prevention was held in Manila, the Philippines in July 2008 to review national action plans on injury and violence prevention. Nine countries and areas, namely Australia, Cambodia, China, Hong Kong (China), Japan, Malaysia, Mongolia, New Zealand and the Philippines, participated and shared their expertise and experience during the Asia Pacific consultation on the World Report on Disability and Rehabilitation held in the Philippines in June 2008. Capacity-building for noncommunicable disease prevention and control and high-level advocacy for policymakers was provided to 19 Member States through the fifth Japan and WHO intemational viSitors programme in Saitama, Japan and a regional meeting on noncommunicable disease prevention and control in Tokyo, Japan in August 2009. SpeCific support was provided to Cambodia, China, Fiji, Mongolia, Papua New Guinea, the Philippines, Solomon Islands and Viet Nam. Pacific island countries were supported to organize national food summits and a regional summit will be organized in April 2010. Advocacy for policy support was provided to PacifiC island countries and included noncommunicable disease prevention, micronutrient deficiency and food security. A "Food Secure Pacific' website (http://www.foodsecurepacific.org!) was developed to raise stakeholder interest and to disseminate advocacy material. Communication and advocacy events were organized alongside national food summits in Cook Islands, Fiji, Samoa, Solomon Islands and Vanuatu to support policies and programmes for noncommunicable disease prevention.

STRATEGIC OBJECTIVE 3

A Pacific island health ministers' meeting to initiate the scale-up of interventions for the prevention and control of noncommunicable diseases as part of the Healthy Islands initiative was held in conjunction with the Regional Committee meeting. The new Western Pacific Regional Action Plan for Noncommunicable Diseases 12 and a package of information, education and communication materials were disseminated. Policy, intervention and advocacy were supported through the posting of up-te-date information on the noncommunicable disease website of the WHO Regional Office. A Meeting on Partnership for Mental Health in the Pacific was convened in February 2008 to discuss how nongovernmental organizations in the Pacific and international organizations could collaborate on mental health and contribute to the work of the Pacific Islands Mental Health Network (PIMHnet). The meeting developed a draft action plan outlining concrete actions that each organization could take in partnership with PIMHnet to improve mental health. At the second meeting of PIMHnet, the Member States finalized a 2009 workplan. The plan included developing training plans for mental health workers based on an assessment of each country's mental health workforce, drafting a set of mental health guidelines, and collaborating with strategic partners to help provide resources to ensure sustainable services.

RER 03.002.WP01: Guidance and support provided to countries and areas for the development and implementation of policies, strategies and regulations for chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities. Appraisal: Fully Achieved Comments on achievements Seven countries (Fiji, Mongolia, Palau, the Philippines, Solomon Islands, Vanuatu and Viet Nam) reported on their plans, strategies and implementation mechanisms during a workshop on community-based rehabilitation held in June 2009 in Manila, Philippines. The Regional Framework for Action on Injury and Violence Prevention (2008-2013) provided guidance to countries in developing their individual action plans. Viet Nam began implementation of its road traffic injury prevention project, both nationally and in three pilot provinces (Yen Bai, Da Nang and Binh Duong). Eighteen Member States developed noncommunicable disease plans or programmes that were in different stages of implementation, and 24 Member States had policies or programmes targeted to one or more noncommunicable disease risk factors. Salt reduction was a common theme across the Region: a profile highlighting the current situation, international best practices and intervention approaches for Member States was developed. In Cambodia, national guidelines for diabetes, hypertenSion, physical activities, and diet for preventing noncommunicable diseases were developed. A training curriculum for capacity-building among diabetes health care providers and general physicians from provincial referral hospitals was also conducted. Policy briefs were drafted to support interventions on noncommunicable disease risk factors. Support was provided to Pacific island countries in the area of policies on food security and noncommunicable disease prevention. A project to increase capacity of local govemments in developing noncommunicable disease policies was rolled out for the provincial government of Guimaras in the Philippines, and a national policy on integrated and comprehensive noncommunicable disease prevention and control was developed. Several guidelines on healthy lifestyles were also supported in the Philippines. Pacific island countries were supported to organize national food summits and a regional summit will be organized in April 2010. Advocacy for policy support was provided to Pacific island countries and includes noncommunicable disease prevention, micronutrient deficiency and food security. A "Food Secure Pacific" website (http://www.foodsecurepacific.orgO was developed to raise stakeholder interest and disseminate advocacy material. Communication and advocacy events organized alongside national food summits in Fiji, Cook Islands, Vanuatu, Samoa and Solomon Islands supported policies and programmes for noncommunicable disease prevention. 12

WPRJRC59.R5

STRATEGIC OBJECTIVE 3

A Pacific island health ministers' meeting was held in conjunction with the Regional Committee meeting to initiate the scaling up of interventions for the prevention and control of noncommunicable diseases as part of the Healthy Islands initiative. Specific support was provided to Fiji, Papua New Guinea and Solomon Islands. Technical and financial support was provided through various projects that contribute to the development and implementation of policies and plans of mental health and substance abuse. These included developing a mental health service model for disaster-affected populations (China and the Philippines); the WHO assessment instrument for mental health systems (Malaysia and the Philippines); and ongoing support and field visits to PIMHnet members. In the Lao People's Democratic Republic, the revision of the mental health policy was supported.

RER 03.003.WP01: Improved capacity in countries and areas to collect, analyse, disseminate and use data on the magnitude, causes and consequences of chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities. Appraisal: Fully Achieved

Comments on achievements A global status report on road safety was published in December 2009 and included the participation of 26 countries in the Region. Guidance was provided to six countries in updating their statistics and reports, which were accessible through the websites of relevant govemment agencies and reflected in the data and validation matrix for a world report on disability and rehabilitation. In Viet Nam, WHO supported the development of several injury surveillance systems. In Cambodia, support was provided for the completion of a knowledge-attitude-practice survey. Monitoring of noncommunicable disease burden and risk factors was addressed in all capacity-building programmes and in the Japan and WHO intemational visitors programme. Member States were supported in developing a set of indicators to monitor the noncommunicable disease burden. The WHO Regional Office worked with WHO Headquarters in developing a set of global indicators for monitoring noncommunicable diseases. Specific support was provided to Solomon Islands to start a cancer registry and to the Philippines to strengthen their cancer registries. All six cancer registry centres in Viet Nam were in operation. A national oral health survey was initiated in Papua New Guinea. The suicide trends in at-risk territories (START) project sought to establish reliable assessments of the incidence of both fatal and non-fatal suicidal behaviour and gain an understanding of their underlying causes. Technical and financial support was provided to Member States in implementing the following activities: • • • • Local START operational workplans were developed in Fiji, Tonga and Vanuatu. Translation and piloting of assessment instruments were supported in Tonga. Training workshops were organized in Tonga and Vanuatu. Financial support was given for the participation of Fiji, Mongolia, Tonga, and Vanuatu at the START meeting and a regional meeting on suicide prevention held in Hong Kong (China) in October 2008. The START meeting in Hong Kong (China) was attended by 11 Member States involved in START. Technical support field visits were carried out in Fiji, Tonga and Vanuatu. Technical support was provided to Malaysia for the development of a national plan of action on suicide prevention. Financial support was provided to Mongolia, the Philippines, Tonga and Vanuatu to collect data on suicide mortality and morbidity.

• • •

Three initiatives jointly contributed to capacity-building and strengthening of information systems: the WHO assessment instrument for mental health systems, START and a global survey on alcohol and health.

STRATEGIC OBJECTIVE 3

RER 03.004.WP01: Improved evidence compiled by WHO on the cost-effectiveness of interventions to address chronic noncommunicable conditions, mental and behavioural disorders, violence and Injuries and disabilities.

Appraisal: Partially achieved: Comments on achievements

OngOing country-specific interventions in China, the Philippines and Viet Nam include a cost-effectiveness assessment. A technical consultation was organized to identify cost-effective interventions for uterine cervical cancer control, which will help Member States to identify appropriate interventions for the local context. Approaches to salt reduction were compiled and disseminated. National food summits in the Pacific IslandS were supported to identify cost effective policy interventions for improving food quality. In Viet Nam, the integrated community-based model for noncommunicable diseases was piloted in Thai Nguyen Province. With the support of WHO Headquarters, another similar programme for an essential package for noncommunicable disease conditions was piloted in an urban district of Ho Chi Minh City. A pre- and post-study on the health impact of salt consumption reduction on hypertension was also piloted in a community. Technical and financial support was provided for the area of alcohol policy development and/or alcohol surveillance in Cambodia, China, Mongolia, the Lao People's Democratic Republic, Tonga, Vanuatu and Viet Nam.

RER 03.005.WP01: Guidance and support provided to countries and areas for the preparation and Implementation of multisectoral population-wide programmes to prevent mental and behavioural disorders, violence and injuries and hearing and visual impairment.

Appraisal: Fully Achieved Comments on achievements

Technical support on drowning prevention was provided to Cambodia, China, Palau, the Philippines and Viet Nam. Intersectoral road safety interventions were initiated in Cambodia, China, Mongolia, the Philippines and Viet Nam. A distance leaming course on road safety was organized in Cambodia. A mental health information and resource package was developed by WHO in the Western Pacific Region and utilized by PIMHnet members. Resource documents for control of alcohol-related harm and for evidence-based suicide prevention programmes were also developed.

RER 03.006.WP01: Guidance and support provided to countries and areas to strengthen their health and social systems in order to prevent and manage chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities.

Appraisal: Fully Achieved Comments on achievements

Technical support on trauma care was provided to China and Viet Nam. WHO in the Westem Pacific Region provided funds for country-level implementation planning or for developing collaboration activities in China, Hong Kong (China), the Lao People's Democratic Republic and the Philippines. An emergency call and care system, together with training for strengthening pre-hospital management of injured persons, was supported in the Lao People's Democratic Republic, A package of essential noncommunicable disease interventions was piloted in Viet Nam. A Plan of Action (20062010) for the Western Pacific Declaration on Diabetes was printed and disseminated to improve diabetes management in the Region. Technical support was provided to Kiribati and Tonga to improve pain relief and palliative care services for cancer. Noncommunicable disease prevention and control was introduced as a component of the Healthy City initiative in China. The healthy universities initiative was started in Mongolia and the Philippines. Health promoting churches were supported in Tonga to address noncommunicable disease risk factors in the community. Integrated risk reduction was supported in Guimaras, the Philippines by strengthening the capacity of the provincial government. The China rural health project, covering 40 counties in eight provinces, was supported to introduce

STRATEGIC OBJECTIVE 3

noncommunicable disease risk reduction. WHO collaborating centres in the area of noncommunicable disease were reviewed and updated to support the work on noncommunicable disease prevention and control. During the biennium, 17 collaborating centres were re-designated, seven were terminated and three new ones were added.

RER 03.006.WP02: Guidance and support provided to countries and areas to strengthen health-system services for the management and treatment of tobacco dependence, including behavioural and pharmacological interventions.

Appraisal: Fully Achieved Comments on achievements

Best practices on cessation were presented to the Regional Workshop on Sustaining Action for the WHO Framework Convention on Tobacco Control held in August 2008 in Manila, the Philippines. Among the best practices, brief interventions provided by all health workers were identified as a model that other countries could adopt and adapt with minimal cost. Three working groups were organized for experts from Australia, Guam and New Zealand to share their work, materials and experiences. A working group was convened with more than 15 countries to discuss how to initiate or scale up work on cessation. As a result, training and capacity-building activities for giving brief advice and organizing cessation services were developed in Cook Islands, Palau and Mongolia with technical experts from Australia and Guam. A special project was initiated in Xian, China in collaboration with the Chaoyang Hospital in Beijing, a WHO Collaborating Centre for Tobacco Control. Exploratory discussions were undertaken with counterparts to expand an initiative of the Department of Health, Hong Kong (China) and the US Mayo Clinic, to provide training on cessation programmes. A publication on reducing the demand for tobacco products was in production and will contain a section on good practices from Brunei Darussalam, Japan, the Republic of Korea and Singapore.

STRATEGIC OBJECTIVE 4

STRATEGIC OBJECTIVE 4 To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

Support for Member States in the Western Pacific Region focussed on policy ?evelopmen~ and planning for the attainment of Millennium Development Goals 4 and 5 through the Implem~ntatlon of the WHO/UNICEF Regional Child Survival Strategy; 13 development of a regional reproductive health strategy; and development of a draft implementation guide for achieving MDG 5. Progress towards MDG 4 and actions towards universal coverage of essential interventions were assessed for seven priority countries (Cambodia, China, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam) through a joint WHO/UNICEF workshop conducted in October 2009. Support for MDG 6 was provided through technical assistance, standards development and capacitybuilding for provision of adolescent-friendly health services, and through the strengthening of linkages between related programmes and services (HIVISTI, reproductive and maternal health, child and adolescent health). Support was given for the development and implementation of national action plans and interventions. Capacities were built for integrated child health programme management and health workers training on key interventions and technical guidelines, including guidelines on essential newborn care, updated guidelines for the Integrated Management of Childhood Illness initiative and the computerized adaptation and training tool, referral care guidelines, training of community health workers, introduction of new tools including communication for behavioural impact, verbal autopsy guidelines, an adolescent health orientation package, and provision of quality health services to adolescents. Monitoring and evaluation was supported through maternal, newborn and child health household surveys, health facility surveys, hospital assessments and programme reviews. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 04.001.WP01: Support to Member States to develop a comprehensive policy, plan and strategy for scaling up towards universal access to effective interventions in collaboration with other programmes, paying attention to gender inequality and gaps in health equity, providing a continuum of care throughout the life course, integrating service delivery across different levels of the health system and strengthening coordination with civil society and the private sector. Appraisal: Fully Achieved Comments on achievements Child health programmes continued to be guided by the WHO/UNICEF Regional Child Survival Strategy that was developed in 2005 and launched in 2006. Five countries completed national strategic plans (Cambodia, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam) with many having also built operational planning capacity for provincial and district levelS. Progress towards MDG 4 and universal coverage of essential interventions was assessed in seven priority countries in a joint WHO/UNICEF workshop organized in October 2009. 13

WPRlRC56.RS

STRATEGIC OBJECTIVE 4

RER 04.002.WP01: National research capacity strengthened as necessary and new eVidence products technologies, interventions and delivery approaches of global and/or national relevance a~ailable t~ improve maternal, newborn, child and adolescent health, to promote active and healthy ageing, and to improve sexual and reproductive health. Appraisal: Fully Achieved Comments on achievements Viet Nam was supported to develop a sampling methodology and collation of information for the follow-up survey assessment of Vietnamese youth and for documenting the best practices in reaching out to most-at-risk adolescents in Than Hoa province. A review of adolescent substance use and responses in the Region was carried out by the National Drug & Alcohol Research Centre, Australia in collaboration with WHO in the Western Pacific Region. Maternal, newborn and child health household surveys, which collected information on intervention coverage, were supported in Cambodia, Papua New Guinea and Viet Nam to guide planning. Although funding and human resources were limited in the Region, support was provided to enhance networking and dynamics among WHO collaborating centres.

RER 04.003.WP01: Technical and policy support provided to Member States for implementing national plans of action for the reduction of maternal and newborn mortality thereby achieving universal coverage of skilled attendants on maternal and newborn care. Appraisal: Fully Achieved Comments on achievements National plans of actions for reducing maternal mortality were updated by seven priority countries in November 2008, leading to plans made by 10 Pacific island countries in April 2009. Technical advice was provided for the development of their strategies and programmes, and participation of country representatives was supported for relevant training courses. In Viet Nam, technical support was provided to the national safe motherhood programme, including newborn care training, training on monitoring and evaluation of the programme, and the implementation of maternal mortality audit. In China, national verbal autopsy guidelines on classification of causes of maternal and under-five deaths, more aligned with international standards, were developed and adapted for national implementation. National guidelines on monitoring and evaluation to improve the quality of maternal and child health data were also developed and adapted for national implementation.

RER 04.004.WP01: Guidelines, approaches and tools for improving neonatal survival and health in use at country level, with technical support provided to Member States for intensified action towards the achievement of universal coverage, effective interventions and progress monitoring. Appraisal: Fully Achieved Comments on achievements Many activities intended to support newborn care overlapped those to support maternal and/or child health. The target for the biennium was achieved through technical support and capacity-building programmes. Regional training on essential newborn care was conducted for priority countries in January 2009. National training immediately followed in the Philippines. A media workshop in June 2008, which focused on maternal and newborn health, generated a lot interest among the media. Updated guidelines for Integrated Management of Childhood Illness in young infants were disseminated to countries. Extended support was provided to Mongolia and the Philippines to update their national guidelines.

A traininQ package for community health workers,

called Care of the Newborn at Home, was field-tested in the

STRATEGIC OBJECTIVE 4

Philippines, in collaboration with WHO Headquarters, the WHO country offi~e and th,: UNICEF country offic:e. The training package was designed to enhance community health workers counselling skills for home VISits during pregnancy and the first weeks of life. In China, the national guidelines on baby-friendly hospital assessment tools and training materials .on breastfeeding were updated and adapted by national application. A community-based model on breastf~dlng promotion with multisectoral, involvement was developed and piloted, and the new method for communication for behavioural impact was introduced to promote breastfeeding. A strategy on nutrition improvement for infant and young children in the underdeveloped areas was also formulated and piloted. WHO played a key role in the development of the mother- and baby-friendly hospital initiative and for the launching of the newborn care protocol in the Philippines. In the Lao People's Democratic Republic, WHO contributed to the improvement of neonatal health by providing technical inputs to national clinical guidelines on newborn care and providing a training-of-trainers programme to national facilitators on essential newborn care. Support was also given to Kiribati in their development of clinical gUidelines for newborn care,

RER 04.005.WP01: Policy and technical support provided to Member States for intensified action towards agreed goals ensuring universal access, coverage and quality of key public health interventions for newborn and child survival. Appraisal: Fully Achieved Comments on achievements WHO in the Western PacifiC Region played a key role in providing support for the development of national child survival strategies and plans of action. Assessments and analyses of data were supported as well as capacitybuilding for integrated approaches, such as IMCI, to scale up implementation of essential interventions at all levels of the health system. Updated guidelines on IMCI were disseminated to countries, and the IMCI Computerized Adaptation and Training Tool (ICAIT) for faCilitating the adaptation process was introduced to representatives from 12 countries (Australia, Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, MongOlia, Papua New Guinea, the Philippines, the Republic of Korea, Solomon Islands and Viet Nam). Support was provided for the first national programme managers course in Cambodia. WHO supported Fiji and the Philippines in updating the national IMCI case management guidelines and applying ICATT-based training in pre-service and in-service education. Computer-based IMCI training was conducted in Fiji in August 2009 for eight Pacific island countries (Fiji, Kiribati, the Federated States of Micronesia, Papua New Guinea, Samoa, Solomon Islands, Tonga and Vanuatu). As an off-shoot of this training, the WHO Regional Office in collaboration with WHO Headquarters extended further technical support to Solomon Islands and Vanuatu to update their guidelines and review strategies for scaling-up. A global field test of a community case management package was organized in the Philippines in collaboration with WHO Headquarters and the WHO Representative Office in the Philippines. Further introduction and implementation of community case management package for community health workers was supported in the Lao People's Democratic Republic and the Philippines. A consensus meeting for updated clinical standards for hospital care for children was supported and the Pocket Book of Hospital care for Children 14 was adapted and disseminated to several countries. The pocketbook was also translated into Khmer and disseminated across Cambodia and Mongolia. Technical support for improving referral care was provided to the Lao People's Democratic Republic to conduct an emergency triage and treatment course. Consultancies were supported in the Pacific to review oxygen procurement and hospital management in Kiribati and to assess the training needs of hospital staff caring for children in Fiji. A child survival country profile was developed for Mongolia and WHO developed advocacy materials for child survival. For monitoring progress, capacity-building for maternal, newborn and child health household surveys was supported for Cambodia, China, Papua New Guinea and Viet Nam. Child health programme reviews along the continuum of care were supported in Cambodia and China. A regional WHO and UNICEF workshop conducted in October 2009 reviewed the ...Q!ogress and actions to im...Q!ove child survival in seven priority countries 14

ISBN 92 4 1546700

STRATEGIC OBJECTIVE 4

(C?ambodia, China, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Vle.t Nam). The country updates and the lessons from the workshop provide a solid platform for integrated actions towards MDG 4 to be reflected in national action plans for the years leading to 2015 and requiring regional support.

RER 04.006. WP01 : Policy and technical support provided to Member States for coordinated implementation of evidence-based strategies, norms and standards for the prevention and care of diseases and health compromising behaviours in adolescents, as well as conditions that place adolescents at risk. Appraisal: Fully Achieved Comments on achievements Efforts were made to improve collaboration within WHO on initiatives that would involve adolescent health, including collating strategic information on substance use, strengthening the focus on adolescents in relevant strategies and interventions, afld incorporating adolescent health in pre-service nursing curricula. Country managers were familiarized with various WHO tools to carry out continuing advocacy; Technical support was provided to the Philippines for the development of standards for adolescent-friendly health services; and to Mongolia for an adolescent health programme review, including the development of tools and protocols. An intercountry meeting involving seven priority countries (Cambodia, China, the Lao People's Democratic Republic, Mongolia, the Philippines, Papua New Guinea and Viet Nam) was held to share experiences, receive inputs from the participants on the draft regional framework to be developed, and build synergy among agencies, governments and nongovernmental organizations. Technical support for enhancing the capacities of health care providers, including responding to young people living with HIV, was provided to Hong Kong (China), Malaysia and the Philippines. Universities in China and Hong Kong (China) were supported to strengthen pre-service curricula of nurses and to improve their competencies to address the needs of adolescents. A draft regional framework to promote adolescent health and development was developed, and support was provided to Cambodia, Mongolia and the Philippines to strengthen their workplans.

RER 04.007.WP01: Technical support provided to Member States for accelerated action towards implementing the Global Reproductive Health Strategy and improving family planning and reproductive health care. Appraisal: Fully Achieved Comments on achievements Countries were supported to strengthen and develop their national family planning strategies and reproductive health services to increase the contraceptive prevalence rate and reduce unwanted pregnancies in Cambodia, the Lao People's Democratic Republic and Mongolia. A global survey on reproductive health was completed in the Philippines. A workshop on universal access to quality reproductive health including family planning was conducted with partiCipants from nine priority countries. A Framework for Accelerated Action for Sexual and Reproductive Health of Young People was developed and disseminated by WHO in the Western Pacific Region, in collaboration with the United Nations Population Fund (UNFPA), UNICEF and the International Planned Parenthood Federation. Needs assessments to ensure universal access to reproductive health, including for vulnerable populations and migrants in some countries, were supported. The Asia-Pacific Operational Framework for Linking HIV/STI Services with Reproductive, Adolescent, Maternal, Newborn and Child Health Services was developed in collaboration with UNICEF, UNFPA and the United Nations Joint Programme on HIV/AIDS. A joint WHO and UNICEF workshop on linking HIV and STI services with reproductive health, adolescent health and maternal and child health services was attended by seven' priority countries (Cambodia, China, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam). A regional strategy on achieving universal access to sexual and reproductive health approached the final development stage.

STRATEGIC OBJECTIVE 4

Technical and financial support was provided for expanding safe abortion services in Mongolia through the assessment of existing services, establishment of model safe abortion clinics, provision of supplies and equipment, and a workshop on a registration system of abortion among private and public hospitals. An intercountry meeting on the prevention of unsafe abortion was conducted in collaboration with UNFPA and UNICEF to develop country strategic plans of action for addressing unmet needs for family planning and for preventing unsafe abortion. Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, the Philippines and Viet Nam all participated. An expert consultation on comprehensive prevention and control of cervical cancer was conducted to identify priority actions for Member States and develop a road map for developing and strengthening cervical cancer control programmes. A feasibility study on introducing routine screening for syphilis during pregnancy care was supported in Viet Nam.

STRATEGIC OBJECTIVE 5

STRATEGIC OBJECTIVE 5 To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE Support was provided in response to acute emergencies Cambodia, China, the Lao People's Democratic Republic, the Philippines, Samoa, Tonga and Viet Nam. Support for emergency preparedness programmes was given to 11 countries. A regional information service was maintained through web-based reporting and document distribution. Support was given for the development of a regional emergency and disaster nursing network. Support was given to the global safe hospitals campaign. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 05.001.WP01: Norms and standards developed, capacity built and technical support provided to Member States for the development and strengthening of national emergency preparedness plans and programmes. Appraisal: Fully Achieved Comments on achievements Significant results were achieved by WHO in the Western Pacific Region under the global Hospitals Safe from Disasters campaign. These included region-specific assessment tools, new guidelines and promotional material. WHO in the Western Pacific Region also contributed inputs to mass casualty training, disaster management training through a public health and emergency management programme in Asia and the Pacific, preparation of new and translation of existing WHO publications, and assessment of national capacities to identify gaps for future WHO support.

RER 05.002.WP01: Norms and standards developed, capacity built and technical support provided to Member States for a timely response to disasters associated with natural and human-generated hazards. Appraisal: Fully Achieved Comments on achievements Considerable efforts were made to improve WHO capacity at the country level to support response to emergencies, but results vary considerably across the Region, depending on the strength and priorities of each country office. The capacity of the Regional Office was operating at its upper limit. The Western Pacific Region has the highest number of natural disasters by region each year, yet responds with the smallest number of fulltime staff and the lowest annual budget.

RER 05.002.WP02: Acute emergency response operations implemented in a timely and effective manner. Appraisal: Fully Achieved Comments on achievements Direct support was provided to seven countries experiencing acute emergencies, namely Cambodia, China, the Lao People's Democratic Republic, the Philippines, Samoa, Tonga and Viet Nam.

STRATEGIC OBJECTIVE 5

RER 05.003.WP01: Norms and standards developed, capacity built and technical support provided to Member States for assessing needs and for planning and implementing transition and recovery actions in post disasters and post conflict situations.

Appraisal: Partially Achieved Comments on achievements

Disaster recovery is an area in which WHO is not often involved. It is very difficult to get donor support for recovery in the health sector. Globally, WHO has yet to fully clarify its own role in recovery or to formulate guidance on the role and responsibilities of the wider health sector in recovery.

RER 05.003.WP02: Ongoing emergency response and recovery operations implemented in a timely and effective manner.

Appraisal: Partially Achieved Comments on achievements

Limited recovery actions were supported in China and Philippines, but not in other countries post-disaster.

RER 05.004.wP01: Coordinated technical support on communicable disease control in disasters resulting from natural and human-generated hazards provided to Member States.

Appraisal: Fully Achieved Comments on achievements

Coordinating technical support on communicable disease control in disasters is a core function of WHO. It is always done in every natural disaster and in conflict.

RER 05.005.WP01: Coordinated technical support provided to Member States on environmental health and food safety in disasters resulting from natural and human-generated hazards.

Appraisal: Fully Achieved Comments on achievements

Coordinating technical support on environmental health in disasters is a core function of WHO. It is always done in every natural disaster and in every conflict. Specific support for food safety is rarely needed or requested after a disaster, with food safety issues usually being managed as a communicable disease surveillance and response issue.

RER 05.005.WP02: Support provided to Member States for strengthening national preparedness, alert and response to food safety and environmental health emergencies.

Appraisal: Fully Achieved Comments on achievements

Formal and informal collaboration within WHO in the Western Pacific Region was particularly strong and has led to major improvements in post-disaster communicable disease surveillance, as well as several recent publications defining the role of food safety and environmental health in natural disasters.

STRATEGIC OBJECTIVE 5

RER 05.006.WP01: Effective communications issued, partnerships formed and coordination developed with other United Nations agencies, governments, local and international nongovernmental organizations, academic institutions and professional associations at country, regional and global levels. Appraisal: Fully Achieved Comments on achievements This is an important area of work and much effort was put into improving WHO's ability to participate in global mechanisms and to support countries. WHO in the Western Pacific Region was particularly effective in participating actively and effectively in humanitarian coordination, and this was recognized by WHO Headquarters as well as our international partners. WHO worked through a cluster approach in China, the Lao People's Democratic Republic, the Philippines, Samoa and Viet Nam. Collaborative arrangements exist and jOint activities were held with the International Federation of Red Cross and Red Crescent Societies, the United Nations International Strategy for Disaster Reduction and the European Commission Humanitarian Aid Office. Support was also provided to initiatives by the Pacific Islands Applied Geoscience Commission, the Asia Pacific emergency and disasters nursing network, the Association of South-East Asian Nations and the network supporting the Asia Pacific Strategy for Emerging Diseases. Work was carried out through academic institutions such as the South-East Asian Ministers of Education Organization Tropical Medicine and Public Health Network, the Asian Disaster Preparedness Center and the Hanoi School of Public Health in Viet Nam. RER OS.006.WP02. Effective communications in emergency and outbreak situations. Appraisal: Fully Achieved Comments on achievements This is a core function of WHO. It is always done in every emergency.

STRATEGIC OBJECTIVE 6

STRATEGIC OBJECTIVE 6 To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

Capacity-building, multisectoral action and multidisciplinary action for health and development in the Region were supported throughout the biennium. Technical support was provided to Member States for surveillance of noncommunicable disease risk factors; school-based health; tackling major risk factors such as the use of tobacco, alcohol, drugs and other psychoactive substances; diet and physical activity; and unsafe sex. Technical assistance and support were provided for activities, training workshops, and advocacy and mobilization efforts for comprehensive tobacco control in high-priority countries. Support was provided for the expansion of setting-based programmes including Healthy Cities, Healthy Islands and health-promoting schools. Technical support was also provided for monitoring the major noncommunicable risk factors for health. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 06.001.WP01: Advice and support provided to countries and areas to strengthen their health promotion capacity across all relevant programmes, and to establish effective multisectoral and multidisciplinary mechanisms and collaborations to promote health and prevent and reduce the occurrence of major behavioural and structural risk factors. Appraisal: Fully Achieved Comments on achievements Capacity-building for health promotion teams was sustained through the regional health promotion leadership training (Prolead Plus) with the participation of 12 countries. The seventh Global Conference on Health Promotion held in Nairobi, Kenya provided an opportunity for building capacity, networking and sharing of good practices. Ten countries from the Region participated in the conference and had a ·chance to dialogue with health promotion foundations from different parts of the world. WHO in the Western Pacific Region developed a technical paper and led a track on capacity-building at the conference. SpecifiC support was provided for health-promoting churches in Tonga. Training on social mobilization was provided in support of the healthy villages project in China. Training on social marketing was provided to stakeholders in Xian, China in support of the United Nations project on reducing vulnerabilities of youth migrants. In Viet Nam, training courses were conducted and materials developed on various aspects of health promotion and healthy settings to enhance the capacity across various ministries and agencies. In the Philippines, guidelines for healthy settings and healthy workplaces were updated and support was provided to a local initiative for the promotion of healthy lifestyles. Three workshops towards the development of a national policy framework and guidelines on urban health system were conducted. The framework for action for health-promoting schools was launched. Support for health-promoting schools was scaled up in several countries. Work on the Healthy Cities iriitiative was sustained and a working group on scaling up and expanding Healthy Cities was convened. Efforts to reduce health inequity in urban settings were advanced through the use of an .

STRATEGIC OBJECTIVE 6

urban health equity assessment and response tool in three countries. In support of a global initiative to strengthen work on healthy urbanization, a new initiati~e on enviro~mentally sustainable and healthy urban transport was launched with projects to support documentation of city project sites in five countries.

RER 06.002.WP01: Guidance and support provided to strengthen national systems for major risk factor surveillance by developing, validating and disseminating programme and evaluation frameworks, tools and operating procedures to countries and areas with a high or increasing burden of premature death and disability attributable to the major behavioural risk factors. Appraisal: Fully Achieved Comments on achievements Technical support was provided for noncommunicable disease risk factor surveys using the WHO STEPwise approach to surveillance (STEPS) in Cambodia, Kiribati, the Lao People's Democratic Republic, Mongolia, Papua New Guinea and Solomon Islands. Implementation of the global school-based students' health survey was supported in Mongolia. Sixteen Member States either completed or were in the process of conducting the STEPS survey. Other Member States had information on noncommunicable disease risk factors through national or subnational surveys. The global school-based students' health survey continued in Guimaras in the Philippines and in Mongolia. Reports of the available STEPS data from Pacific island countries were collated and developed as policy advocacy materials.

RER 06.003.WP01: Technical assistance, training and advocacy support provided to countries and areas with a high and increasing burden to strengthen institutions in order to address/prevent public health problems associated with tobacco. Support provided to the Conference of the Parties to the WHO Framework Convention on Tobacco Control for implementation of the provisions of the Convention. Appraisal: Fully Achieved Comments on achievements Technical assistance and support were provided for activities, training workshops, advocacy and mobilization efforts for comprehensive tobacco control in high-priority countries. The three high-priority countries of the Bloomberg Initiative (China, the Philippines and Viet Nam) were involved in the launching of the WHO six-point package of effective poliCies for tobacco control (MPOWER) at national and local levels and in the development of MPOWER training packages, and were also sites for the first round of a global adult tobacco survey. Through partnership and collaborative projects with the South-east Asia Tobacco Control Alliance, support was also provided to Cambodia, the Lao People's Democratic Republic, the Philippines and Viet Nam for work on tobacco taxation, health promotion foundations, advocacy on Article 5.3 of the Framework Convention on Tobacco Control, graphic health warnings and smoke-free settings. Tools for using data for policy and action . were developed to complement training on monitoring of second-hand smoke (air nicotine and particulate matter) conducted with teams from China, Japan, the Philippines, the Republic of Korea and Viet Nam in collaboration with the John Hopkins School of Public Health, who also provided project support to implement these activities in countries. Two meetings of focal points were convened in the biennium. These meetings provided opportunities for sharing of experiences, building skills, networking and providing support and advice on implementation of tobacco control programmes. The first meeting in 2008 was on sustaining action on the WHO Framework Convention on Tobacco Control. The second meetinfJ in 200~ covered the Regional.~ction Plan for the Tobacco Free Initiative In the Western PaCifiC (2010-2014). Countnes and areas that partiCipated In these meetings were Australia, Brunei Darussalam, Cambodia, China, Cook Islands, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Hong Kong (China), Japan, Kiribati, the Lao People's Democratic Republic, Macao (China), Malaysia, the Marshall Islands, Mongolia, New Zealand, Niue, Palau, Papua New Guinea, the Philippines, the Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam. 15 WPRlRC60.R4

STRATEGIC OBJECTIVE 6

In the area of advocacy and social mobilization for tobacco control, support was provided to countries for World No Toba~ Day in 2008 (youth and tobacco) and 2009 (graphic health warnings). Collaboration and support was provided for tobacco-free sports activities, including the Beijing Olympics, the Southeast Asian Games and Indoor Games. Special projects on tobacco and gender were started in Viet Nam. Tools designed by WHO in the Western Pacific Region for data application projects were adapted for the tenth anniversary of the global tobacco surveillance system; WHO in the Western Pacific Region was requested to train all country surveillance officers from all regions at the CDC in Atlanta, Georgia in June 2008. Surveillance activities (youth, school health professionals, and health professional students) were undertaken in American Samoa, Cambodia, China, the Commonwealth of the Northern Mariana Islands, Cook Islands, the Federated States of MicroneSia, Fiji, Guam, Hong Kong (China), Kiribati, the Republic of Korea, the Lao People's Democratic Republic, Macao (China), Malaysia, Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, the Philippines, Samoa, Singapore, Solomon Islands, Tuvalu, Vanuatu and Viet Nam.

RER 06.004.WP01: Technical support provided to countries and areas with a high and increasing burden of major risk factors and disease in order to strengthen Institutions for preventing public health problems associated with alcohol, drugs and other psychoactive substance use. Appraisal: Fully Achieved Comments on achievements A network of focal points for alCOhol nominated by Member States was formed in 2008. The first regional meeting on reducing alcohol-related harm was held in 2008, resulting in identification of priority areas of common concern and in a draft Regional Plan of Action for the Reduction of Alcohol-related Harm in the Western Pacific (20092014). Regional coordination was undertaken of Member States' partiCipation in a global alcohol and health survey. A regional technical consultation on a global strategy to reduce the harmful use of alcohol was held in 2009 to support WHO Headquarters in developing a global strategy for the 2010 World Health Assembly. A regional review of youth alcohol and drug abuse was carried out as starting point for further collaboration within WHO in the Western Pacific Region. Country support and activities continued in Cambodia, the Lao People's Democratic Republic, Mongolia, Tonga, Vanuatu and Viet Nam on alcohol policy development and implementation and development of monitoring systems. Support was given to China for a pilot study to develop a national survey on alcohol. Integration of alcohol as a risk factor into noncommunicable disease was advanced with Guimaras province, the Philippines, as a strategy laboratory. Support was given to drug treatment, tuberculosis and HIV care integration in Cambodia, China, Viet Nam and Malaysia and to other United Nations agencies in the Philippines through HIV staff training. The following regional tools and resources were developed for use in the next biennium: • • • • WHO Western Pacific Regional Strategy to Reduce Alcohol-related Harm: How to Develop an Action Plan to Implement the Strategy; 16 A Regional Plan of Action for the Reduction of Alcohol-related Harm in the Western Pacific (2009-

2014};17 an alcohol advocacy kit - resource materials for advocacy by civil society; and a regional alcohol control legislation guidance document.

RER 06.005.WP01: Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed and technical support provided to countries and areas with a high and increasing burden to strengthen institutions in order to address/prevent public health problems associated with unhealthy diets and phYSical inactivity. Appraisal: Fully Achieved Comments on achievements Twenlycountries and areas developed, or were in the process of develC12!t:l9.. and implementing, pOlicies, plans

16 ISBN 9789290614463 17 ISBN 9789290614456

STRATEGIC OBJECTIVE 6

and programmes focused on diet and physical activity. The following activities and countries were supported:

• • • • •

• •

publication of the Pacific physical activity guidelines for adults - a framework for accelerating the communication of guidelines (for all the Pacific island countries); workshops for the development of food-based dietary guidelines in Kiribati, Samoa and Vanuatu; collection and analysis of information on food availability in PacifiC island countries to promote food fortification and prevent noncommunicable disease; development of a working document on the assessment of fiscal policy influences on food supply and diets in Pacific island countries; a meeting in November 2008 in Sydney, Australia on improving food supply to reduce noncommunicable disease risk factors in the Pacific; a meeting in November 2008 in Sydney, Australia on adding value to Pacific island foods, which facilitated a dialogue between the food industry and health sector on imported and processed food; preparatory steps for the "Food Secure Pacific' (formerly the "Pacific Food Summit"), inciuding preparation of a draft of the Pacific declaration on food security, a draft framework for action to implement the declaration, food security profiles for Pacific island countries, a Food Secure Pacific website, and conducting national food summits in Cook Islands, Fiji, Samoa and Vanuatu.

In addition, among the Asian countries, Cambodia, China, Mongolia, the Philippines and Viet Nam developed and implemented policies, plans and programmes focused on diet and physical activity.

RER 06.006.WP01: Evidence-based and ethical policies, strategies, interventions, recommendations, standards and guidelines developed, and technical support provided to countries and areas to promote protected sex and strengthen institutions in order to address and manage social and individual consequences of unsafe sex.

Appraisal: Fully Achieved Comments on achievements

Technical support was provided to countries and areas to promote protected sex and strengthen institutions to address social and individual consequences of unsafe sex. Key funded achievements included: a strategy to ensure the safety of abortion services in different areas of Mongolia; an intercountry meeting on unsafe abortion; a feasibility study of on-site syphilis screening during pregnancy care in Viet Nam; and activities for implementation of STIIHIV/AIDS services together with safe abortion services in Mongolia.

STRATEGIC OBJECTIVE 7

STRATEGIC OBJECTIVE 7 To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

The overall approach was to build the awareness, skills and capacity of technical programmes and countries on poverty and equity, gender, and human rights issues in health and to develop, disseminate and promote the use of tools to support this work. Implementation support was provided to technical programmes and countries to address poverty and equity, gender and human rights in their policies, programmes and actions. Another approach was to strengthen capacity on equity analysis, monitoring and measurement, as well as collection, analysis and use of health information disaggregated by relevant social stratifiers, through equity-focused analysis of selected national surveys and datasets and the documentation of good practices and lessons learnt on equity in health. Capacity and skills were strengthened through technical support in selected technical programmes and countries, namely: • tuberculosis (capacity-building on equity and gender among national tuberculosis programme managers in China); • malaria (focusing on ethnic minorities); • HIV/AIDS (through a human rights-based analysis of harm reduction approaches in Cambodia, China, Malaysia and Viet Nam); • communicable disease surveillance and response (through the development of a regional gender analysis framework); • reproductive health (capacity-building on gender and reproductive rights in China); • noncommunicable diseases (equity-focused analysis of noncommunicable disease data sets in five countries). • Tobacco Free Initiative (development of a pilot project on gender and tobacco in Viet Nam and some advice to Palau and the Philippines); and • health planning (regional training in equity, gender and human rights for health leaders and participation in a workshop on equity, gender, human rights in Vanuatu). The evidence base for work in this area was strengthened through initiation of the development of country profiles on gender, equity and human rights issues in health in seven countries (Cambodia, China, Malaysia, Mongolia, the Philippines, Tonga and Vanuatu). These profiles will form the basis for subsequent capacity-building and action planning on these topics in the next biennium. An equity focus also informs WHO's work in health systems strengthening and primary health care. Several publications and tools were developed, disseminated and used to support the approaches outlined above, including web pages on equity, gender, human rights and social determinants of health; four modules in the regional publication series on integrating poverty and gender into health programmes; nine country cases on promoting health equity in the evidence-policy-action process; and a human rights-based assessment of drug treatment centres in four countries.

STRATEGIC OBJECTIVE 7

ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 07.001.WP01: Support provided to strengthen the capacity of the Organization and Member States to reduce health inequities, address socioeconomic determinants of health and promote more equitable and pro-poor policies, programmes and interventions.

Appraisal: Fully Achieved Comments on achievements

Capacity and skills were strengthened through technical support provided on integrating a focus on poverty and equity into health policies, programmes and actions in selected technical programmes and countries, namely: tuberculosis (capacity-building on equity and gender among national tuberculosis programme managers in China); malaria (focusing on ethnic minorities); noncommunicable diseases (equity-focused analysis of noncommunicable disease data sets in five countries); and health planning (regional training in equity, gender and human rights for health leaders, and participation in workshop on equity, gender and human rights in Vanuatu). Capacity and skills of n"ational counterparts in Viet Nam were strengthened through the organization of a training workshop on the social determinants of health and health equity; and in Vanuatu through partiCipation in a workshop on equity, gender and human rights in health. The evidence base for work in this area was strengthened through initiation of the development of country profiles on gender, equity, and human rights issues in health in seven countries (Cambodia, China, Malaysia, MongOlia, the Philippines, Tonga and Vanuatu). These profiles will form the basis for subsequent capacity-building and action planning on these topics in the next biennium. To support capacity-building and technical advice on implementation, the following publications and tools were developed, disseminated and used: • four web pages on equity, gender, human rights and social determinants of health; • four modules in the regional series, Integrating Poverty and Gender into Health Programmes: A Sourcebook for Health Professiona/s,18 namely: the foundational module on gender and the modules HIV/AIDS, sexual and reproductive rights, and food, water and sanitation; and • nine country cases, along with a synthesiS chapter, from a high-level meeting on promoting health equityevidence, policy and action, compiled and published in book format under the tile: Promoting Health and Equity: Evidence, Policy and Action - Cases from the Western Pacific Region. 19 In Viet Nam, a social determinants of health network was set up, capacity built, and technical assistance provided for analysis. A telehealth via satellite programme was also pioneered with Ho Chi Minh City Public Health Association to bring health information to seafarers.

RER 07.002.WP01: Opportunities created and mechanisms used to facilitate action across sectors to reduce health inequities and address the socioeconomic determinants of health.

Appraisal: Fully Achieved Comments on achievements

Capacity-building and consultation on a WHO trade and health diagnostic tool was undertaken and an assessment of trade in health services using the tool was initiated in Viet Nam. Intercountry and national training and consultation were conducted on public health and intellectual property, especially public health safeguards in line with the Agreement on Trade-Related Aspects of Intellectual Property Rights (the TRIPS Agreement). Technical support was provided to review patent legislation and incorporate public health safeguards in line with the TRIPS Agreement. Information was exchanged and country experiences were shared on developments in trade, globalization and access to medicines, especially intellectual property rights and trade agreements.

ISBN 92 9 061J94 4 ISBN 987 92 9 061427 2

STRATEGIC OBJECTIVE 7

RER 07.002.WP02: Opportunities created and mechanisms used to facilitate action. across sectors to address the socioeconomic determinants of health in specific settings (e.g. urban setting). Appraisal: Fully Achieved Comments on achievements Three countries (China. Japan and the Republic of Korea) were made subjects of ~ document on h~althy cities and active ageing, which was formulated to highlight the programmes and actlv.ltl~s related to ac:tl~e ageing. Funds were provided to augment support for translation. data processing, and pnntlng, and for logistics for the conduct of the photojournalists' encounter in formulating the document. Two batches of short courses on urban health equity were conducted for urbanizing local government units in the Philippines.

RER 07.002.WP03: Support is given to countries' development of trade agreements that reflect public health interests, as outlined In WHO guidance. Appraisal: Partially Achieved Comments on achievements Support and technical assistance was provided to four national workshops on issues related to trade and health (China, the Lao People's Democratic Republic, Tonga and Viet Nam). An informal conSUltation on intellectual property rights and public health was held for selected Pacific island countries. Technical input was provided to countries upon request (Malaysia, the Philippines and Viet Nam). Two briefing notes were published.

RER 07.003.WP01: Support provided to strengthen country capacity to collect, analyse and use information on health and social determinants that is disaggregated by various relevant indicators of social exclusion, such as sex, age, ethnicity, income or location. Appraisal: Fully Achieved .

Comments on achievements Capacity and skills of staff of the national tuberculosis programme in China were strengthened through the provision of technical support on equity-focused reporting and recording. The evidence base for work in this area was strengthened through completion of equity-focused analysis of noncommunicable disease data sets in five countries and initiation of the development of country profiles on gender, equity and human rights issues in health in seven countries (Cambodia, China, Malaysia, Mongolia, the Philippines, Tonga and Vanuatu). These profiles will form the basis for future capacity-building and action planning on these topics in the next biennium. Preparatory work was also undertaken to support equity analysis of national health data in Mongolia.

RER 07 .004.WP01: Support provided to strengthen the capacity of the Organization and Member States to promote ethical human-rights based approaches to health. Appraisal: Fully Achieved Comments on achievements Capacity and skills of national counterparts in China were strengthened through the organization of a workshop on gender and reproductive rights; in Viet Nam through a workshop on gender and human rights; of future health leaders through training in equity, gender and human rights; of respective national counterparts through the organization of regional meeting on WHO's guiding principles on human organ transplantation; and by participation in an international symposium on bioethics issues of international concern, with emphasis on advance directives. Development and publication of a report containing an assessment of compulsory treatment of people who use drugs was carried out for four countries (Cambodia, China, Malaysia and Viet Nam), based on an application of selected human rights principles. A draft paper was prepared for an international journal based on the report.

STRATEGIC OBJECTIVE 7

To support capacity-building and technical advice on implementation, publications and tools were developed, disseminated and used, including a webpage on human rights and health. A module on the rights-based approach to health was being developed for use by local govemment units, particularly chief executives and local health boards, in the Philippines. WHO in Viet Nam supported an international conference and research symposium on realizing the rights to health and development for all. A review of functions and gaps was used to develop a capacity-building proposal for the Department of International Cooperation, Viet Nam.

RER 07.005.WP01: Support provided to strengthen the capacity of the Organization and Member States to promote more gender-responsive health policies, programmes and interventions. Appraisal: Fully Achieved Comments on achievements Capacity and skills were strengthened in selected technical programmes and countries. Technical support was provided on integrating a focus on gender into health poliCies, programmes and actions including: • tuberculosis (capacity-building on equity and gender among national tuberculosis programme managers in China); • reproductive health (capacity-building on gender and reproductive rights in China); • Tobacco Free Initiative (development of a pilot project on gender and tobacco in Viet Nam and some technical advice to Palau and the Philippines); • gender mainstreaming for government counterparts (the Lao People's Democratic Republic); • communicable diseases surveillance and response (capacity-building for WHO staff and development of a framework on gender and communicable disease survey and response); • health planning (regional training in equity, gender and human rights for health leaders, workshop in Vanuatu); and • organization of workshops on gender mainstreaming in health in the Regional Office and South Pacific country office (for WHO staff and selected government staff); and training on gender mainstreaming for United Nations and Government counterparts in Viet Nam. Analysis of access of women to health financing schemes such as health equity funding and community-based health insurance in Cambodia and a workshop to discuss preliminary findings and policy implications were conducted. Harmonized gender and development guidelines with a simplified checklist were used in the Philippines and an additional 40 health staff were trained in their use.

RER 07.005.WP02: Support provided to build capacity of Member States to implement the Strategy For Integrating Gender Analysis and Actions into the Work of WHO, including support for Member States to mainstream gender and rights into reproductive, women, maternal and child health. Appraisal: Fully Achieved Comments on achievements Technical support was provided to build the capacity of Member States for implementing a strategy for the integration of gender analysis and actions into the work of WHO. Key achievements included: • Data collection, analysis and report writing on WHO gender mainstreaming and baseline assessment completed and report were finalized. • The China gender case study was reviewed and the report was being finalized. Support was provided for the Chinese translation and adoption of WHO's training module on Gender Mainstreaming for Health Managers - A Practical Approach, which was used for the training workshops of the China Rural Health Project and the national tuberculosis control programme of China in September 2009. • Fiji conducted training on gender capacity-building in October 2009 for officials and health managers. • The Lao People's Democratic Republic translated the gender and rights in reproductive health and maternal health manual for a learning workshop.

STRATEGIC OBJECTIVE 7

• • •

WHO staff members in the Western Pacific Region were provided with training on gender in Manila, and six staff members attended gender mainstreaming training at WHO Headquarters in March 2009. Cambodia, Mongolia, China, Tonga and Malaysia were supported to develop a country gender and health profile to inform national health policy and programmes. Viet Nam strengthened the implementation, monitoring, evaluation and reporting of the Law on Gender Equality and the Law on Domestic Violence Prevention and Control, and started conducting a National Survey on Women's Health and Domestic Violence in April 2009.

STRATEGIC OBJECTIVE 8

STRATEGIC OBJECTIVE 8 To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

For WHO in the Western Pacific Region, the focus of this strategic objective was on supporting policy development, building capacity for monitoring and evaluation, and disseminating good practices on the following: water, sanitation and hygiene; waste management; air quality management; chemical safety; health impact assessment; climate change; and occupational health. Policy development was enhanced through the dissemination of policy frameworks and technical support (e.g. the Declaration of the First East Asia Ministerial Conference on Sanitation and Hygienethe 'Beppu Declaration'). Capacity-building support for monitoring and evaluation was provided through the publication of assessment guidelines, conduct of training and workshops, and collaboration on national and regional assessment projects. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 08.001.WP01: Evidence-based assessments made, and norms and guidance formulated and updated on major environmental hazards to health (e.g. poor air quality, chemical substances, electromagnetic force, radon, drinking water, waste water reuse); technical support provided for the implementation of international environmental agreements and for monitoring MDG 8. Appraisal: Fully Achieved Comments on achievements Health vulnerability assessments were completed in Cambodia, Mongolia, and Papua New Guinea. Three regional assessments were carried out to coliect evidence on sanitation, on hygiene and health with focus on MDG targets, and on hygiene behaviours and related health impacts. Country profiles on climate change and health, as well as on air quality and health, were produced. 20 Water supply and sanitation sector assessments: a guide for country-level action was published. Support was provided to Cambodia for their national policy on health impact assessment, to Japan for the revision of air quality standards, and to Samoa for the development of drinking-water quality standards.

Support was also provided for the enactment of the Beppu Declaration, establishing East Asia Ministerial Conference on Sanitation and Hygiene processes. Participation of Mongolia and Samoa in the United Nations Framework Convention for Climate Change was also supported for the fourteenth session of the Conference of Parties in Samoa. Assistance for the achievement of MDG 7 targets was provided through country support and regional publications, such as the Training Workbook on Water Safety Plans for Urban Systems,21 and the report Sanitation, hygiene and drinking-water in the Pacific island countries - converting commitment into action. 22 Training on a water safety plans was scaled up in Viet Nam, and a roadmap and directive were completed in that country. In the Lao People's Democratic Republic, studies and action plans on indoor air quality, health care waste management and water and sanitation were completed. The Philippines was supported in the formulation of standards and guidelines on the management of toxic chemical exposures. 20 ISBN 9789290614180 21 ISBN 92 9 061402 1 22 ISBN 978 92 9 0614012

STRATEGIC OBJECTIVE S

RER OS.002. WP01: Technical support and guidance provided to countries and areas for the implementation of primary prevention interventions that reduce environmental hazards to health enhance safety and promote public health, including in specific settings and among vulnerabl~ population groups. Appraisal: Fully Achieved

Comments on achievements Primary prevention initiatives for household water treatment and public sanitation were supported in household, city and community settings in China, the Lao People's Democratic Republic, Malaysia, the Philippines and Viet Nam. An Asian asbestos initiative was launched with WHO support. Projects in Cambodia (arsenic in drinking water) and Mongolia (cyanide and mercury poisoning) were also launched. A plan was formulated to undertake cost-effectiveness and cost-benefit analyses of a health sector adaptation strategy for climate change in several countries. The Lao People's Democratic Republic, the Philippines and Viet Nam were supported in implementing WHO guidance on water safety plans. Japan and the Republic of Korea initiated cohort studies on the effects of chemicals on children's health and development. A regional scientific conference with the theme of environmental health from fetus to the elderly was held, and results of the studies in Japan, the Republic of Korea and other countries were presented. In Papua New Guinea, a strategy and guidelines for health care waste management were developed for health facilities, with three training-af-trainers courses conducted in two provinces. Cambodia was supported for the establishment of a range of policies, regulations, strategies, action plans and studies including on chemical management in workplaces; public health and agriculture pesticides; detection and management of arsenicosis; household water treatment technologies; water supply systems for rural areas; health care waste management; and climate change.

RER OS.003.WP01: Technical assistance and support to Member States for strengthening occupational and environmental health policy-making, planning of preventive interventions, service delivery and surveillance. Appraisal: Fully Achieved

Comments on achievements Technical support was provided to: • Cambodia. Mongolia and Papua New Guinea for an adaptation and vulnerability assessment and climate change and health project. • Brunei Darussalam,: Cambodia, China, the Lao People's Democratic Republic and Mongolia for the development of national environmental health action plans; • Cambodia, China, the Lao People's Democratic Republic Mongolia, Papua New Guinea, the Philippines, Solomon Islands, Tonga and Viet Nam with advice on strengthening occupational health services; • China, the Philippines and Viet Nam for strengthening environmental health; • China, the Lao People's Democratic Republic and the Philippines for water safety plans; and • Cambodia, the Lao People's Democratic Republic, Mongolia, Papua New Guinea and Viet Nam for the formulation of national action plans on health care waste management. China, the Lao People's Democratic Republic, Mongolia and Papua New Guinea also received advice on the strengthening of surveillance. This included occupational health in China; water safety and sanitation in the Lao People's Democratic Republic; mercury pOisoning in Mongolia; and health care waste management in Papua New Guinea. WHO was involved in the implementation of a workers' health protection project in Viet Nam, working with the Minist of Health's National Institute of Occu ational and Environmental Health, Nha Tran Pasteur Institute,

STRATEGIC OBJECTIVE 8

Tay Nguyen Institute of Epidemiology, and Institute of Public Health and Hygiene, Ho Chi Minh City. In the Lao People's Democratic Republic, technical support was provided for the establishment of technical working groups on water and sanitation, and health care waste management. The Philippines conducted training on occupational health and safety for hospital workers. Training was also conducted in Cambodia on chemical safety in the workplace, safe management of pesticides at national level, detection and management of arsenicosis in arsenic high-risk provinces, and health care waste management for provincial health staff. Two organizations in China were supported to implement a WHO global plan of action for worker's health to reduce occupational risks.

RER 08.004.WP01: Guidance, tools and initiatives created in order to support the health sector to influence policies in priority sectors, assess health impacts, determine costs and benefits of policy alternatives in those sectors, and select investments in non-health sectors that improve health, environment and safety. Appraisal: Fully Achieved Comments on achievements Initiatives to develop and implement healthy policies were launched in the transport, water and sanitation sectors regionally and nationally in Cambodia, China, the Lao People's Democratic Republic, Malaysia, the Philippines and Viet Nam. Regional water and sanitation sector assessment guidelines were adapted specifically for use in the Philippines and Viet Nam. Networks and partnerships were supported through the establishment of a poison information network in the Pacific and an Asia-Pacific water safety plan network. A workshop was conducted with the technical working group for a world health survey on the functions of health authorities in relation to water, sanitation and hygiene. A meeting on climate change and health in the Western Pacific was conducted. A meeting on occupational health was supported in Ha Noi, Viet Nam in December 2008. In the Lao People's Democratic Republic, support was given for the development of a national environmental health action plan, environmental health policy and strategies, and technical guidelines on health impact assess ment.

RER 08.005.WP01: Health-sector leadership enhanced for creating a healthier environment and changing policies in all sectors in order to tackle the root causes of environmental threats to health, through means such as responding to emerging and re-emerging consequences of development on environmental health, climate change, and altered patterns of consumption and production and to the damaging effect of evolving technologies. Appraisal: Fully Achieved Comments on achievements The impact of WHO work on outreach and mass media was reflected by coverage of national environmental health action plans (e.g. print and television coverage in Brunei Darussalam), and chemical safety (e.g. on the aerial spraying of pesticides in the Philippines). Viet Nam developed, printed and implemented: information, education and communication messages; public service announcements;. and material on the risk factors of occupational health in enterprises and companies. Two regional events, the Third Environmentally Sustainable Transport Regional Forum in Singapore, and the first International Seminar of the Asian Asbestos Initiative. in Japan, were conducted with the help of WHO technical

input. 45

STRATEGIC OBJECTIVE 8 .

Mass media coverage of WHO leadership in environmental and occupational health increased by 5% through the World Health Day on climate change, the World Water Day, the International Year of Sanitation, and the frequent environmental health emergencies. The Fourth High-level Meeting on Environment and Health in South-east and East Asian countries was convened in March 2009 in Beijing, China in collaboration with the United Nations Environment Programme. Regional events consisting of the second meeting of the advisory board and the third scientific conference on environment and health in South-east and East Asian countries were held in the Republic of Korea in April 2008. National forums on environment and health were held in Cambodia, China, the Lao People's Democratic Republic and the Republic of Korea, with the support of WHO. In the Lao People's Democratic Republic, working groups were strengthened to address key emerging and reemerging occupational and environmental health matters. These included health care waste, health impact assessment, a water and sanitation technical working group, and ministerial and other high-level forums on environment and health. Working groups were also established and strengthened in Cambodia to address key emerging and re-emerging occupational and environmental health concerns, such as climate change, management of pesticides, management of chemicals in the workplace, and water and sanitation.

STRATEGIC OBJECTIVE 9

STRATEGIC OBJECTIVE 9 To improve nutrition, food safety and food security, throughout the lifecourse, and in support of public health and sustainable development. SUMMARY OF THE REGIONAl CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

A partnership was established among regional and international organizations, nongovernmental organizations, academia and industry that will lead to a Pacific-wide approach to assuring food security, nutrition and food safety for the island countries and areas. Resources were mobilized to address the Millennium Development Goals and used towards enhancing food security, nutrition and food safety in Cambodia, China, the Philippines and Viet Nam. WHO in the Western Pacific Region contributed to a reduction in micronutrient deficiencies in Asia and the Pacific by advancing food fortification and iron supplementation by mobilizing resources, building partnerships between governments and industry, providing technical guidance on weekly iron and folate supplementation, and supporting Fiji in establishing the first mandatory flour fortification standards in the Pacific. Work began on the development of WHO global guidelines for food complaints systems, food recall and food safety emergency and on increasing the sharing of information on food contamination and foodbome disease surveillance through the International Food Safety Authorities Network (INFOSAN) and Asia FoodNet. Support for the promotion of breastfeeding was provided through consultative services on the implementation of the national codes of marketing of breast-milk substitutes in Cambodia, China, the Philippines, Papua New Guinea and Viet Nam; and the introduction of the communication for behavioural impact approach for exclusive breastfeeding for six months in China, the Lao People's Democratic Republic, Papua New Guinea and the Philippines. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 09.001.WP01: Partnerships formed and advocacy and support provided to countries to Increase pOlitical, financial and technical commitment to address nutrition, food safety and food security through intersectoral action. Appraisal: Fully Achieved Comments on achievements Many countries and areas were able to demonstrate that nutrition, food safety and food security were being addressed in an intersectoral and integrated manner in national policies, plans of action and funding. Countries and areas included: Cambodia, China, the Commonwealth of the Northern Mariana Islands, Cook Islands, the Federated States of Micronesia, Fiji, Guam, Kiribati, Mongolia, Samoa, Niue, the Philippines, Papua New Guinea, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu and Viet Nam. Support was provide to these countries and areas for the following activities: • development of a national nutrition policy, strategy and plan of action in the Lao People's Democratic Republic; • development of a plan of action for accelerating the reduction of stunting in Viet Nam; • collaborative missions by the FAO and WHO to Mongolia and Solomon IslandS in support of these countries developing food security, food safety and nutrition policies and plans of action; • formulation and implementation of national action plans for nutrition in the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia and Guam; • convening of workshops on national plans of action for nutrition for Pacific island countries, entitled Nutrition, Diet & Lifestyle: ScalinQ Up Action in the Pacific, in February 2008 and February 2009 in Fiji.

STRATEGIC OBJECTIVE 9

Countries and areas that participated in these workshops were Cook Islands, Fiji, Kiribati, Niue, Papua New Guinea, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu. Five countries were supported through an integrated approach to planning and funding: • Technical support was given to Cambodia, China, the Philippines and Viet Nam to develop policy, plans and interventions on infant and young child feeding and food safety through the Spanish-Millennium Development Goals fund. • Cambodia, the Lao People's Democratic Republic, Papua New Guinea and the Philippines were supported in applying for funds from the Bill & Melinda Gates Foundation and other donors for infant and young child feeding programmes. • In the Lao People's Democratic Republic, a national food safety policy, a national nutrition policy and supporting strategies were launched with multisectoral participation. • Technical support was given to the Lao People's Democratic Republic for the preparation of a proposal for improving nutrition, food safety and water quality through complementary interventions, for submission to donors. • The Viet Nam Food Administration within the Ministry of Health was able to reinforce its role as a leading and coordinating institute. The network at national and provincial level was reinforced through the involvement of ilifferent stakeholders in the training courses, workshops and meetings.

RER 09.002.WP01: Evidence-based norms, assessments and guidance developed, adapted where appropriate and disseminated, to enable countries and areas to implement cost effective interventions responding to all forms of malnutrition and food borne diseases, and to promote healthy dietary practices in the Western Pacific.

Appraisal: Fully achieved Comments on achievements New guidelines, strategies and approaches were introduced to improve undernutrition and overnutrition. These included: • Communication for behavioural impact plans on breastfeeding were developed through workshops conducted in China, the Lao People's Democratic Republic, Papua New Guinea and the Philippines. • New materials on the International Code of Marketing of Breast-milk Substitutes were produced and disseminated. These materials were introduced in Cambodia, China, Papua New Guinea and Viet Nam in collaboration with UNICEF and the International Code Documentation Centre of the International Baby Food Action Network. • A WHO pOSition statement on weekly iron and folic acid supplementation for women of reproductive age was developed by WHO Headquarters and WHO in the Western Pacific Region. • In Cambodia, seven national nutrition policies and guidelines were developed or updated and disseminated. Training modules for community health workers were also produced. Three new food safety guidance documents and manuals were drafted to improve food safety. In recognizing the public health significance of countries being improperly prepared for food recalls and food emergencies, WHO in the Western Pacific Region initiated the development of guidance documents on food recalls, food complaints and food emergencies. Given the significance of these guidance documents, WHO Headquarters considered it important to advance the drafting of them in a collaborative manner. Subsequently, FAO was involved in further review. It was anticipated that these documents would be finalized in early 2010 after being trialled in Cambodia, Fiji, the Lao People's Democratic Republic and Viet Nam in 2009.

RER 09.003.WP01: Improved capacity in countries and areas to collect, analyse, disseminate and use data on the magnitude, causes and consequences of undernutrition and overnutrition, inappropriate diets and physical inactivity.

Appraisal: Fully Achieved Comments on achievements Support was given to countries for obtaining essential information on nutritional status, as a basis for planning programmes and mobilizing resources for their implementation. In the Philippines, support was provided for assessing, for the first time, the zinc status of the population based

STRATEGIC OBJECTIVE 9

on the sixth national nutrition survey. A Cambodia anthropometric survey was conducted in 2008 with support from WHO in the Western Pacific Region. Baseline and end line surveys of the weekly iron folic acid supplementation programme were conducted in order to inform the development of a national policy on anaemia prevention and control. In MongOlia, support was provided to conduct a fourth national nutrition survey Nutrition surveillance and emergency preparedness in response to the food price crisis were strengthened through participation in the joint FAO-ASEAN Regional Conference on Food Security in May 2009 and in the ASEAN meeting on food security and nutrition surveillance in July 2008. In Tonga, a school food policy was disseminated and was being implemented.

RER 09.004.WP01: Capacity built and support provided to target Member States for the development, strengthening and implementation of nutrition plans, policies and programmes aimed at improving nutrition throughout the life-course. Appraisal: Fully Achieved Comments on achievements In Cambodia, a national nutrition strategy (2009-2015) and a strategic framework for food security and nutrition (2008-2012) were developed with support from WHO in the Western Pacific Region. Infant and Young Child Feeding Cambodia, China, Papua New Guinea and Viet Nam reviewed implementation of their national codes on marketing of breast-milk substitutes with WHO consultants. Also, in Viet Nam, breastfeeding was promoted through mass media and monitoring was done of the implementation of the national code in that country. China, the Lao People's Democratic Republic, Papua New Guinea and the Philippines all conducted training programmes and developed proposals for funding of programmes to promote breastfeeding using a communication for behavioural impact approach for promoting behavioural change. Training-of-trainers workshops were conducted in Fiji for Pacific countries and in the Philippines to support the introduction of the new WHO Child Growth Standards for the assessment of nutritional status, growth and development. Micronutrient deficiencies A session on the prevention of anaemia with weekly iron and folic acid supplements in women of reproductive age was conducted at the Micronutrient Forum, in Beijing, China in May 2009. A paper on this approach for the prevention of anaemia was presented at the 19th International Congress of Nutrition, in Bangkok, Thailand in October 2009 and meetings were held with partner agencies to scale up these programmes. A guide on weekly iron and folic acid supplementation best practices was produced by a consultant and reviewed by experts and a communication strategy was developed for scaling up weekly iron and folic acid supplementation. Technical and financial support was given for weekly iron and folic acid supplementation and deworming for women of reproductive age in Yen Bai province, Viet Nam, in collaboration with the University of Sydney, Australia and the National Institute of Malariology, Parasitology and Entomology, Viet Nam. Meetings were held with food fortification partners in Sydney, Australia in November 2008 and December 2009, in Ho Chi Minh City, Viet Nam in February 2009, and in Manila, the Philippines in November 2009 to promote wheat flour and rice fortification in Asian and Pacific countries. Iodine deficiency disorders and related interventions were monitored in China and surveys were planned to assess iodine status and consumption of iodized salt in the Pacific. Management of malnutrition Training courses were supported for the management of malnutrition in the Lao People's Democratic Republic and for a second application to the Arab Gulf Program for United Nations Development Organizations for support with research on causes and processes followed for care-seeking and management of malnutrition.

STRATEGIC OBJECTIVE 9

Nutrition in the prevention and control of HIV/AIDS and tuberculosis Three papers were presented at a World Food Programme workshop on nutrition, food security and tuberculosis and HIV policy and programme implications in Bangkok in August 2009. Collaborative activities and joint approaches with HIV and tuberculosis programmes in the WHO Regional Office and WHO Headquarters were developed, including resource mobilization through the preparation of proposals for the ninth round of the Global Fund.

RER 09.005.WP01: Foodborne disease surveillance and food contamination monitoring programmes strengthened regionally and in targeted countries and areas.

Appraisal: Fully Achieved Comments on achievements

Foodborne disease surveillance and food contamination monitoring programmes were strengthened regionally and in targeted countries and areas through the following actions: • Asia FoodNet and its associated electronic network were established and members were sharing information on foooborne diseases and surveillance. • The capacity of Asia FoodNet was strengthened through training on the burden of food borne disease work and on global salmonella surveillance, with further training planned for early 2010 to strengthen food emergency response. • Training on food borne disease outbreak investigation was provided in Viet Nam. • Technical and other support was provided in response to melamine food contamination in several countries in 2008; Ebola Reston in pigs in the Philippines in 2008-2009; histamine contamination of canned tuna in the Pacific; cholera associated with dog meat in Viet Nam; and food poisoning associated with turtle meat in Papua New Guinea. Microbiological risk assessment capacity was strengthened through training in Fiji and Malaysia in 2009; subsequently Malaysia initiated microbiological risk assessments as part of its risk analysis process. • Technical support was provided to the monitOring of chloropropanols in soy sauce in Cambodia in 2008 and 2009. • Together with the Canadian International Development Agency, WHO supported a national survey in Viet Nam of agri-foods for contaminants and a report to be shared with the Global Environment Monitoring System - Food Contamination Monitoring and Assessment Programme.

•

RER 09.006.WP01: National capacity built to enable food control systems to be based on risk-analysis prinCiples, implement effective food safety education and to operate food safety emergency response systems with links to International systems.

Appraisal: Fully Achieved Comments on achievements

Ten countries initiated action to strengthen their food control systems with regard to legislation and enforcement based on risk analysis principles .. with technical support by WHO in the Western Pacific Region: • Fiji's Government passed new food standards in line with Codex guidance. • The Federated States of Micronesia and Solomon Islands began drafting food standards. • China reviewed and was revising its food safety legislation. • Viet Nam was reviewing its legislation. • Food law was being'drafted in Samoa. • Food law was approved in the Marshall Islands and Kiribati. • Papua New Guinea was reviewing its standards to assess their degree of compliance with Codex. • Risk-based food inspection capacity was strengthened in Malaysia and Kiribati. A second meeting of the Pacific Food Safety and Quality Legislation Expert Group was held to facilitate discussion and strengthen capacity in stanOards development in Pacific island countries. A training workshop was held for Pacific island countries to develop capacities in risk-based imported food inspection and export certification.

;

, •

STRATEGIC OBJECTIVE 9

Fiji was initiating action to strengthen its food control system by providing training on and setting up a food emergency response system. "Five Keys to Safer Food", "Five Keys to a Healthy Diet" and "Five Keys to Appropriate Physical Activity" are strategies primarily providing simple messages on how to prepare food safely, what to consume to stay healthy, and how to keep moving to stay in good shape. The three strategies were introduced to many consumers during 2008-2009 through their integration into the Olympic Games in China and the South-east Asian Games in the Lao People's Democratic Republic. The five keys to safer food were also introduced to schools in Liaoning and Shanxi, China; were included as an integral component of primary education in Papua New Guinea; and formed part of food handler education in Hong Kong (China).

STRATEGIC OBJECTIVE 10

STRATEGIC OBJECTIVE 10 To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE

Seventeen countries received support in quality improvement, eight in developing proposals for World Economic Forum Global Health Initiatives, 12 in policy and planning, five in law and regulation, and four each in aid effectiveness and coordination. Ten countries received technical support to improve health systems financing, financial risk protection, safety nets and national health accounts. Health financing situations were reviewed in 12 countries in the Region, which resulted in the development of the Health Financing Strategy for the Asia Pacific Region (2010-2015).23 Technical support was provided to improve health financing, social health protection and safety net arrangements. Technical support was also provided to develop health information system policies, strategic plans and e-health strategies in two countries; improve hospital information systems in two countries; and use information to assess health systems performance in two countries. Support was also given to improve health information systems for maternal and child health in two countries and to strengthen capacity in using the WHO International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) in three countries. Vital registration system assessment tools were introduced in one country. Human resources for health policies and strategic actions were developed in three countries, and workforce databases were updated in 12 countries. Furthermore, a WHO collaborating centre for nursing, a nursing network for disaster response, and an alliance on human resources for health were established. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 10.001.WP01: Improved management and organization of health service delivery, through both

public and non-public providers and networks, reflecting the principles of integrated primary health care with increased coverage, equity, and quality of health services leading to better health outcomes. Appraisal: Fully Achieved Comments on achievements Quality improvement training-of-trainers with start-up funds for activities was provided to teams from six Asian countries twice and to 12 Pacific countries once. A safe surgery initiative was launched in the Philippines. World Economic Forum Global Health Initiatives (GHI) proposals incorporating cross-cutting health systems strengthening were being implemented or were approved in seven countries and assistance for proposal development was provided in eight countries. A major workshop involving nine countries in the Western PacifiC Region and three countries in the South-East Asia Region was held to identify areas of synergy between GH I and health systems that were later included in proposals and implementation plans.

23 ISBN 978 92 9 0614586

STRATEGIC OBJECTIVE 10

Viet Nam developed a primary health care model integrating noncommunicab!e diseases that as pilot~d in one rural province and one urban district. Quality assurance work included regulation, work on a national action plan, and training of trainers. With WHO technical assistance, the Lao People's Democratic Republic successfully applied for health systems strengthening support from the GHI fund and developed an integrated maternal and child health and expanded programme on immunization strategy. WHO support was provided in one province for implementation. Tonga received support for training 16 staff in the primary health care area. The Philippines developed training modules in quality assurance and for promoting primary health care at local government level.

RER 10.002.WP01: Improved national capacities and practices for governing, steering, and regulating the health sector through (i) evidence-based policy dialogue, (ii) policy analysiS, (iii) greater transparency and accountability for performance, and (iv) more effective intersectoral collatloration. Appraisal: Fully Achieved Comments on achievements Proposal development support was provided to China, Cambodia, Fiji, the Lao People's Democratic RepubliC, Mongolia, Papua New Guinea, Solomon Islands and Viet Nam. Assessment of the private sector's role in health was completed in Papua New Guinea and was initiated in Malaysia. Support provided to law and regulation successfully resulted in law change in Nauru, Tonga and Viet Nam. Support was provided to at least 13 countries for health policy, health planning and health sector reviews, and a process to develop a regional strategy on health systems strengthening and primary health care was initiated. The regional strategy will be completed by September 2010. Viet Nam was supported on law and regulation, reform of public administration in the health sector, and administrative and financial management. The Lao People's Democratic Republic completed its seventh national health sector development plan and WHO provided inputs to the process. The WHO Representative Office in the Philippines supported attendance at a flagship course on health systems reform, developing a manual on local health systems, and using the local government unit scorecard. Fiji received support for a review of the Medical and Dental Act, and in Cambodia, technical cooperation assisted the development of the Health Strategic Plan for Cambodia (2008-2015). Work on leadership for health promotion was supported across WHO in the Western Pacific Region.

RER 10.002.WP02: National capacity for sustainable organizational structure, health policy and intersectoral collaboration improved to support public health threat and event management In line with the International Health Regulations (2005). Appraisal: Fully Achieved Comments on achievements Significant progress occurred within a number of Member States in the Region with regard to the strengthening of national capacity for sustainable structure, health policy and intersectoral collaboration. This is inherent in the Asia Pacific Strategy for Emerging Diseases (APSED) as well as with the International Health Regulations (IHR) 2005 approaches and strategies that were adopted and generally well implemented by Member States. APSED focuses on capacity development in five areas - surveillance and response, laboratory, risk communication, infection control, and zoonoses. With capacity development in these areas, Member States should meet IHR (2005) criteria by the 2012 deadline. Capacity development includes the development of structures and policies in country that will ensure good function and sustainability of programmes in these five areas. The Lao People's Democratic Republic and Mongolia have significantly strengthened their national capacities for sustainable operations. The comprehensive approach of the Lao People's Democratic Republic led to a major

STRATEGIC OBJECTIVE 10 improvements in the ove~1I strengthening of APSED activities, especially in the area of surveillance and re~pon~e; WHO. ~III continue to support capacity development in that country. In Mongolia, a strong field epidemiology training programme was developed and was being implemented. Extensive training will continue next year.

RER 10.002.WP03: National capacity for governance and leadership in integration of health promotion in health systems development is strengthened through capacity-building for appropriate infrastructure and sustainable financing for outcome-oriented and equitable health promotion. Appraisal: Partially AChieved

Comments on achievements A training programme on improving health promotion effectiveness in health systems development was developed using experiences from the regional health promotion leadership development programme and other projects that applied reflective practice and quality improvement in strengthening health promotion. The materials contain tools on quality improvement and inputs on strategic communication. The training targeted project teams working on Global Fund prOjects. The training was developed and will be pilot-tested in the Lao People's Democratic Republic and the Philippines. Some activities planned for lhe last quarter of 2009 had to be postponed due to the extensive floods in the Philippines.

RER 10.003.WP01: Improved coordination of the various mechanisms (including donor assistance) that support Member States in their efforts to achieve national targets for health system development and global health goals. Appraisal: Fully Achieved

Comments on achievements A four-country case study on WHO compliance with the principles of the 2005 Paris Declaration on Aid Effectiveness was completed and recommendations were under advisement. Formal technical support was provided for sector-wide approaches in Cambodia, Papua New Guinea, Samoa and Solomon Islands. Support for donor coordination was provided in almost all countries where WHO had a country office. The WHO Viet Nam country office strengthened the health partnership group and supported the joint annual health review process. The WHO Cambodia office facilitated a technical working group on health and an international health partnership process. In the Lao People's Democratic Republic, sectoral working groups and task forces were sUpported as part of sector-wide coordination.

RER 10.004.WP01: Contribute to strengthened country health information systems that provide and use high quality and timely information for health planning and for monitoring of country and major international goals. Appraisal: Fully Achieved

Comments on achievements A regional health information and evidence for policy framework for action was developed and will provide overall guidance for the next six years. Data quality and validation improvement, data analysiS and presentation improvement, and improving data sharing and dissemination will be the focus areas in the 2010-2011 biennium. Key actions in 2008-2009: • Countries supported to develop or improve strategic plans on health information systems development: Technical and financial support was provided to a number of countries including Cambodia, China, the Lao People's Democratic Republic, MongOlia, Papua New Guinea, the Philippines, and Solomon Islands. • Strengthened use of health information in health sector reviews and other decision-making processes: Support was given to Cambodia and China on using health indicators and health information to improve health systems management.

STRATEGIC OBJECTIVE 10

•

Improved data collection: Special attention was given to improving vital statistic~ in the Region and to this end a joint regional vital statistics improvement strategy was developed with the United Nations Economic and Social Commission for Asia and the Pacific and other partners.

RER 10.005.WP01: Contribute to better knowledge and evidence for health decision-making, by consolidation and publication of existing evidence, facilitation of knowledge generation in priority areas and leadership in health research policy and coordination, Including ensuring ethical conduct. Appraisal: Fully Achieved Comments on achievements Financial and technical support was provided to countries to use information and communication technologies to strengthen their health information systems and work towards compliance with international norms and standards. In cooperation with other development partners, new tools such as vital statistics assessment tools and health system assessment framework were introduced to different countries. Technical support was provided to countries to use new information and communication technology models to improve the smooth functioning of national health information systems. With the appointment of a technical officer in August 2009, work accelerated on the Asia Pacific observatory on health systems and poliCies. An in-principle agreement on governance arrangements was reached with the World Bank and the Asian Development Bank, and the first wave of observatory publications were well advanced. Country reports from the Philippines and Malaysia were expected in the first quarter of 2010, and the first draft of a policy brief on human resources for health was received.

RER 10.D06.WP01: Strengthened national health research for health systems development, within the context of regional and international research and engagement of civil society. Appraisal: Fully Achieved Comments on achievements Technical support was provided for health policy research and on ethical aspects of health research to various countries in the Region, including China, Cambodia, the Lao People's Democratic Republic, Malaysia, Mongolia, the Philippines and Viet Nam. In cooperation with international partners, such as the Evidence-Informed Policy Network, Asia and the Alliance for Health Policy and System Research, health systems and policies research teams were established in these countries and training was provided on issues such as systematic reviews and preparation of policy briefs. Follow-up support included international-standard peer review and tailored technical guidance to research teams on how to refine and strengthen their research methods. I nternational workshops for country staff were also provided on establishing an ethical review process for health research. Within the Regional Office, 17 ethic reviews were organized and conducted for WHO-funded research proposals and routine coordination work with WHO collaboration centres was undertaken.

RER 10.D07.WP01: Improved use of e-health applications (such as electronic medical records and distance learning) and networking - including the network of WHO collaborating centres - to strengthen health systems. Appraisal: Fully Achieved Comments on achievements .

The Pacific Open Learning Health Net (POLHN) continued to provide online and hybrid courses. course materials and health information to health professionals in the Pacific island countries. Its purpose is to use elearning to improve the quality and standards of practice of health professionals. One of the strengths of POLHN is its ability to increase access to continuing health education and online health resources in an affordable and relevant manner. Students who work and study simultaneously are provided with an opportunity to immediately apply their learning to the workplace.

STRATEGIC OBJECnVE 10

RER 1?007.W~02: ~mplementation of knowledge management strategy, including improved access to health mformatlon via portals, such as the Global Health Library, Regional Index Medicus, and HINARI. Appraisal: Partially Achieved Comments on achievements Technical and financial support was provided to Mongolia to develop a national e-health strategic plan. The WHO global e-health survey was conducted in most countries in the Region. Budget and staffing limitations prevented some proposed general activities being undertaken, including some on knowledge management.

RER 10.008.WP01: Support provided to strengthen health workforce information, knowledge base and the capacity of countries and areas for policy development and planning, and the enhancement of research, networking and information-sharing. Appraisal: Fully Achieved Comments on achievements National capacity in evidence-based health workforce policy and strategy development was strengthened through: • revision and upgrading of the country health workforce profiles and indicators at the regional level, to be consistent with the global workforce indicators and to improve the knowledge base for policy and strategy development; • testing a workforce information management system in several countries to determine the system's ability to capture minimum wOrkforce data for purposes of planning, monitoring and evaluation of workforce trends; • development of a tool with a user guide to support workforce planning and projection; • support of workforce situation analysis and update of databases. including policy dialogue and strategy development in several countries including China, the Lao People's Democratic Republic, Papua New Guinea and some Pacific island countries; and • collation and sharing country experiences in building and sustaining national workforces during a review of the regional strategy implementation. Sharing of information and experiences among countries in the Region and with other WHO regions was facilitated by: • collaboration with institutions, professional associations and experts to undertake review of workforce initiatives, standards and regulations in nursing and medical education and migrant workers; • strengthening the wOrk of the Asia Pacific Emergency and Disaster Nursing Network to respond to urgent and emerging needs of countries that experienced natural disasters and outbreak of diseases; • updating the human resources for health page on the WHO regional website to facilitate widespread access to key information and global resources; and • contributing to the development of global health workforce indicators.

RER 10.009.WP01: Technical support provided to countries and areas to improve the production, distribution, skill mix, retention and the management of their health workforces. Appraisal: Fully Achieved Comments on achievements National leadership capacity was enhanced, and tools for workforce planning developed, in response to changing health contexts. Sl,Jpport was provided to Cambodia, China, Fiji, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, Samoa and Viet Nam through meetings focused on policy development and strategic planning to address emerging pandemics, chronic diseases, ageing populations, migration, and strategies to attract committed health workers to the under-served areas. Planning tools were developed in the Philippines and Viet Nam. Technical inputs were provided in the development of a draft WHO Global Code of Practice for the International Recruitment of Health Personnel and a guide was developed for nursing development and career pathways linked to service needs. Leadership training was conducted in China, Mongolia, Papua New Guinea and Viet Nam.

STRATEGIC OBJECTIVE 10

Increased production of health workers and improved quality and standards of education, skills and competencies were assisted through support to increase the production and the skills and competencies of health workers including continuing professional development through the fellowships programme and open/online learning. This benefited more than a thousand health workers. Core competencies were developed in various aspects of nursing including community health and primary health care, chronic care, infection control and psychosocial care for use in countries in the Region. WHO in the Western Pacific Region contributed to a review of midwifery curricula and supported the development of online health courses to be delivered via the Pacific Open Learning Health Network. During 2008-2009, WHO in the Western Pacific Region worked towards strengthened collaboration among partners for a cohesive approach to building and sustaining national health workforces, and to placing human resources for health at the top of national health agendas, particularly in the Pacific. Consultations among Member States, partners, professional groups institutions and other stakeholders led to the establishment of a Pacific Alliance for Human Resources for Health. The alliance aims to advocate for political commitment and support of partners for strengthening national health workforces in the Pacific, forge collaboration among national stakeholders, and improve the quality of workforce data and information sharing. WHO supported the work of regional medical and nurSing associations, such as the Association for Medical Education in the Western Pacific Region and the South Pacific Chief Nursing and Midwifery Officers Association, in improving the quality and standards of education and training. A new WHO Collaborating Centre for Nursing, Midwifery and Health Development was designated. Support was provided to sustain and maintain these entities and build their capacity.

RER 10.010.WP01: Technical support provided to improve health system financing in terms of the availability of funds, social and financial risk protection, equity, access to services and efficiency of resource use. Appraisal: Fully Achieved Comments on achievements Health financing was a policy focus in all target countries. During 2008-2009, China, Cambodia, the Lao People's Democratic Republic, Mongolia, the Philippines and Viet Nam all explicitly committed to universal coverage. The Health Financing Strategy for the Asia Pacific Region (2010-2015)24 was developed to intenSify and expand. WHO evidence-based health system financing policy and technical support to all countries. Technical support was provided to improve health system financing and further reduce out-Of-pocket payments by strengthening social and financial risk protection. The 2007 national health accounts report showed that outof-pocket payments as a percentage of total health expenditure reduced in China from 54% to 49%, in Mongolia from 37% to 28% and in Viet Nam from 67% to 62%.

RER 10.011.WP01: Norms, standards and measurement tools are used for tracking resources and estimating economic consequences of illness, cost and effects of interventions, financial catastrophe and impoverishment, and social exclusion. Appraisal: Fully Achieved Comments on achievements The WHO national health accounts tool was adopted in all target countries. A revised draft of the system of health accounts was prepared with country inputs, for further use by countries within and outside the Organization for Economic Development to track and report health financing and expenditure data. Data related to national accounts policy were produced and discussed by using the WHO simulation tool for social health insurance. Support was provided in the use of WHO method for the organizational assessment for improving and strengthening health financing. Studies on the depth and breadth of social health protection and the health impacts of the global financial crisis were undertaken in 12 countries in the Region. The main findings of these studies were presented to high-level meetinQs. 24 WPRlRC60.R3

STRATEGIC OBJECTIVE 10

RER 10.012.WP01: Health financing data, information and evidence are used for developing, implementing and monitoring health financing policies and strategies. Appraisal: Fully Achieved

Comments on achievements WHO in the Western Pacific Region supported the development of national health accounts in Fiji, the Federated States of Micronesia, Malaysia, Mongolia, Vanuatu and Viet Nam. These countries produced their first national health accounts reports with technical support from WHO. The national health accounts development work continues with funding support from the Asian Development Bank and the World Bank to further institutionalize the system as a regular government activity in four of the six countries. Technical support was provided to Cambodia, China, the Lao People's Democratic Republic, Mongolia, the Philippines and Viet Nam to discuss and use health financing data and information for developing national health financing policies and strategies.

STRATEGIC OBJECTIVE 11

STRATEGIC OBJECTIVE 11 To ensure improved access, quality and use of medical products and technologies SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE Pharmaceuticals

Technical support was provided to Member States that needed to improve access to good-quality essential medicines, through the development and implementation of national medicines policies, selection of essential medicines, and improvements to the medicines supply system. Consistent advocacy through various means on improving access to essential medicines resulted in stronger political commitment of national. governments, as reflected in the development and implementation of policies for universal access. China and Malaysia are good examples. The commitment to and realization of universal access in China will have a substantial impact on the global situation in the coming years. Member States were also provided technical support to monitor medicines prices and availability. Eighteen countries in the Region participated in the regional medicines price information exchange. Member States were also provided with support to improve the transparency, good governance and efficiency in their medicines regulation and quality assurance system, and to strengthen collaboration between national regulatory authorities and law enforcement agencies. Technical support for the development, implementation and monitoring of standard treatment guidelines was provided to Member States wishing to improve their rational use of medicines. A review was conducted of the implementatibn of the Regional Strategy for Improving Access to Essential Medicines in the Western Pacific (2005-2010)25. A Regional Framework for Action on Access to Essential Medicines (2010-2015) and a regional medicines price information exchange system were developed. Technical support was provided to a number of Member States for the following: development, implementation and monitoring of national medicines policies and access; monitoring of medicines price; medicines regulation; quality assurance and combating counterfeit medicines; improving medicines supply systems; and promoting rational use of medicines. Health Technology

The Asia Pacific Strategy for Strengthening Health Laboratory Services (2010-2015) was successful~ developed and was endorsed by the sixtieth session of the Regional Committee Meeting in 2009. Through the regional external quality assessment scheme, support was provided on laboratory parameters to 24 national laboratories in the Western Pacific and South-East Asia Regions. Three workshops on the management of national blood programmes were conducted by the Centre for Transfusion, Health Sciences Authority, Singapore, a WHO collaborating centre. Traditional Medicine

Four Member States received support for the development, monitoring and implementation of comprehensive national policy and regulations to ensure improved access, quality and use of traditional medicines. Two publications, WHO Standard Acupuncture Point Locations in the Western Pacific 27 Region and Medicinal Plants in Papua New Guinea,28 were published. Support and technical advice on the development, monitoring and implementation of comprehensive national policy and regulations to ensure improved access, quality and use of traditional medicines was provided to four countries at the request of their governments.

25 WPRlRC55.R4 26 WPRlRC60.R6 27

ISBN 978 92 9 061383 I

28 ISBN 978 92 9 061249 0

STRATEGIC OBJECTIVE 11

ASSESSMENT OF REGIONAL EXPECTED RESULTS

RE~. 11.001.WP01: Support provided to countries and areas to develop, monitor or revise a comprehensive policies on access, quality and use of essential medical products and technologies. Appraisal: Fully Achieved Comments on achievements Pharmaceuticals Fourteen Pacific island Member States were supported to improve medicines policies and access to essential medicines through a WHO and European Community partnership project. Eleven Member States were supported to develop, revise or assess their national medicines policies (Cook Islands, the Federated States of Micronesia, Fiji, Malaysia, the Marshall Islands, the Philippines, Samoa, Solomon Islands, Tonga and Vanuatu). Twenty-two Member States were supported to improve different aspects of medicines supply systems (Brunei Darussalam, Cambodia, China, Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the Lao People's Democratic Republic, Malaysia, the Marshall Islands, Mongolia, Nauru, Niue, Palau, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam). Fourteen Member States attended a training workshop on improving medicines supply system in a decentralized enVironment in Yogyakarta, Indonesia in October 2008, and 12 Member States participated in a training course on improving medicines supply in Pacific Island countries in Melbourne, Australia in July 2009. Four Member States were supported to review their medicines expenditure and financing (Cook Islands, the Marshall Islands, Nauru and Tuvalu). The implementation of the Regional Strategy for Improving Access to Essential Medicines in the Western Pacific (2005-2010)29 was assessed in Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, and the Philippines. The strategy was reviewed and a draft document on a regional framework for action was devised and reviewed through an expert consultation in November 2009. A regional medicines price information exchange system was initiated and 18 countries partiCipated. Health Technology The Asia Pacific Strategy for Strengthening Health Laboratory Services (2010-2015) was successfully 30 developed and was endorsed by the sixtieth session of the Regional Committee Meeting in 2009. In Cambodia, support was given to the development and finalization of a national policy for medical laboratory services and policy and regulation for national blood transfusion services. Support was provided to Fiji for the development and finalization of national blood service legislation and policies, and to Viet Nam for the drafting of national technical guidelines for the national blood programme. Support was provided to Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines and Viet Nam for their partiCipation the second and third joint Singapore-WHO Workshops on Management of National Blood Programmes, held in July 2008 and July 2009 in Singapore. Traditional Medicine Two more Member States (Cambodia and the Lao People's Democratic Republic) developed traditional medicine policies, and the Philippines and Mongolia assessed implementation of their policies on traditional medicine.

RER 11.002.WP01: Support provided to countries and areas to implement internationally accepted norms, standards and guidelines for the quality, safety, efficacy and cost-effectiveness, and to strengthen the national regulatory system and quality assurance of medical products and technologies. Appraisal: Fully Achieved Comments on achievements Pharmaceuticals Collaboration with the International Criminal Police Organization, World Customs Organization and national counterparts (medicines reQulators, national police and customs) to combat counterfeit drugs in MekorlR 29 WPRlRC55.R4 30 WPRlRC60.R6

STRATEGIC OBJECTIVE 11

countries resulted in the successful completion of Operation Storm 1 and 2. Mechanisms of international and national collaboration among health and medicines authorities and law enforcement agencies were established in the Mekong countries. Efforts to improve good governance and transparency in medicines regulation and procurement continued in Cambodia, the Lao People's Democratic Republic, Malaysia, Mongolia, the Philippines and Papua New Guinea. Efforts to improve pharmacovigilance and patients safety were undertaken through an international courses and country technical support. Thirteen Member States were supported to participate in an introductory course on pharmacovigilance in Manila in 2008. Regulators, manufacturers and experts from eight Member States participated in the WHO Biregional Workshop on Production, Control and Regulation of Anti-venoms in Indonesia in May 2008. An innovative approach to improving pharmacovigilance and patient safety, involving consumers in medicines surveillance, was implemented and expanded in Malaysia and the Philippines. Nine Member States were supported to participate in the Thirteen International Conference of Drug Regulatory Authorities in Switzerland in September 2008. Twenty-one Member States benefited from activities on strengthening national regulatory system, quality assurance and legislative/regulatory framework, namely: Brunei Darussalam, Cambodia, China, Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the Republic of Korea, the Lao People's Democratic Republic, Malaysia, Mongolia, Niue, Papua New Guinea, the Philippines, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam. Health Technology Support was given to Fiji to develop standard operating procedures and guidelines for the national blood programme. Staff of the Centre for Standardization and Quality Control in Laboratories, Viet Nam were supported to attend a training course on laboratory quality systems and external quality control systems in Bangkok, Thailand; and a blood programme training course in Shanghai, China. A training-of-trainers workshop on monitoring and evaluating the quality of blood transfusion services was conducted in China. Through a regional external quality assessment scheme, support was provided to 19 national laboratories in the Western Pacific Region (American Samoa, Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the Marshall Islands, Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu, Viet Nam and Wallis and Futuna) for the external quality assessment scheme for laboratory parameters. Traditional Medicine The WHO publication, Standard Acupuncture Point Locations in the Western Pacific Region,31 was completed. Australia, Japan, Hong Kong (China), the Republic of Korea and Viet Nam participated and contributed to the drafting of an international classification for traditional medicine in East Asia.

RER 11.003.WP01: Support provided to countries and areas to promote evidence-based, scientifically sound and cost-effective use of medical products and technologies and traditional medicine by health workers, practitioners and consumers. Appraisal: Fully Achieved Comments on achievements Pharmaceuticals A training course on the use of treatment guidelines was developed and then conducted in Cook Islands, Fiji, Kiribati, Nauru, Solomon Islands, Tonga and Tuvalu in an effort to promote the rational use of pharmaceuticals. A technical working group on medicines selection and use in Pacific island countries was formed. The first meeting was held in July 2009. The group initiated the development of a common approach of treatment guidelines for diabetes and childhood illnesses, and reviewed the essential medicines lists for Pacific island countries. Focused interventions to improve rational use of medicines by health care providers and consumers were introduced and implemented in Cambodia, China and Mongolia. Pharmacoeconomics and evidence-based medicines selection were introduced in member countries of the Association of South-east Asian Nations, throuoh an intercountry trainino course in Brunei Darrussalam in December 2008 and throuoh a national trainino

31 ISBN 978929061383 I

STRATEGIC OBJECTIVE 11

workshop in China in september 2009. Twenty-two Member States were supported through activities on evidence-based selection and rational use of medicines, namely: Brunei Darussalam, Cambodia, China, Cook Islands, the Federated States of Micronesia, Fiji, Kiribati, the Lao People's Democratic Republic, Malaysia, the Marshall Islands, Mongolia, Nauru, Niue, Palau, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu and Viet Nam. Health Technology Support was given to Cambodia for the implementation of a strategic plan for national blood transfusion services (2007-2011) and to the Philippines for the construction of a new national blood centre. The Lao People's Democratic Republic was supported to attend the meeting of a regional congress of the International Society Of Blood Transfusion in Nagoya, Japan in November 2009. Three workshops on the management of national blood programmes were conducted by the Centre for Transfusion, Health Sciences Authority, Singapore, a WHO collaborating centre. For World Blood Donor Day, three Member States were supported in 2008 (Fiji, Kiribati, and the Lao People's Democratic Republic) and eight in 2009 (Cambodia, China, the Federated States of Micronesia, Fiji, Kiribati, the Lao people's Democratic Republic, Malaysia, Mongolia, the Philippines, Samoa and Viet Nam).

Traditional Medicine A publication detailing 126 common medicinal plants of Papua New Guinea was completed;32 similar publications were under development in Mongolia and the Lao People's Democratic Republic.

32 ISBN 978 92 9 061249 0

STRATEGIC OBJECTIVE 12

STRATEGIC OBJECTIVE 12 To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE Leadership and management capacities of governing bodies in the Region continued to be strengthened. A reform agenda was launched to undertake various measures, ultimately designed to strengthen the capacity of WHO in the Western Pacific Region to meet Member States' needs at country level. The Regional Director's Development Programme fund was utilized almost entirely in support of various innovations, including biregional publications with the WHO South-East Asia Regional Office, and crisis/disaster responses. During the 2008-2009 biennium, five Country Cooperation Strategy processes were finalized and 17 partnerships were formed with intergovernmental organizations and other stakeholders. Aid effectiveness was enhanced through further alignment and harmonization due to health sector-wide coordination mechanisms. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 12.001.WP.01: Effective leadership and direction of WHO in the Region through enhancement of governance, coherence, accountability and synergy of the work of WHO. Appraisal: Fully Achieved Comments on achievements All resolutions proposed were adopted by the sixtieth session of the Regional Committee in Hong Kong (China). The Regional Director's Development Programme fund was utilized to aid the development of innovative programmes in the Region as well as biregional publications with the WHO South-East Asia Regional Office; and to provide immediate financial support to a series of crisis and disaster relief operations.

RER 12.002.WP.01: WHO country presence is effectively led at the country level, harmonized with other development partners and guided by WHO Country Cooperation Strategies that support the national health agendas of Member States in the context of the 11th General Programme of Work. Appraisal: Fully Achieved Comments on achievements Nine countries and areas in the Region that had a WHO presence had an existing Country Cooperation Strategy or initiated or launched one during the biennium. Successful discussions on harmonization and alignment were held during a workshop of WHO Representatives in the Western Pacific Region. WHO country office staff continued to provide support to Ministries of Health and other key counterparts and stakeholders ensuring strong partnership and leadership on health.

STRATEGIC OBJECTIVE 12

RER 12.003.WP01: Global and regional health development architecture effectively providing more sustained and predicable technical and financial resources for health based on a common health agenda which responds to the health needs and priorities of Member States in the Region. Appraisal: Fully Achieved Comments on achievements WHO collaboration was further strengthened with other United Nations agencies. intergovernmental bodies. nongovernmental organizations and other partners in a number of priority health areas. including emerging diseases. HIV/AIDS. dengue control. health system development. maternal and child health. reproductive health. tuberculosis. pharmaceuticals. noncommunicable disease and mental health. Good progress was made in resource mobilization in the Region. especially by country offices. through active engagement with donor partners. The total amount mobilized reached US$ 70 million through more than 90 agreements and letter of exchanges. Viet Nam adopted a cluster approach to emergency response and WHO became the leading agency of the health cluster.

RER 12.004.WP01: Essential multilingual health knowledge and advocacy material made accessible to Member States, regional health partners and other stakeholders in the Region thorough effective exchange and sharing of knowledge. Appraisal: Fully Achieved Comments on achievements The emergence of the pandemic influenza A (H1 N1) 2009 and numerous natural disasters that affected several Member States in the Region resulted in high demand for information from WHO in the Western Pacific Region Co-ordination of technical responses and effective communication with the media and the public during these public health emergencies were crucial and were successfully achieved. Nearly 50 press releases were issued on various public health matters. These received extensive media coverage and were featured in major newspapers and publications. and on television and radio stations. When the pandemic A (H1 N1) 2009 outbreak started in late April 2009. updates were issued on a daily basis. When disasters struck in some Member States in 2009 (e.g. floods in the Philippines and Viet Nam and an earthquake and tsunami in Samoa). timely information was delivered on the relief and rehabilitation work. The public were kept informed on the efforts of WHO staff to reach out to the affected Member States through financial and other forms of support. Messages stressed the importance of helping the victims to deal with physical and emotional losses'; repairing damage to public health infrastructures; and assisting health and relief workers in coping with the trauma and stress brought about by these calamities. All these events greatly increased the volume of visitors to the WHO Regional Office website and raised WHO's profile as the leading public health authority within the Region. Media and risk communications training was conducted for both WHO staff and officials in the health and associated ministries in Member States.

STRATEGIC OBJECTIVE 13

STRATEGIC OBJECTIVE 13 To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively. SUMMARY OF THE REGIONAL CONTRIBUTION TO ATTAINMENT OF THE STRATEGIC OBJECTIVE Training was conducted for relevant WHO staff at the regional and country office level in programme management related to the results-based approach and the functionality of the Global Management System. Management and donors were updated on the status of financial implementation and financial practices and controls were maintained throughout the biennium, despite the complexity of the new Global Management System environment. Until the Global Management System is fully stable and glitches are fixed, there will be continuous cross-referencing of data in the personnel administration system, especially in generating reports. All regional linkS to the WHO global private telecommunications network operated within the agreed service level, providing access to global and regional applications and information sources, including the regional data centre and country office IT sources. A new generation of equipment took the place of the ageing offset printers and WHO staff were trained on the new digital technology. The Regional Office instituted an Internet-driven text broadcasting system for emergency situations. ASSESSMENT OF REGIONAL EXPECTED RESULTS RER 13.001.WP01: Work towards achievement of WHO strategic objectives in the Region is supported by effective programme planning and development, reflecting country needs, and including strategic and operational planning through a results-based approach, performance monitoring and evaluation. Appraisal: Fully Achieved Comments on achievements Work plans were developed, monitored and reported on by all budget centres for the mid-term, i8-month and end-of biennium assessments. Training was conducted for relevant WHO staff in programme management related to a results-based approach and the functionality of the Global Management System.

RER 13.001.WP02: Support for roll-out, implementation and further development of the Global Management System (GSM) for implementation, monitoring and evaluation of WHO's collaborative programmes in the Region through the Programme Budget. Appraisal: Partially Achieved Comments on achievements Roll-out of the Global Management System progressed with considerable work undertaken to fix the glitches and to make changes. The system continued to be improved. In particular, the procurement system was revised and simplified. Other improvements were made in some areas of between-screen navigation, and the need for further work was identified.

STRATEGIC OBJECTIVE 13

RER13.002.wP01: Sound financial practices and efficient management of financial resources is facilitated in the Region through timely and accurate guidance and the provision of relevant management reports. Appraisal: Fully Achieved Comments on achievements Daily guidance was provided to managers of WHO budget centres in the Western Pacific Region on how to operate the Global Management System. Training on how to take reliable and usable management reports was ongoing. Financial rules and regulation in accordance with International Public Sector Accounting Standards were disseminated to all managers of WHO-WPR budget centres for application in day-to-day operations. Management and donors were regularly updated of the status of financial implementation. Financial practices and controls were successfully maintained throughout the biennium despite the complexity of the Global Management System environment.

RER 13.003.WP01: Human resources poliCies and practices in place to attract and retain top talent, promote learning and professional development, manage performance and foster ethical behaviour. Appraisal: Fully Achieved Comments on achievements Guided by the WHO global human resource policies and practices, WHO in the Western Pacific Region adapted to the Global Management System. With the implementation of the Global Management System and the opening of the Global Service Centre, the Regional Office adjusted to changes in the human resource processes and continued to cope within acceptable tolerances. Until the Global Management System is stable and glitches are fixed, a continuous cross-referencing of data in the Personnel Administration System will be continued, especially in generating reports.

RER 13.004.WP01: Country-level ongoing support and development of secure and cost-effective solutions that meet the changing needs of the Organization. Appraisal: Fully Achieved Comments on achievements All regional links to the WHO global private telecommunication network operated within the agreed service level, providing access to global and regional applications and information sources, including the regional data centre and country office IT systems. Information and communication technology support for WHO country offices was strengthened during the biennium with the implementation of a meeting tool and a remote desktop support tool.

RER 13.004.WP02: Development of secure and cost-effective solutions that meets the changing needs of the Organization. Ongoing support to regional, country, and global information systems and their users, information products and their effective use is supported within a Knowledge Management System (KMS). Appraisal: Fully Achieved Comments on achievements The regional Internet and Intranet sites were continuously improved and updated.

STRATEGIC OBJECTIVE 13

RER13.00S.WP01: Provision of management and administrative support at both regional and country level through Service Level Agreements (SLAs).

Appraisal: Partially Achieved Comments on achievements

Although administrative support was provided in a timely manner at WHO country offices, many other priorities and complexities dependant of the Global Management System will need to be stabilized and normalized in order to systematically establish Service Level Agreements.

RER 13.006.WP01: A safe environment in the Regional Office and Country offices for all staff.

Appraisal: Fully Achieved Comments on achievements

WHO provided the highest standards of service possible to all staff at the regional and country office levels within the financial constraints experienced by the Organization in 2008-2009. Compliance requirements of the United Nations minimum operational security standards and minimum residential security standards were becoming more stringent because of the global security situation. Input was provided to pertinent documentation for submission to the Executive Board and the World Health Assembly, seeking sustainable financial support for this purpose.

WPRlRC6113 page 1 ANNEX 2

IMPROVED WAYS OF WORKING STRUCTURE, PROCESSES AND STRATEGIC FRAMEWORKS

1. INTRODUCTION

In recent years, Member States in the Western Pacific Region have experienced considerably

higher demand for prompt and effective responses to national and regional public health risks and

•

emergencies. In addition they have been faced with the challenge of continuing their planned health and health-related improvement efforts, including towards attainment of the Millennium Development Goals, within the context of dramatic changes to global and national economies and the entry of a number of new well-funded and well-focused partners into the international health arena. In supporting the countries and areas of the Region, WHO shared these experiences and also faced

internal challenges as the Organization-wide Medium-term Strategic Plan (2008-2013)1 and its associated strategic objectives and expected results were planned and implemented, supported by a new Global Management System. In 2008, the Western Pacific Region became the first Region to introduce the Global Management System and significant extra effort was required at regional and country office levels to identify and help resolve early system design, roll-out and operational problems. In 2009, it became apparent that WHO needed to strengthen its organizational structure and explore

•

best ways of working in the Region to meet the external and internal changing conditions. In addition, a number of the performance indicators used by the Secretariat were no longer relevant or did not adequately represent its efforts towards the expected results. Changes were clearly needed to improve the efficiency and effectiveness of WHO operations. At the sixtieth session of the Regional Committee for the Western Pacific in Hong Kong (China) in September 2009, the Regional Director outlined his vision for WHO in the Region and shared his intentions for the direction of the Secretariat. One of the key reform areas that the Regional Director identified for the Secretariat was to find improved ways of working to attain the Organization's mission.

Document WPRlRC58/4

WPRlRC6113 page 2 Annex 2

2. NEW WAYS OF WORKING

The health sector is recognized as being very large, complex and multifaceted with high levels of specialization. WHO has a further level of complexity in that it has a commitment to provide tailored support, both individually to countries as well as collectively to, and on behalf of, Member States across the Region, taking a leadership role in public health. Health organizations worldwide are generally structured around their specialist component areas that are often focused on specific health conditions or interventions. These component areas can very quickly become rigid compartments or silos, discouraging cooperative internal organizational approaches to shared health problems and hampering good working interfaces with external partners. In endorsing the Medium-term Strategic Plan (2008-2013) in May 2007, the World Health Assembly acImowledged that the Plan was intended to cut across the different programme units within the Organization by planning and budgeting according to the cross-cutting strategic objectives, capturing the mUltiple links between determinants of health, health outcomes, health policies, systems and technologies. The strategic objectives also intended for clear, measurable and budgeted expected results to be set for the Organization across the globe. As the end of the first of the three bienniums covered by the Medium-term Strategic Plan drew near in 2009, it was eVident that implementing the strategic objective approach in the Region had promoted some improved collaboration and coordination, but that the quality of performance management and measurement in the WHO technical and country units could be further improved. More importantly, the top-down implementation of the Medium-term Strategic Plan had limited sound articulation of country and regional contexts and priorities in the regional planning processes and their ultimate adequate reflection in the global planning documents. A confounding factor had been the introduction of the Global Management System in 2008, but it was clear'that WHO required some new ways of wbrking in the Region to frrmly re-establish a participatory bottom-up planning process. •

•

3. STRUCTURE AND WORK PROCESSES

In late 2009 and early 2010, the Regional Director undertook a systematic and detailed reView of

WHO workplans at the country level and technical programmes at the regional level. These reviews confirmed the need to rationalize and streamline the work of WHO and to effect structural changes to better manage WHO's response to specific priorities. As a result, work in the Regional Office was

WPRlRC6113 page 3 Annex 2 reorganized to cluster by groups of strategic objectives around priority public health challenges. The overall number of technical units was reduced to 17, aligned to operate more consistently with the WHO system of planning, budgeting, implementing and monitoring. Details of the new groupings of the technical units within the Regional Office are shown below in Figure 1.

Figure 1: WHO Western Pacific Regional Office - Grouping of Technical Units .

Division: Building Healthy Communities and Pop~lation

• •

• • • • •

Environmental health Maternal and child health and Nutrition Mental health and Injury prevention Noncommunicablediseases and Health promotion Tobacco Free Initiative

Division: Combating Communicable Diseases

• • • •

Expanded Programme on Immunization HIV/AIDS and STI Malaria, other vectorborne and parasitic diseases Stop TB and Leprosy elimination

Division: Health Sector Development

• • • • •

Essential medicines and health technologies Health care financing Health information, evidence and research Human resources for health Health services development

Division: Health Security and Emergencies

• • •

Communicable disease surveillance and response Emergency and humanitarian action Food safety

Two other divisions, Programme Management and Administration and Finance, continue to hold enabling and supporting functions.

WPRlRC6113 page 4 Annex 2 The individual WHO technlcal work areas were examined to identify best practices and to develop and introduce new ways of working as required. As a start, to promote improved cooperation and harmonization of work across the technlcal units, a number of new teclmical working groups were established to address topics such as antimicrobial resistance, laboratories and the Millennium Development Goals. The Regional Director's country and regional reviews confirmed that the focus on planning the implementation of the Medium-term Strategic Plan did not fully take into accourit country-driven planning processes. It was plain that this planning imbalance required correction and that a framework was needed to robustly plan and link the country and regional work of WHO to more effectively drive actions within the strategic directions set by the Medium-term Strategic Plan. The framework would need to better facilitate the aligmnent of WHO country work with Member State's individual health goals, and to improve the oversight, monitoring and management of WHO teclmical work across the Region in line with Member States' collective goals. •

4. STRATEGIC FRAMEWORKS

All individual Member States have identified national health goals. For most of them, a WHO Country Cooperation Strategy has been developed that reflects the national goals. WHO's in-country work must be clearly driven by and focussed on national health goals. To ensure this proper focus and a bottom-up approach, while remaining true to the WHO Medium-term Strategic Plan and strategic objectives, a number of changes to planning work practices are being introduced and a simple planning framework template has been developed.. The template-the Country Strategic Framework-is designed to articulate four levels and how they are linked: • the short-term tangible services, tasks and inputs provided by the WHO Secretariat to support a country within a single biennium; • • the short- and medium-term outputs and results expected of the WHO secretariat; the relevatlt objectives and outcomes to which the WHO Secretariat, Member State(s) and partners contribute; and •

WPRlRC6113 page 5 Annex 2 • the fundamentallonger-tenn health goals and impacts that the individual Member State desires and often has in common with others regionally and globally. The Country Strategic Framework, using its bottom-up planning process through the four levels, will be used to help guide fonnulation of sound perfonnance indicators and to monitor progress internally. It will infonn and be integrated with the various levels of the WHO Medium-tenn Strategic Plan and strategic objectives. As a consequence, the results of the different and varied planning processes

at country level, such as the Country Cooperation Strategies and the United Nations Development Assistance Frameworks, will be clarified and better aligned to describe the efforts required of both the Secretariat and Member States to achieve the broader health goals . Technical work at the regionalleve1 must be clearly driven by the regional priorities endorsed by the Regional Committee and reflect and support the individual Member States' national goals and needs. The technical work must to be organized and presented in a logical, consistent and coherent manner and planned within the underlying core corporate determinants of WHO actions~the

WHO global agenda,

General Programme of Work,2 and Medium-tenn Strategic Plan. To achieve this, changes are being introduced to the planning processes for technical work, and technical units in the Regional Office are currently using a simple planning framework template similar to the country offices, a Technical Strategic Framework. An outline of the current framework template is shown in Figure 2. The successful creation of synergistic Country Strategic Frameworks and Technical Strategic Frameworks will more firmly base strategic and operational planning processes on individual countries' priorities and the agreed collective regional technical agenda, and also will improve measurement, monitoring and accountability for clearer results from the Secretariat within the framework of the Medium-term Strategic Plan. Completion of the Country Strategic Frameworks and Technical Strategic Frameworks in the Region is expected before the end of 2010. The results of this improved way of working will be reflected in the Proposed Programme Budget 2012-2013 to be presented to the sixty-second session of the WHO Regional Committee for the Western Pacific in 2011.

Document WHA A59125

WPRlRC61/3

page 6 Annex 2 Figure 2: Outline of the template for preparing Country Strategic Frameworks and Technical Strategic Frameworks

Health Goals and Impacts desired at country and/or regional levels.

These are health-related results desired by Member States individually (in a Country Strategic Framework) or collectively (in a Technical Strategic Framework). They are normally achievable over a longer term (10 years or more) and require the effort of Member States, the WHO Secretariat and external partners. They are drawn from national health or related strategic plans, Country Cooperation Strategies, resolutions of the Regional Committee and/or World Health Assembly, Millennium Development Goals, etc. This level can be related to and linked with the strategic objectives in the WHO Medium-term Strategic Plan. .

.... Objectives and Outcomes

INFORMING UP AND DOWN

T T

•

These describe the desired situations, conditions or behaviours that result from the efforts of the WHO Secretariat, Member State(s} and partners. The time-frame is usually medium term (three to nine years) and stretching over more than one WHO biennium. They are normally described in terms of health conditions, health interventions or health systems.

INFORMING UP AND DOWN WHO Outputs and Results

These describe the actions and/or results that individual WHO country offices and regional technical units will deliver, to contribute to the Objectives and Outcomes. They can be referenced to the WHO Core Functions as defined in the Eleventh General Programme of Work. Medium-term (three to nine years) outputs and results can be related to the regional expected results in the WHO Medium-term Strategic Plan and linked with the Organizationwide expected results. Short-term outputs and results can be related to the office-specific expected results in WHO biennial programme budgets and the Global Management System. .

•

INFORMING UP AND DOWN .

WHO Tasks and Inputs

These are the shorter-term tangible WHO services and inputs provided by country offices and regional units within a single biennium to support the Member States' individual and collective long-term Health Goals and Impacts.

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Technical Documents

Date d'adoption 31 décembre 2010

Source Organisation mondiale de la santé