WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RÉGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Sixty-seventh session Manila, Philippines 10–14 October 2016 Provisional agenda item 8
WPR/RC67/3 31 August 2016 ORIGINAL: ENGLISH
PROGRAMME BUDGET 2014–2015: BUDGET PERFORMANCE (FINAL REPORT)
This document presents the final report on the utilization of the Programme Budget for the 2014–2015 biennium by source of funding, category, budget centre and category of expenditure. The utilization of assessed contributions amounted to US$ 74.2 million or 99.9% of available assessed contributions (US$ 74.3 million) from 1 January 2014 to 31 December 2015 (Table 3a). In addition, activities that utilized voluntary contributions amounted to US$ 185.0 million (Tables 3a and 3b), representing 96.2% of the available resources. Total utilization was US$ 259.2 million or 97.2% of the total available resources and 86.2% of the final working allocation of US$ 300.7 million. Utilization of funds by category and by budget centre is shown in Tables 4a and 4b, respectively. The utilization by category of expenditure is shown in Table 5. Information on progress made by the Western Pacific Region towards achievement of the outputs for which the Secretariat is accountable, as defined in the Programme Budget, is provided in the Annex. The information is based on an end-of-biennium assessment from 1 January 2014 to 31 December 2015. The Regional Committee for the Western Pacific is requested to review and note the final report on budget performance.
WPR/RC67/3 page 2 1. FINANCIAL UTILIZATION OF PROGRAMME BUDGET 2014–2015 This document presents the final report on utilization of the Programme Budget by the Western Pacific Region for the 2014–2015 biennium by source of funding, category, budget centre and category of expenditure. 1.1 Level of programme budget The global Programme Budget 2014–2015 was approved at the Sixty-sixth World Health Assembly in May 2013. The proposed Programme Budget 2014–2015 allocation for the Region was presented to the sixty-fourth session of the WHO Regional Committee for the Western Pacific in October 2013. The Programme Budget 2014–2015 is a single budget figure covering both assessed contributions and voluntary contributions. The provision of a single budget figure provides a view of all resources from all sources. The approved Programme Budget 2014–2015 for the Region was US$ 270.0 million. During the biennium, additional ceiling increases by US$ 27.0 million were recorded under the emergencies component of the Programme Budget (US$ 6.6 million for polio eradication and US$ 20.4 million for outbreak and crisis response). In 2014, the Region also received a budget allocation of US$ 3.7 million for the Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits. The framework is an international arrangement endorsed by the World Health Assembly in May 2011 to improve global pandemic influenza preparedness and response. Thus, the final working allocation for the Region as at 31 December 2015 amounted to US$ 300.7 million (Table 1).
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WPR/RC67/3 page 3 Table 2 summarizes the gaps in financing for the 2014–2015 biennium. Total assessed contributions distributed for the 2014–2015 biennium to the Region amounted to US$ 74.3 million (US$ 76.3 million in 2012–2013). Total voluntary contributions mobilized during 2014–2015 amounted to US$ 192.3 million (US$ 211.7 million in 2012–2013). Total funds available from all sources for the 2014–2015 biennium amounted to US$ 266.6 million, which represents 88.7% of the final working allocation of US$ 300.7 million. Table 2 Gaps in financing for 2014–2015 by category – all funds (US$ millions) 3URJUDPPH %XGJHW $YDLODEOH UHVRXUFHV &DWHJRU\ )LQDO ZRUNLQJ DOORFDWLRQ D $YDLODEOH UHVRXUFHV *DS WR WR ILQDO ILQDO ZRUNLQJ 9& 7RWDO DOORFDWLRQ *DS ZRUNLQJ F G H I GD DOORFDWLRQ
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WPR/RC67/3 page 4 1.2 Funds Utilization The total utilization of assessed contributions amounted to US$ 74.2 million, or nearly all available assessed contributions of US$ 74.3 million. In addition, activities utilizing voluntary contributions during this period amounted to US$ 185.0 million or 96.2% of the available resources (US$ 192.3 million). Total utilization of funds amounted to US$ 259.2 million or 97.2% of the available resources and 86.2% of the final working allocation. The utilization by source and by level of funding is shown in Tables 3a and 3b. These figures are compared with those of the previous biennium. Table 3a Utilization of all funds (US$ millions)
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WPR/RC67/3 page 5 Tables 4a and 4b show the utilization of all funds (expenditures plus encumbrances) by category and budget centre, respectively. Table 4a Funds utilization by category (US$ millions)
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WPR/RC67/3 page 7 The utilization of total available resources by expenditure category is in Table 5; whereas, Table 5a shows the utilization of available resources by category of expenditure for country offices with utilization exceeding US$ 10 million. Table 5 Funds utilization by category of expenditure (US$ millions) )XQG 8WLOL]DWLRQ )XQG 8WLOL]DWLRQ
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Despite the global trend of increases in costs and inflation, the Secretariat managed to maintain an expenditure level similar to the previous biennium through close monitoring and cost-control measures. In line with past biennial expenditure patterns, the largest percentage of expenditures was attributed to staff cost (44.4%), followed by contractual services (22.0%), direct financial cooperation or DFC (13.0%) and travel (8.9%). The decrease in staff costs as compared to the previous biennium was mainly attributed to the change in accounting for the cost of direct seconded staff (US$ 5.8 million of included staff costs for 2012–2013). The cost of direct seconded staff is now recorded outside the Programme Budget, similar to expenses for reimbursable procurement. Staffing levels remained consistent with those of the previous biennium. Contractual service expenses have also remained consistent with the previous biennium. DFC spending was reduced by US$ 3.7 million. As part of the assurance activity process, the Region prioritized DFC management and controls, leading to enhanced collaboration with DFC counterparts and improved productivity. As at 31 December 2015, the Region has no overdue DFC reports. Travel costs increased by 5.0%, as compared with the previous biennium. The increase in travel cost can be attributed to the emergency response to Typhoon Haiyan in the Philippines and Cyclone Pam in the Pacific islands. Management continues to closely monitor travel and find ways to deliver activities at reduced costs.
WPR/RC67/3 page 8 Table 5a Funds utilization by category of expenditure for country offices with utilization exceeding US$ 10 million (US$ millions) /DR 3HRSOH V 'HPRFUDWLF 3DFLILF ,VODQG &DPERGLD 5HSXEOLF &RXQWULHV 3DSXD 1HZ *XLQHD
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For the seven country offices utilizing greater than US$ 10 million per office in 2014–2015, total utilization of 51% of the total regional utilization remained constant between bienniums. Staffing and related costs were reduced in line with the overall reduction in staffing. However, the increases in contractual services, medical supplies and literature and travel-related expenditure can be attributed to emergency activities in the Philippines and Pacific island countries. No significant change occurred in the general operating costs across bienniums, a testament to the Secretariat’s commitment to monitor and control operating costs. 1.3 Audit activities The WHO Regional Office for the Western Pacific and the country offices of WHO in China and Viet Nam underwent external audits during the biennium 2014–2015. And as at January 2016, all external audit recommendations were fully implemented and the audit reports were officially closed. Internal auditors performed audits of the Regional Office and the WHO country offices in Fiji, the Philippines and Solomon Islands during 2014–2015. All internal audit recommendations were fully implemented and officially closed. Two of the four internal audits undertaken in 2014–2015 received “satisfactory” ratings to signify that the controls that are in place to mitigate the key risks were satisfactory. The “partially satisfactory” ratings from the Fiji and Solomon Islands audits have prompted the installation of improved controls and processes. In addition, the internal audit report for the Regional Office identified good practices that may be beneficial for other regions, such as: clearance of overdue DFCs; the network of both Programme Management Officers and Programme and Administrative Officers; quality control for international travel; and the terms of reference for the newly created Compliance and Risk Management Officer, which includes coverage of both administration/finance and programme management.
WPR/RC67/3 page 9 The Secretariat continues to welcome auditors to the Region to assess the overall control environment and identify areas for improvement. For 2016, internal audits are scheduled for WHO country offices in Cambodia in June and Papua New Guinea during Q4. An external audit is scheduled for the Office of the WHO Representative in Fiji (Division of Pacific Technical Support) during Q4 2016. Results will be reported at the 2017 session of the WHO Regional Committee for the Western Pacific. The table below summarizes the audits in the Region during 2014–2015. ƵĚŝƚĞĚ ďLJ /ŶƚĞƌŶĂů ƵĚŝƚ /ŶƚĞƌŶĂů ƵĚŝƚ /ŶƚĞƌŶĂů ƵĚŝƚ /ŶƚĞƌŶĂů ƵĚŝƚ džƚĞƌŶĂů ƵĚŝƚ džƚĞƌŶĂů ƵĚŝƚ džƚĞƌŶĂů ƵĚŝƚ KĨĨŝĐĞ ^ŽůŽŵŽŶ /ƐůĂŶĚƐ &ŝũŝ ZĞŐŝŽŶĂů KĨĨŝĐĞ WŚŝůŝƉƉŝŶĞƐ sŝĞƚ EĂŵ ZĞŐŝŽŶĂů KĨĨŝĐĞ ŚŝŶĂ ^ƚĂƚƵƐ ůŽƐĞĚ ůŽƐĞĚ ůŽƐĞĚ ůŽƐĞĚ ůŽƐĞĚ ůŽƐĞĚ ůŽƐĞĚ
Average time taken by the Secretariat to close audit recommendations was less than five months, which reflects the commitment to assess and implement recommendations rapidly in the Western Pacific Region. 1.4 Compliance and controls In addition to audits, the Secretariat continues to improve controls through strengthened management, training, communication and monitoring of high-risk transaction areas in the Region, particularly donor reporting, DFC contracts, and goods and service procurement activities. The introduction of donor proposal and reporting templates, revision of the Programme Management User Handbook, introduction of automated reminder notifications for overdue and upcoming donor reports, and overall monitoring through the Programme Committee (PC) and Programme Management Officer (PMO) network have improved accountability to donors. The introduction of online validations during transaction processing and enhanced workflow approvals in the Global Management System (GSM), supported by periodic reports, have led to better monitoring and control.
WPR/RC67/3 page 10
As part of the assurance activity process, the Region prioritized DFC management and controls that have led to enhanced collaboration with DFC counterparts and improved productivity. Since September 2015, the Region is maintaining zero overdue DFCs. With the continuous efforts by the Secretariat, overdue donor reporting is close to zero. The status of all cash and bank accounts in the Region have an “A” rating, with no pending reconciliation items over 90 days old. Gender balance and geographical distribution of staff remain high priorities for the Western Pacific Region. Significant progress in the area of gender parity has been made through recruitment policy adjustments and increased awareness-building of staff. Female staff in Region constituted 36% as of 31 December 2015, an increase of 5% over the past three years. With current practices, the proportion rose to 42% as of the end June 2016. Geographical distribution of staff is another strong point in the Western Pacific Region with 42 countries represented in the 172 professional staff at the end of 2015. Also, the Western Pacific Region continues to be the only Region with a majority of international staff from outside the Region. Outreach activities for underrepresented countries of the Region are also being implemented. In order to strengthen the compliance and risk management areas, recruitment has been completed for the Compliance and Risk Management Officer position. This staff member reports directly to the Regional Director to help coordinate risk and compliance work across the Region. Risk registers are being used as management tools in all budget centres in the Region, and as part of the 2015 year-end closure process the Internal Control Framework self-assessment checklist was completed by all budget centre managers. The overall regional summary score for the self-assessment by budget centres reported for year-end 2015 was 3.7 out of maximum score of 4, which signifies a strong framework and awareness of internal controls. 1.5 Outputs and results The Annex contains the end-of-biennium assessment of implementation of the Programme Budget 2014–2015. The end-of-biennium assessment examines progress towards achievement of the outputs for which the Secretariat is accountable, as defined in the Programme Budget. Of 81 outputs for the biennium, 76 (or 94%) were fully achieved.
WPR/RC67/3 page 11
2. ACTIONS PROPOSED
The Regional Committee for the Western Pacific is requested to review and note the final report on budget performance.
WPR/RC67/3 page 12
WPR/RC67/3 page 13 ANNEX
PROGRAMME BUDGET 2014–2015
SUMMARY OF PROGRESS MADE TOWARDS ACHIEVEMENT OF OUTPUTS AND OUTCOMES BY CATEGORY AND PROGRAMME AREA
1 January 2014–31 December 2015
APRIL 2016
WPR/RC67/3 page 14
Annex
WPR/RC67/3 page 15 Annex COUNTRIES AND AREAS OF THE WESTERN PACIFIC REGION COUNTRY American Samoa Australia Brunei Darussalam Cambodia ACRONYM ASM AUS BRN KHM COUNTRY New Caledonia New Zealand Niue Northern Mariana Islands, Commonwealth of the Palau Papua New Guinea Philippines Pitcairn Islands Republic of Korea Samoa Singapore Solomon Islands Tokelau ACRONYM NEC NEZ NIU MNP
China Cook Islands Fiji French Polynesia Guam Hong Kong SAR (China) Japan Kiribati Lao People's Democratic Republic Macao SAR (China) Malaysia Marshall Islands Micronesia, Federated States of Mongolia Nauru
CHN COK FJI PYF GUM HOK JPN KIR LAO
PLW PNG PHL PCN KOR WSM SGP SLB TKL
MAC MYS MHL FSM MNG NRU
Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna
TON TUV VUT VNM WAF
WPR/RC67/3 page 16
Annex
List of abbreviations
ACTMalaria AMR APMEN APO APSED ARD ASEAN ASPIRE bOPV CCASIA CCNASWP CCS CLO CoIA CSU cVDPV DFC DRM DRM-H ECSAT EENC eLENA EOC EPI
Asian Collaborative Training for Malaria antimicrobial resistance Asia-Pacific Malaria Elimination Network Asia Pacific Observatory on Health Systems and Policies Asia Pacific Strategy for Emerging Diseases asbestos-related diseases Association of Southeast Asian Nations Asia-Pacific International Research and Education Network bivalent oral polio vaccine Codex Coordinating Committee for Asia Codex Coordinating Committee for North America and the South West Pacific country cooperation strategies Country Liaison Officer Commission on Information and Accountability for Women’s and Children’s Health Country Support Unit circulating vaccine-derived poliovirus direct financial cooperation disaster risk management disaster risk management for health Eye Care Systems Assessment Tool Early Essential Newborn Care electronic Library of Essential Nutrition Actions Emergency Operations Centres Expanded Programme on Immunization
WPR/RC67/3 page 17 Annex ERF ERAR EVD FAO FCTC FETP Gavi GBV GEM GER GISRS GLAAS Global Fund GMS GNNTD GOARN GPW GSC GSM GYTS HCV HeRAMS HINARI HIS HPV HR HRH Emergency Response Framework Emergency Response to Artemisinin Resistance Ebola virus disease Food and Agriculture Organization of the United Nations WHO Framework Convention on Tobacco Control Field Epidemiology Training Programme Gavi, the Vaccine Alliance gender-based violence Global Engagement Management gender, equity, and human rights WHO Global Influenza Surveillance and Response System Global Analysis and Assessment of Sanitation and Drinking Water Global Fund to Fight AIDS, Tuberculosis and Malaria Greater Mekong subregion Global Network for Neglected Tropical Diseases WHO Global Outbreak Alert and Response Network General Programme of Work Global Service Centre Global Management System Global Youth Tobacco Survey hepatitis C virus Health Resources Availability and Mapping System HINARI Access to Research in Health Programme health information systems human papillomavirus vaccines human resources human resources for health
WPR/RC67/3 page 18
Annex IB-VPD IEC IHR IMCI INFOSAN IPV IRIS JE LF MDA MDR-TB mhGAP M&E MOH NFP NHPSPs NTDs NRA OECD OPV PB PCV PDO PEN invasive bacterial vaccine-preventable diseases information, communications and education International Health Regulations Integrated Management of Childhood Illness International Food Safety Authorities Network inactivated polio vaccine Institutional Repository of Information Sharing Japanese encephalitis lymphatic filariasis mass drug administration multidrug-resistant tuberculosis mental health gap action programme monitoring and evaluation ministry of health national IHR focal points national health plans, strategies and policies neglected tropical diseases national regulatory authority Organisation for Economic Co-operation and Development oral polio vaccine programme budget pneumococcal vaccine Programme Development and Operations WHO Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings Pacific Islands Mental Health Network programmatic management of drug-resistant TB Performance Management and Development System
PIMHnet PMDT PMDS
WPR/RC67/3 page 19 Annex PMO RAN RCC R&D rGLC RMNCAH RPRG SDGs SDH SEAR SEARO SIA STH STI TADDS TAG TARSS TB tOPV TPPA TRIPS TRM UHC UNESCAP UNICEF VDPV WASH Programme Management Officer Regional Administration Network Regional Certification Commission research and development regional Green Light Committee reproductive, maternal, newborn, child and adolescent health Western Pacific Regional Programme Review Group on Neglected Tropical Diseases Sustainable Development Goals social determinants of health South-East Asia Region South-East Asia Regional Office supplementary immunization activity soil-transmitted helminth sexually transmitted infections Tool for the Assessment of Diabetes and Diabetic Retinopathy Management Systems Technical Advisory Group Tool for the Assessment of Vision Rehabilitation Services tuberculosis trivalent oral polio vaccine Trans-Pacific Partnership Agreement Agreement on Trade-Related Aspects of Intellectual Property Rights traditional medicine universal health coverage United Nations Economic and Social Commission for Asia and the Pacific United Nations Children’s Emergency Fund vaccine-derived poliovirus water, sanitation and hygiene
WPR/RC67/3 page 20
Annex WPRIM WPR WPRO WPV WR WSP Western Pacific Region Index Medicus Western Pacific Region Western Pacific Regional Office wild poliovirus WHO Representative water safety plans
WPR/RC67/3 page 21 Annex TABLE OF CONTENTS
CATEGORY 1 – COMMUNICABLE DISEASES CATEGORY 2 – NONCOMMUNICABLE DISEASES CATEGORY 3 – PROMOTING HEALTH THROUGH THE LIFE-COURSE CATEGORY 4 – HEALTH SYSTEMS CATEGORY 5 – PREPAREDNESS, SURVEILLANCE AND RESPONSE CATEGORY 6 – CORPORATE SERVICES/ENABLING FUNCTIONS
WPR/RC67/3 page 22
Annex
WPR/RC67/3 page 23 Annex
CATEGORY 1. COMMUNICABLE DISEASES
Reducing the burden of communicable diseases, including HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and vaccine-preventable diseases Summary of progress and achievements HIV, hepatitis, sexually transmitted infections Implementation of the work plan, notably the global HIV health sector strategy and WHO HIV guidelines, progressed well. With the support of the WHO Regional Office for the Western Pacific (WPRO), work at the national level focused on exploring the linkage of vertical programme structures to tuberculosis (TB) and maternal and child health, better strategic information systems, expansion of quality interventions for key populations, and sustaining investments through the integration of HIV into broader health systems strengthening efforts. WPRO also worked on the financing aspect of priority communicable diseases through universal health coverage (UHC).
Member States in the Region recognized the importance of viral hepatitis by endorsing the Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2020, a comprehensive action-oriented plan with targets addressing viral hepatitis across the Western Pacific Region. National hepatitis action plans were endorsed in AUS, JPN, MNG and VNM, while initial planning has started in FJI, KIR, MYS, PHL and KOR. AUS and MNG have ratified the proposed strategy for elimination of hepatitis C virus (HCV) by 2030; the latter was developed with WPRO support.
Major challenges were faced in the transition from external to national funding for HIV, as well as the lack of structures and resources for viral hepatitis response in many Member States. The decreasing resources for provision of WHO's technical assistance, coming at the wake of an evolving need for specialized technical expertise in areas such as HIV, hepatitis and sexually transmitted infection (STI) laboratory work, drug-resistance surveillance, molecular epidemiology and implementation research, also posed a major challenge. In response, WPRO adjusted its staffing profiles and increased crossdivisional collaboration to maximize use of available expertise. Also, the institutional network of WHO collaborating centres and technical partners was continuously expanded. However, resources to support and fund external technical assistance remained insufficient.
WPR/RC67/3 page 24 Annex Tuberculosis
To facilitate adaptation in the Western Pacific Region of the The End TB Strategy endorsed by the Sixty-seventh World Health Assembly in 2014, WPRO developed the Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016–2020. Member States endorsed the framework at the sixty-sixth session of the Regional Committee. WPRO also initiated work to facilitate implementation of The End TB Strategy Pillar 2 components (i.e. bold policies and supportive systems) particularly on TB drug regulation, TB care financing and antimicrobial resistance (AMR) as a collaborative effort across the Organization.
Under the regional Green Light Committee (rGLC), monitoring missions on programmatic management of drug-resistant TB (PMDT) were organized in all multidrug-resistant tuberculosis (MDR-TB) high-burden countries and other priority countries. WHO country offices supported the expansion of PMDT leading to a notable increase in detection and enrolment of MDR-TB cases. The adoption of a WHO-endorsed new molecular diagnostic test dramatically contributed to increased case finding, as in the case of PHL and VNM. However, the expansion was accompanied by reduction in the treatment success rate in some countries attributable to a decrease in quality of care. Technical assistance missions were therefore undertaken based on needs assessments and country requests.
Countries made progress in TB control and care among high-risk populations including systematic TB screening for priority risk groups. TB drug regulation was also strengthened. CHN developed an action plan to promote research and development of second-line anti-TB drugs by local pharmaceutical companies, thereby contributing to the global response to the MDR-TB crisis. In PHL and VNM, the introduction of new drugs was preceded by strengthened collaboration between the national TB programme and the national drug regulatory authorities, including the pharmacovigilance systems. Work addressing childhood TB was also accelerated in countries.
WPRO convened two national programme managers meetings for high-burden and Pacific island countries, one of which was jointly held with the TB Technical Advisory Group (TAG) to provide advice on upcoming activities. National TB surveillance systems were supported and strengthened and regional analyses were conducted and results published in the Western Pacific Surveillance and Response Journal.
WPR/RC67/3 page 25 Annex With rapid economic growth and changing expectations from the public, many countries in the Region faced major health financing reforms that significantly affected TB control programmes. In light of decreasing donor attention to infectious diseases, WPRO supported advocacy efforts within countries to ensure adequate financing for TB control. WPRO also contributed to a meeting on health insurance reform in order to advocate for TB financing and connect with the broader health-financing sector. Countries applying under the new funding model of the Global Fund to Fight AIDS,
Tuberculosis and Malaria (Global Fund) were provided with extensive support throughout the whole application process. Malaria All 10 malaria-endemic countries in the Region made important progress towards achieving the 2015 targets of the Regional Action Plan for Malaria Control and Elimination in the Western Pacific 2010– 2015 and considered malaria elimination a feasible goal, having incorporated elimination into their national malaria strategic plans. The leaders of countries meeting at the Ninth East Asia Summit endorsed a goal of an Asia Pacific region free of malaria by 2030. This significant progress was achieved with the support of WHO at all levels through organization and implementation of various capacity-strengthening activities on malaria elimination, diagnostic testing and vector management, including provision of technical support to countries in updating and strengthening implementation of their malaria strategic plans and other policies and guidelines on diagnostic testing, antimalarial treatment and vector control. WPRO provided technical assistance to seven countries in reviewing and updating their national malaria plans.
Of major importance regionally and globally were the regional consultations on the new Global Technical Strategy for Malaria 2016–2030, the technical brief for control and elimination of vivax malaria and Action and Investment to Defeat Malaria 2016–2030, which provided a comprehensive framework for countries to develop tailored programmes for accelerating malaria elimination.
The WHO Emergency Response to Artemisinin Resistance (ERAR) in the Greater Mekong Subregion (GMS) Regional Hub, based in KHM, had been fully functional since 2014. Biregional ERAR staff posted in GMS countries, as well as in WPRO, provided technical support to countries to contain the spread of drug-resistant malaria. The WHO South-East Asia Region (SEAR), the Western Pacific Region (WPR) and GMS supported ERAR activities through the organization of technical consultations and meetings to improve access to malaria services for migrant and mobile populations; the review of the status of artemisinin and multidrug resistance; the development of an advocacy strategy; strengthening surveillance, and monitoring and evaluation; and supporting operational
WPR/RC67/3 page 26 Annex research studies. A Strategy for Malaria Elimination in the Greater Mekong Subregion 2015–2030 was also developed and was adopted by Member States. Biregional training courses on malaria elimination were held in PHL (February 2014) and Thailand (August 2015). A biregional training course on strengthening malaria vector control for elimination was conducted jointly with Asia Pacific Malaria Elimination Network (APMEN) and Asian Collaborative Training for Malaria Asian Collaborative Training for Malaria (ACTMalaria) in PHL in July 2015.
Although remarkable progress had been achieved, there remained several challenges that the Region and countries needed to consider and address. Malaria drug resistance and more recently insecticide resistance were key technical concerns. Resistance to artemisinin and its partner drugs including delayed parasite clearance had been confirmed in KHM, LAO and VNM, posing a threat not only in the GMS but also in neighbouring countries. Sustained financial support remained a challenge in implementing global, regional and national strategies and plans. This would have implications for WHO's continuous provision of high-quality and sufficient technical support at the regional and country levels. At the same time, monitoring of the adaptation and implementation of recommended activities was also a challenge to national programmes. Neglected tropical diseases
Neglected tropical diseases (NTDs) are considered endemic in 28 countries in the Western Pacific Region. With strong technical assistance from WPRO, NTD programmes in many countries of the Region made good progress towards achievement of the regional and global targets set in the global NTD road map and the Regional Action Plan for Neglected Tropical Diseases 2012–2016. Interventions against NTDs were coordinated and delivered with significant success in 21 countries in 2014–2015 with WHO support.
For lymphatic filariasis (LF), KHM, COK, MHL, NIU, PLW and VUT submitted dossiers on their efforts to eliminate the disease as a public health problem. Except for MHL and PLW, which needed to further strengthen information in their dossiers for resubmission, the others were in the process of validation for official WHO acknowledgement of such status. Five additional countries were nearing achievement of elimination status, of which TON and VNM had started development of dossiers. Ten countries implemented mass drug administrations (MDAs) and/or stopped MDAs in part of the country after passing transmission assessment surveys. PNG-recommenced MDAs continued in 2014 and 2015 in two districts.
WPR/RC67/3 page 27 Annex For blinding trachoma, reports from KHM, CHN, LAO and VNM indicated that it was no longer a public health problem.
To accelerate elimination of schistosomiasis, KHM, LAO and PHL initiated the establishment of a multisectoral initiative to complement preventive chemotherapy interventions with water, sanitation and hygiene (WASH) and animal health interventions. Control of soil-transmitted helminth (STH) infection continued to scale up. PHL shifted from decentralized school deworming by each province to a nationwide centralized school deworming for all provinces on a single day twice a year, through strengthened coordination between its Department of Education and the Department of Health, resulting in improved treatment coverage. In 2014, KHM, LAO, TUV and VNM achieved 75% national coverage for school-age children, while KHM, LAO, PHL and TUV did so for preschoolaged children.
Yaws case detection (through surveillance) and treatment continued in VUT and the impact of MDAs against trachoma on yaws was investigated in SLB.
Capacity to detect and respond to dengue continued to be strengthened in most affected countries at both national and subnational levels, through strengthening of both surveillance and outbreak response, based on APSED and on the principles of integrated vector management.
Control of foodborne trematodes was supported in KHM, LAO and VNM, but lack of donation of quality-assured medicines and financial resources remained a major challenge.
The Western Pacific Regional Programme Review Group on Neglected Tropical Diseases (RPRG) was convened in 2014 and 2015 to provide guidance to countries. In response to the endorsement of the NTD Strategic and Technical Advisory Group of the general process for validation of the eradication and elimination of NTDs, the regional process to validate elimination of NTDs as a public health problem was established.
Cross-programme initiatives were established within the Organization to better support multisectoral collaboration in countries. WPRO continued to harness support from the RPRG, WHO collaborating centres and other partners for strengthening NTD prevention and control, including strengthening diagnostic capacity in countries. WPRO also organized the Regional Training Workshop on Integrated NTD Programme Management in 2015 to build capacity of national NTD programmes on efficient programme planning and management.
WPR/RC67/3 page 28 Annex
Although remarkable progress has been made at the regional and national levels, particularly with preventive chemotherapy interventions, lack of financial and human resources at the national level and in WHO remained a challenge. WPRO would therefore continue its advocacy efforts with potential partners. Capacity strengthening at national and subnational levels, as well as resource mobilization for surveillance, operational research and innovation, would be required to translate guidelines and national plans into practice at all programme levels. Assessment of existing burden and availability of health service for morbidity management and disability prevention has been neglected in a number of countries, and continuous advocacy and guidance to increase focus in morbidity management would be necessary. Vaccine-preventable diseases Implementation of the Expanded Programme on Immunization (EPI) work plan was successful during the 2014–2015 biennium, with work on diseases targeted for elimination and accelerated control progressing well in the Region. Although the Region experienced a resurgence of measles in 2013–2014, seven countries and areas (AUS, BRN, KHM, JPN, MAC, MNG and KOR) were verified as having interrupted endemic measles virus transmission for a period of at least 36 months. Measles outbreak response and catch-up or follow-up immunization campaigns were conducted in KHM, LAO, FSM, PNG, PHL, SLB, VUT and VNM. In this biennium, KHM and 16 of 17 regions in PHL were validated as eliminating maternal and neonatal tetanus. Only PNG and one region in PHL remained to be validated. Thirteen countries had been verified as having achieved the regional hepatitis B control goal, including one (SGP) in 2015.
Approaches to reduce inequities in immunization had been identified and were being addressed. All countries with 2013 WHO–United Nations Children's Emergency Fund (UNICEF) estimated vaccination coverage levels below 70% had undertaken actions to improve coverage. By 2014 (the most recent data available) all but PNG and VUT had coverage levels above 70%. Significant efforts to improve coverage had been directed to achieving coverage of more than 70% in 2015. A good example of a country effort was WSM, where reported administrative immunization coverage for 2015 had reached 95%, attributable in part to the training of nurses as vaccinators. With technical support from WPRO, use of an online immunization registry had been initiated at the national level that would facilitate tracking of children with missed opportunities for vaccination. In the case of LAO, selected approaches to identify high-risk populations for vaccine-preventable diseases (VPDs) had been implemented, resulting in close to 90% coverage.
WPR/RC67/3 page 29 Annex Technical support was provided to low- and middle-income countries in the Western Pacific Region in developing and analysing evidence to guide decisions on new vaccine introduction. These activities included the following: compilation of evidence on rotavirus, pneumococcal vaccine (PCV) and human papillomavirus (HPV) vaccines for VNM; a rotavirus vaccine effectiveness study in PHL; HPV vaccine demonstration projects in LAO, PHL and SLB; and PCV impact assessments in LAO, MNG and PNG. An HPV vaccination costing, post-introduction evaluation and coverage survey in LAO and an HPV cost-effectiveness study in VNM were supported. A PCV cost-effectiveness analysis was conducted for MNG. Continued technical support was provided for strengthening new vaccines surveillance for invasive bacterial vaccine-preventable diseases (IB-VPD) and rotavirus in low- and middle-income countries in the Region. In addition, several countries started to integrate their Japanese encephalitis (JE) surveillance into existing IB-VPD surveillance systems.
Outbreaks of vaccine-preventable diseases, particularly measles and the circulating vaccine-derived poliovirus in LAO required a concerted outbreak response, which delayed other planned activities aimed at strengthening routine immunization systems. Key risks and impediments included inadequate funding to support countries not eligible for funding from Gavi, the Vaccine Alliance, especially those with large populations (CHN and PHL). This could limit support in the areas of routine immunization strengthening and new vaccine introduction. Limited MOH human resources in various development areas could slow down implementation of the work plan. There was also an evolving need for diverse technical expertise in immunization due to technical progress in the supply chain, progress in laboratory testing and increasing country activities in the vaccine regulatory area. WPRO continued to assist Member States through its network of experts by strengthening the role of WHO collaborating centres. The Regional Alliance for National Regulatory Authorities may be a good source of experts from the Region in the future.
WPR/RC67/3 page 30 Annex
ASSESSMENT OF PROGRAMME OUTPUTS HIV/AIDS 1.1.1 Implementation and monitoring of the global health sector strategy on HIV/AIDS 2011– 2015 through policy dialogue and technical support at global, regional and national level Appraisal: Fully achieved
Comments on achievements WPRO support focused on the five high-burden countries (KHM, CHN, MYS, PNG and VNM) and three low-burden countries (LAO, MNG and PHL). All eight countries have developed and have been implementing costed national HIV/AIDS strategic plans in line with the global health sector strategy. Moreover most of the high-burden countries in Asia, as well as FJI, have moved from prevention and control to elimination of mother-to-child transmission of HIV and syphilis, and have linked those to hepatitis B control efforts. A biregional validation mechanism for elimination was established, which could help inform ongoing discussions on how broader elimination efforts for HIV, hepatitis and syphilis could be achieved in the context of global HIV, hepatitis and STI strategies. National AIDS programme review recommendations were followed up in KHM, LAO, MNG, PHL and VNM, focusing on exploring possible linkage of vertical programme structures to TB and maternal and child health, better strategic information systems, prioritizing expansion of quality interventions for key populations and sustaining investments made through integration of HIV into broader health systems strengthening efforts. WPRO continued to work on financing of priority communicable diseases through UHC.
All countries had implemented most of the recommendations of the WHO 2013 consolidated guidelines on use of antiretrovirals for treatment and prevention. In PHL, discussions on
implementing recommendations on the use of antiretroviral pre-exposure prophylaxis have started.
Support to strategic information systems, specifically in CHN and MNG, focused on estimations and projections for high-risk populations by establishing denominators through biregional consultation. HIV epidemiological support, including integrated behavioural surveillance analysis, was provided in LAO, MNG, PNG and PHL. WPRO also supported the improvement of treatment monitoring (treatment cascade from HIV testing, linkage to care, starting treatment and retention). Initial biregional and global meetings with a global 10-indicator framework and additional Region-specific indicators guided work in KHM, LAO, MNG, MYS, PNG, PHL and VNM. WPRO continued supporting the HIV case-based surveillance work in KHM and PHL.
WPR/RC67/3 page 31 Annex Following release in 2015 of WHO’s updated global HIV drug resistance strategy, promoting use of routine treatment programme monitoring metrics as early working indicators, five countries (KHM, CHN, PNG, PHLand VNM) have included such indicators in HIV treatment sites and had been regularly analysing and reporting these data.
While the Region had progressed in the treatment of HIV, challenges remained in relation to stigma and discrimination, and in ensuring access to both prevention and treatment services. Major
bottlenecks centred on quality of and access to HIV diagnosis and viral-load monitoring. The transition from external to national funding for HIV, the lack of structures and resources for viral hepatitis response in many Member States and the decreasing resources for WHO's technical assistance were of major concern.
1.1.2
Adaptation and implementation of the most up-to-date norms and standards in
preventing and treating paediatric and adult HIV infection, integrating HIV and other health programmes, and reducing inequities Appraisal: Fully achieved
Comments on achievements WHO had promoted the implementation of the new WHO global guidelines on the use of antiretrovirals for HIV treatment and prevention, HIV testing services, and HIV interventions for key populations. However, more people die from viral hepatitis than from HIV, tuberculosis and malaria combined in the Western Pacific Region. Countries with the highest burden and prevalence of viral hepatitis B and C are CHN, MNG, PHL and VNM.
In 2015, the first regional Member State consultation on viral hepatitis and the first Regional Strategic Technical Advisory Committee Meeting were held. Recognizing viral hepatitis as an epidemic requiring urgent attention, Member States in the Region endorsed the Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2020. National hepatitis action plans were endorsed in AUS, JPN, MNG and VNM, while initial planning had started in FJI, KIR, MYS, PHL and KOR. National hepatitis consultations were held in CHN, FJI, KIR, MNG, PHL and VNM. To support development of national action plans, disease burden analysis for chronic hepatitis B and C was initiated in CHN, KIR, MNG, PHL, KIR and VNM. Formal baseline assessments of the viral hepatitis situation and response were conducted in KIR and MNG. A WPRO-supported strategy for the elimination of HCV by 2030 was ratified by AUS and MNG.
WPR/RC67/3 page 32 Annex Equitable access to affordable drugs and diagnostics remained a major impediment for people living with hepatitis B and C. Negotiations to reduce prices of drugs against hepatitis C in MNG have been successful. Other challenges related to the fragmentation of hepatitis response and the lack of national resources beyond hepatitis B immunization. Tuberculosis 1.2.1 Intensified implementation of the Stop TB Strategy to scale up care and control, with focus on reaching vulnerable populations, strengthening surveillance, and interventions and alignment with health sector plans facilitated Appraisal: Fully achieved
Comments on achievements To facilitate adoption and adaptation of the global End TB Strategy in the Western Pacific Region, WPRO developed the Regional Framework for Action on Implementation of the End TB Strategy in the Western Pacific 2016–2020, which was endorsed by Member States at the sixty-sixth session of the Regional Committee in October 2015. WPRO convened two national programme managers meetings for high-burden (CHN, KHM, LAO, MNG, PHL, PNG and VNM) and Pacific island countries, one of which was combined with a meeting of the TB TAG, which provided advice on upcoming activities. National TB surveillance systems were supported and strengthened using the WHO standards and benchmarks tool, regional analyses were conducted, and results were published in the Western Pacific Surveillance and Response Journal.
Many countries faced challenges in sustaining TB control financing in light of decreasing donor attention to infectious diseases. In addition, with rapid economic growth and changing expectations from the public, many countries in the Region were facing major health financing reforms under which TB control programmes were significantly affected. Therefore, countries applying to the Global Fund new funding model were provided with extensive support, which included national TB programme reviews, epidemiological assessments, country dialogues, updates of national strategic plans for TB control, new funding model concept note development and other activities required in the application process (FJI, KHM, LAO, MNG, PNG, PHL, PIC, SLB and VNM). In addition, WHO supported advocacy efforts within countries to ensure adequate financing for TB control. WPRO also contributed to a meeting on health insurance reform in order to advocate for TB financing and connect with the broader health-financing sector.
WPR/RC67/3 page 33 Annex Declining donor funding both for WHO and country programmes remained a major risk for the full implementation of WHO’s programmes as well as country-level adoption of WHO’s strategies. The funding shortfall for a Regional Office staff post had been addressed by diversifying funding sources and multitasking of staff members in different programme areas (e.g. between TB and leprosy). Funding shortfalls in some country offices were being addressed through gradual task shifting from international professional staff to national professional officers. 1.2.2 Updated policy guidance and technical guidelines on HIV-related tuberculosis, delivery of care for patients with MDR-TB, tuberculosis diagnostic approaches, tuberculosis screening in risk groups and integrated community-based management of tuberculosis. Appraisal: Fully achieved
Comments on achievements The recently endorsed End TB Strategy calls for a broader approach to TB control involving other sectors and players. Countries were supported in implementing updated global guidance in the key areas of TB/HIV, drug-resistant TB, TB diagnosis, high-risk group screening, and TB care and control in the community. Three meetings were organized to address the issues of drug regulation, childhood TB and advocacy workshops on TB control financing. Implementation of the Pillar 2 components (i.e. bold policies and supportive systems) particularly on TB drug regulation, TB care financing and AMR had been initiated as a collaborative effort across the Organization. Under the rGLC, PMDT monitoring missions were organized in all MDR-TB high-burden countries and other priority countries. Technical assistance missions were conducted based on need assessment and request of the country.
In response to the challenges of TB in children, WPR organized a meeting with representatives from TB and child health sectors from KHM, CHN, LAO, MNG, PNG, PHL and VNM and became the first WHO region to establish a Regional Taskforce for Child TB, with representation from the child health sector and the national tuberculosis programmes (NTPs) to oversee development and implementation of national action plans with a focus on strengthening involvement of a broader community and improving case-finding, management and prevention of TB in children.
WHO country offices supported the expansion of PMDT leading to a notable increase in detection and enrolment of MDR-TB cases, particularly in PHL and VNM. The expansion was accelerated partly through the rapid adoption of a WHO-endorsed new molecular diagnostic test. Countries made progress in TB control and care among high-risk populations including systematic TB screening for
WPR/RC67/3 page 34 Annex priority risk groups, namely TB contacts, people living with HIV, prisoners, migrants, workers exposed to silica in mines, diabetes patients, older people, and people living in slums and endemic geographical pockets.
The strengthening of TB drug regulation in countries was also supported. In CHN, the Country action plan on quality assured anti-TB drugs in China was developed. In PHL and VNM, collaboration between the NTP and the national drug regulatory authorities had been strengthened, including pharmacovigilance systems.
The challenge of decreasing funds was addressed through effective utilization of country-level donor funds, and better coordination among technical and implementation partners.
Malaria 1.3.1 Countries enabled to implement malaria strategic plans, with focus on improved diagnostic testing and treatment, therapeutic efficacy monitoring and surveillance through capacity-strengthening Appraisal: Fully achieved
Comments on achievements WPRO supported countries towards achievement of targets set in their national plans and in the Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010–2015) through provision of technical assistance, strengthening of national capacity, surveillance and programme reviews, facilitation of stakeholder dialogues and promotion of partnerships, resource mobilization and research.
As all malaria-endemic countries in the Region have included malaria elimination goals in their national strategic plans and with the development of a Strategy for Malaria Elimination in the Greater Mekong Subregion 2015–2030, capacity-building for elimination including strengthening surveillance has become a key issue. Biregional training courses on malaria elimination were held in PHL (February 2014) and Thailand (August 2015): the former attended by senior malaria staff from seven WPR countries (CHN, MYS, PHL, KOR, SLB, VUT and VNM) and from four SEAR countries; and the latter attended by GMS countries from both regions (KHM, CHN, LAO, VNM from the WPR, and Myanmar and Thailand from the SEAR). Two biregional training courses on integrated vector management were held in MYS (October 2014 and November 2015) attended by participants from KHM, LAO, MYS, PHL, SLB, VUT and VNM. A biregional training course on strengthening
WPR/RC67/3 page 35 Annex malaria vector control for elimination was conducted jointly with APMEN and ACTMalaria in PHL in July 2015, with participants from eight WPR countries (KHM, CHN, LAO, MYS, PNG, PHL, SLB and VNM).
Technical assistance was provided in strengthening malaria diagnostic capacities in countries. Since 2012, WPRO had conducted external quality assessments of 14 malaria laboratories in eight countries of the Region: KHM, CHN, LAO, MYS, PHL, SLB, VUT and VNM. WPRO continued to support maintenance of a regional malaria slide bank at the Research Institute for Tropical Medicine (RITM), a WHO Collaborating Centre for Malaria Diagnosis.
WPR supported countries’ surveillance, monitoring and evaluation activities through programme reviews and malaria data management including data compilation and verification for the World Malaria Reports for 2014 and 2015. Drug efficacy and insecticide resistance monitoring activities were also implemented, with support from regional networks such as the Pacific Malaria Drug Resistance Monitoring Network, the GMS Drug Efficacy Monitoring Network and ACTMalaria.
Despite progress, malaria control continued to encounter challenges, one of the biggest of which was the emergence of multidrug resistance in the GMS. Other challenges included health system issues such as inadequately trained human resources, weak surveillance systems and decreasing fund availability, the latter posing a threat to the sustainability of high-quality WHO staff, specifically national professional officers, to support national programmes. Although a number of donors,
partners, networks and other stakeholders were providing various forms of technical support to malaria programmes in countries, the presence of multiple players presented a concomitant need to address significant coordination issues. 1.3.2 Updated policy recommendations, strategic and technical guidelines on vector control, diagnostic testing, antimalarial treatment, integrated management of febrile illness, surveillance, epidemic detection and responses Appraisal: Fully achieved
Comments on achievements WPRO continued to contribute towards implementation of global strategies by successfully organizing regional consultations and meetings with relevant stakeholders and by providing in-country technical assistance. Notable among these were the regional consultations on the new Global Technical Strategy for Malaria 2016–2030, the technical brief for control and elimination of
WPR/RC67/3 page 36 Annex vivax malaria, and the Action and Investment to Defeat Malaria 2016–2030, which produced three documents that provided a comprehensive framework for countries to develop tailored programmes for accelerating malaria elimination. The first informal consultation to develop the Western Pacific Regional Framework for Malaria 2016–2020 was held in December 2015, which reviewed progress of the current regional strategy (2011–2015), defined regional priorities and identified key interventions to accelerate malaria elimination in WPR.
WHO regional and country staff provided technical support to countries in updating their malaria strategic plans (KHM, LAO, PNG, PHL, SLB, VUT and VNM) and in reviewing and enhancing their policies and guidelines on diagnostic testing, antimalarial treatment, and vector control.
Sustaining financial support remained a challenge for implementing global, regional and national strategies and plans. At the same time, monitoring of the adaptation and implementation of recommended activities also posed a challenge given the limited human resource capacity in the Region. Neglected tropical diseases 1.4.1 Implementation and monitoring of the WHO road map for NTDs 2020 facilitated Appraisal: Fully achieved
Comments on achievements WPRO strongly contributed towards achievement of targets set in the global NTD road map and the Regional Action Plan for Neglected Tropical Diseases in the Western Pacific 2012–2016 through backstopping technical support for countries and direct country technical assistance in preventive chemotherapy planning, implementation and monitoring; case management at the community and facility levels; integrated vector management where relevant; monitoring progress; developing and processing dossiers for validation of elimination; capacity-building at the regional, national and subnational levels; promoting integrated programme management; advocating and facilitating intersectoral collaboration; facilitating supply forecasting and access to donations; stakeholder coordination and resource mobilization; priority-setting; and implementation and translation of operational research.
The 14th and 15th meetings of the Western Pacific Regional Programme Review Group on Neglected Tropical Diseases (RPRG) were held in 2014 and 2015, respectively, which provided guidance to countries, and facilitated the establishment of the regional process of validating the elimination of
WPR/RC67/3 page 37 Annex NTDs. WPRO also organized the Regional Training Workshop on Integrated NTD Programme Management in January 2015 to build capacity of national NTD programmes on efficient programme planning and management, including management of severe adverse events during MDA campaigns. As a result, 15 countries (KHM, FJI, PYF, KIR, LAO, MYS, MHL, FSM, PHL, PNG, SLB, TUV, VNM, VUT and WSM) completed and submitted a joint application package requesting donation of quality-assured medicines for NTDs.
Dengue control was supported in affected countries at both national and subnational levels through strengthening of surveillance and outbreak response capacities, including vector control. Several dengue outbreaks affecting countries were successfully controlled. A dengue burden estimation project was initiated in KHM.
Advocacy for NTDs continued in strong partnership with RPRG and the Global Network for Neglected Tropical Diseases (GNNTD). Resources were mobilized from JPN, KOR, GNNTD and WHO headquarters (USAID, GSK).
A key challenge in countries was the lack of sustained human and financial resources at the national level and in WHO. Given the multitude of diseases covered (14 diseases with significantly different epidemiology and endemicity in 28 countries of the Region), it was critically required to have at least one NTD professional staff in WPRO, one NTD focal point for the Pacific, and NTD focal points in countries with multiple disease burdens, such as LAO, PNG PHL and VUT. 1.4.2: Implementation and monitoring of NTDs facilitated by evidence-based technical
guidelines and technical support Appraisal: Fully achieved
Comments on achievements With multiple NTDs endemic in most of the 37 countries and areas of the Region, WPRO continued to support countries in such aspects as adapting technical guidance for NTD diagnosis, treatment, case management, transmission control, monitoring, evaluation and surveillance.
WPRO supported 15 countries (KHM, KIR, FJI, PYF, LAO, MHL, MYS, FSM, PHL, PNG, WSM, SLB, TUV, VNM and VUT) in their completion and submission of a joint application package to request from WHO the donation of quality assured medicines against NTDs. Technical assistance was provided to KHM, LAO, PHL and VNM in developing/updating their integrated NTD plans of
WPR/RC67/3 page 38 Annex action, and to KHM, LAO and VNM in revising and/or finalizing their NTD implementation and monitoring and evaluation (M&E) policy and strategy. WPRO supported PHL in developing a national strategic plan for schistosomiasis elimination, and in revising its case management and treatment guideline for paragonimiasis. MVP also supported KHM, LAO and PHL in establishing a multisectoral initiative to complement preventive chemotherapy intervention with WASH, animal health and nutrition interventions to accelerate elimination of schistosomiasis. Technical assistance was provided to BRN, LAO, MYS and PHL for expert review of their LF programmes. KHM, COK, MHL, and VNM were supported in the development of dossiers for elimination of LF as a public health problem, and a national training on prevention and management of severe adverse events during MDA campaigns was organized in PHL. Training on parasitological diagnosis of
schistosomiasis and STH was supported in KHM, and a sentinel-site monitoring of prevalence of STH and schistosomiasis using stool examination was supported in LAO.
WPRO organized the Regional Training Workshop on Integrated NTD Programme Management in January 2015 to build capacity of national NTD programmes on efficient programme planning and management, including prevention and management of severe adverse events. WPRO also organized the 14th and 15th RPRG meeting on NTD in the Western Pacific Region to review country progress and provide technical guidance to countries. WPRO also implemented the third and fourth regional external quality assessment of laboratories on helminths diagnosis in 2014 and 2015, respectively, where nine laboratories from six countries (KHM, CHN, LAO, MYS, PHL and VNM) participated.
WPRO also facilitated review and selection of proposals submitted by countries for the joint Special Programme for Research and Training in Tropical Diseases small-grant scheme. Eight proposals from KHM, CHN, MYS, MNG, PHL and VNM addressing implementation research issues on NTDs, dengue and leprosy were funded.
WPR/RC67/3 page 39 Annex 1.4.3 New knowledge, solutions and implementation strategies that respond to the health needs of disease-endemic countries developed through strengthened research and training Appraisal: Fully achieved
Comments on achievements In close coordination with the Special Programme for Research and Training in Tropical Diseases, WPRO coordinated and implemented the small-grants scheme on implementation research for infectious diseases of poverty that covered malaria, tuberculosis and neglected tropical diseases, including dengue and leprosy. WPRO communicated closely with principal investigators in order to improve their research proposals and to facilitate clearance and approval of national ethics review board, as well as the WPRO Ethics Review Committee. Sixty-nine proposals were received from nine countries in the Region and 19 research proposals were selected: four focusing on malaria, seven on tuberculosis and eight on NTDs. Vaccine-preventable diseases 1.5.1 Implementation and monitoring of the Global Vaccine Action Plan as part of the Decade of Vaccines collaboration, strengthened with emphasis on reaching the unvaccinated and undervaccinated populations Appraisal: Fully achieved
Comments on achievements High coverage levels of vaccination (96.5%) have been sustained in the Region. WPRO focused its technical assistance to priority countries (KHM, LAO, PNG and VNM) in order to improve equity in accessing immunization services and close immunity gaps in underserved populations. Major
components of this approach included capacity-building, the development of strategies to reach unvaccinated and under-vaccinated populations, and the introduction of new vaccines. In order to ensure sustainability of immunization programmes, countries were supported in building and strengthening decision-making mechanisms on immunization, such as national advisory groups. Parallel work was undertaken to advocate for immunization legislation and inclusion of an immunization allocation into the national budget.
In order to improve data quality, WPRO has introduced web-based data management and reporting systems for VPD surveillance in a number of priority countries, as well as electronic immunization
WPR/RC67/3 page 40 Annex registries, and has routinely conducted data quality assessments and capacity development of national staff.
VPD outbreaks, particularly measles, and the outbreak of vaccine-derived poliovirus in LAO has hampered efforts to strengthen routine immunization systems and improve equity, as resources were centred on outbreak response. Inadequate funding for priority non-Gavi-supported countries,
especially those with large populations such as CHN and PHL was a major challenge. Likewise, foreseen significant reductions in budget allocated to the immunization programme for Gavisupported countries (PNG, SLB and VNM) could constrain the scope of technical support in the areas of routine immunization strengthening and new vaccine introduction. Therefore more careful planning of coordination with different immunization partners would be needed to maximize the use of other resources available.
1.5.2
Intensified implementation and monitoring of measles and rubella elimination and
hepatitis B control strategies facilitated Appraisal: Fully achieved
Comments on achievements The third meeting of the Regional Verification Commission was convened in Seoul in 2014. Since then, seven countries and areas (AUS, BRN, KHM, JPN, MAC, MNG and KOR) were verified as having interrupted endemic measles virus transmission for a period of at least 36 months. Other countries and areas have also been making progress towards the goal. Measles outbreak response and catch-up or follow-up immunization campaigns were conducted in KHM, LAO, FSM, PNG, PHL, SLB, VUT and VNM. WPRO participated with WHO headquarters and other partners in developing and finalizing the updated supplementary immunization activity (SIA) guidelines and monitoring tools.
KHM and 16 of 17 regions in PHL were validated as having eliminated maternal and neonatal tetanus. PNG and one region in PHL remained to be validated.
In October 2015, the Regional Committee for the Western Pacific approved the Regional Action Plan for Viral Hepatitis in the Western Pacific 2016–2021. Thirteen countries, including SGP, achieved the regional hepatitis B control goal in 2015. However, hepatitis B remained hyper-endemic among adults in the Region with a corresponding high risk of transmission to infants. Low hepatitis B birth dose coverage was a challenge in the Region, with 10 countries reporting birth dose coverage of less
WPR/RC67/3 page 41 Annex than 80% in 2013. Intensive efforts were therefore needed to achieve the regional goal of reducing hepatitis B prevalence to less than 1% among children by 2017. However, deviations from survey protocols in some countries jeopardized the accuracy of serosurvey results. Also, efforts to restore confidence in hepatitis B vaccinations were being undertaken in countries where adverse effects after immunizations had been reported, such as CHN and VNM. Provision of cold-chain equipment for maternity wards for birth doses and the development of information and education (IEC) materials were also planned towards the hepatitis B control goal. WPRO published new and updated hepatitis B prevention guidance in January 2015. WPRO’s hepatitis website was also redesigned and updated in 2015. The third meeting of the Hepatitis B Expert Resource Panel was held in January 2015, which provided guidance on achieving the regional hepatitis B control goal. 1.5.3 Target product profiles for new vaccines and other immunization-related technologies defined and research priorities to develop vaccines of public health importance and overcome barriers to immunization agreed Appraisal: Fully achieved
Comments on achievements KHM, PHL and SLB introduced pneumococcal conjugate vaccine into their national immunization programme during this biennium. KIR introduced rotavirus vaccine, and LAO, PHL and SLB conducted a demonstration project with HPV. WPRO provided technical support in developing and analysing evidence to guide decisions on new vaccine introduction. Strengthening of new vaccines surveillance for IB-VPD and rotavirus in low- and middle-income countries in the Region was also supported. surveillance. Several countries have started to integrate JE surveillance into existing IB-VPD
Major challenges included inadequate funding, poor quality of surveillance data and other epidemiologic evidence, and limited MOH expertise in data analysis and interpretation and research implementation.
WPR/RC67/3 page 42 Annex
CATEGORY 2. NONCOMMUNICABLE DISEASES
Reducing the burden of noncommunicable diseases, including cardiovascular diseases, cancers, chronic lung diseases, diabetes and mental disorders, as well as disability, violence and injuries, through health promotion and risk reduction, prevention, treatment and monitoring of noncommunicable diseases and their risk factors Summary of progress and achievements Noncommunicable diseases
In line with the Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014–2020), support was provided to continue raising awareness of noncommunicable diseases (NCDs) as a development issue. Efforts are focused on prioritizing NCDs in the health planning of the development agenda at the national level. Strategic communications including social media have been sustained in many countries, including CHN, KHM, LAO, MNG, NIU, PNG, SLB and TON. Through technical support, countries developed multisectoral strategies and action plans and coordinated action across sectors (finance, health, education and key policymakers) for NCD prevention and control.
Developing capacity in NCD management was a key area of work. Support has been provided to Member States to: (1) strengthen capacities and skills of policy-makers and health-care professionals through development of tools and the organization of fellowships, study tours and training; (2) improve service delivery through implementation of the WHO Package of Essential
Noncommunicable Interventions for Primary Health Care in Low-Resource Settings (PEN) at national and local levels (FJI, KHM, KIR, LAO, FSM, MNG, PLW, PHL, SLB, TKL, TON, TUV, VUT, VNM and WSM); (3) strengthen their health promotion infrastructure and sustainable financing mechanism (CHN, COK, FJI, MNP, SLB, VNM and WSM); and (4) scale up settings-based approaches such as health-promoting schools and healthy cities, islands and villages (CHN, COK, FJI, FSM, HOK, KHM, KIR, KOR, LAO, MNG, MYS, PHL, SLB, TON, VUT and VNM). Considering the importance of quality data and information for programme planning, WHO supported strengthening national surveillance systems and monitoring of global, regional and national targets (ASM, BRN, CHN, COK, FJI, PYF, HOK, JPN, KHM, KIR, LAO, MAC, MNG, MNP, NRU, NEZ, PHL, PNG, KOR, SGP, SLB, TKL, TUV, VUT, VNM, WAF and WSM).
WPR/RC67/3 page 43 Annex To support Member States in developing better policies and governance, WHO provided technical support in the development and improvement of legislation and regulation, particularly in areas of tobacco control and nutrition and diet-related marketing, labelling and taxation. Expert consultations were also organized to define strategies for promoting health in settings such as cities and workplaces (AUS, FJI, GUM, JPN, NEZ, PHL, KOR, SGP and VNM).
The Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) was adopted in 2014 at the sixty-fifth session of the WHO Regional Committee for the Western Pacific. Two regional consultations were conducted in 2015, bringing together national and regional tobaccocontrol partners from 30 countries and areas to discuss prioritization and implementation of the regional action plan. With a strong focus on accelerating and implementing the WHO Framework Convention on Tobacco Control (FCTC), support has been provided to expand and strengthen tobacco-control networks at regional and local levels through workshops for smoke-free cities and smoke-free United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage sites.
As the countries make progress in countering NCD risk factors, challenges are emerging that require immediate attention. WHO supported countries to prepare for such issues, especially in tobacco control: electronic nicotine delivery systems, trade and legal challenges from the tobacco industry.
The commitment of Member States to respond to the challenges of the NCD epidemic needs to be matched with adequate financial and human resources. Further efforts are required to build the capacity of countries in planning and coordinating action across multiple sectors. Implementing evidence-based strategies is a challenge that needs to be addressed in order to focus limited resources on strategic, cost-effective interventions, especially in countries where political climates and economic downturns have put strains on the sustainability of funds earmarked for health. Mental health and substance abuse
Based on the Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in the Western Pacific endorsed at the sixty-fifth session of the Regional Committee, which provides a framework for prioritizing and accelerating mental health policies and actions in Member States, WHO supported Member States in identifying ways to strengthen mental health policies, strategies and plans.
WPR/RC67/3 page 44 Annex Member States participated in the ATLAS on substance use (2010): Resources for the prevention and treatment of substance use disorders. This contributed to the development of an enhanced situation analysis and needs assessment used in policy development and service planning. WHO organized activities to increase awareness on mental health, suicide prevention and alcohol use that included campaigns and distribution of advocacy materials during World Mental Health Day and other advocacy opportunities. To support Member States in addressing the harmful use of alcohol among young people, WHO developed and published a resource book and brochure as a technical tool that Member States may adopt and use for advocacy. WHO continues to support the strengthening of legislation related to alcohol products and control. The Regional Forum on Protecting Young People from the Harmful Use of Alcohol held in Hong Kong SAR (China) on 29–30 April 2016 was aimed at enhancing progress from Member States on alcohol harm prevention and reduction activities, as well as engaging more young people to decry the harmful use of alcohol.
To further build country capacity in delivering mental health and social care services, WHO provided technical support in the facilitation of training courses on mental health in 12 countries (COK, FJI, PYF, KHM, KIR, LAO, MYS, FSM, PLW, VUT, VNM and WSM).
The changing economic landscape has affected health priorities, and often budget cuts are made in mental health programmes. Technical capacity at the country and regional levels needs to be further strengthened to counterbalance industry interference in the development of alcohol-related policy and achieve stronger regulations and enforce effective control of the harmful use of alcohol.
Violence and injuries
With violence and injuries being the leading cause of death in the Region for those aged 5–49 years, the Regional Action Plan for Violence and Injury Prevention in the Western Pacific (2016–2020) was adopted at the sixty-sixth session of the Regional Committee for the Western Pacific in October 2015. It provides a guide in developing and implementing strategic, evidence-based action and coordinating technical support to Member States. Simultaneously, a Global plan of action to strengthen the role of the health system within a national multisectoral response to address interpersonal violence, in particular against women and girls and against children was adopted at the Sixty-ninth World Health Assembly in May 2016.
In order to increase awareness on the preventability of violence and injuries and advocate for greater prioritization and strategic planning in the national and regional agenda to scale up action, various
WPR/RC67/3 page 45 Annex communication products had been developed such as a documentary and posters on violence against women, and infographics on road safety, interpersonal violence and drowning prevention.
In response to requests from Member States, capacity development opportunities have been prioritized for all forms of violence and injury prevention. Such capacity-building programmes use a localized version of WHO's Teach VIP curriculum, and promote engagements with the Safe Communities Movement.
The Bloomberg Initiative for Global Road Safety 2015–2019 enabled countries (such as KHM, CHN, PHL and VNM) to strengthen the prevention of road traffic injuries at the national level. Further efforts are needed in accelerating implementation of country-specific action for the prevention of violence and injuries, which has been limited to small-scale activities.
Disabilities and rehabilitation
With support from WHO, Member States achieved greater collaboration between MOH and the ministry of social affairs by jointly undertaking planning of the rehabilitation sector to address health and rehabilitation concerns of people in the Region. Integration of rehabilitation into national health strategic plans was prioritized in some countries and specifically Pacific island countries achieved considerable progress in community-based rehabilitation.
Support was provided in developing a status report and convening regional meetings to strengthen knowledge and capacity, and enable a network of Member States in the area of rehabilitation and disability. Subregional training has been implemented to support Member States in overcoming challenges of under-reporting, unavailability and complexity of population disability data. As internationally comparable measurement tools for disability are being developed, Member States have been supported in improving the quality of data for service provision, including gaps in services in countries.
Despite improvements in intersectoral collaboration, understanding of the roles of ministries of health with relation to other ministries is still challenging.
With regard to blindness prevention and control, WHO supported the development of national plans, regional meetings, training, epidemiological surveys and the development of disease-specific strategies. Member States used evidence to prioritize planning, for example prevalence of blindness
WPR/RC67/3 page 46 Annex surveys. The programme has promoted a set of recommendations to increase effectiveness of the national eye care system and improve quality of services. Support has been provided to the
development of country-specific strategies to increase cataract surgical outputs through public–private partnership models. WHO provided technical support in developing three new survey tools – the Eye Care Service Assessment Tool (ECSAT), the Tool for the Assessment of Diabetes and Diabetic Retinopathy Management Systems (TADDS), and the Tool for the Assessment of Vision Rehabilitation Services (TARSS) – which were piloted and implemented across WPR in order to support countries in assessing delivery of eye care in general and specifically people with diabetic retinopathy, which was a rising cause of avoidable blindness in WPR. Nutrition
The Action Plan to Reduce the Double Burden of Malnutrition in the Western Pacific Region (2015– 2020) approved at the sixty-fifth session of the Regional Committee in October 2014 guided the work of the regional nutrition programme in supporting Member States to develop and update nutritionrelated national plans of action. WHO provided technical support in developing a monitoring framework and baseline country profiles. To advance implementation of legal instruments related to nutrition, WHO coordinated legal support to Member States. Nutrition surveillance activities were also supported in countries. Interagency coordination and collaboration was strengthened through the first United Nations Global Nutrition Agenda introduced to the Region at the first United Nations Regional Nutrition Meeting for Asia and the Pacific. This interagency collaboration focused on updating national protocols on the integrated management of acute malnutrition and joint advocacy. A Biregional Workshop on
Restricting the Marketing of Foods and Non-Alcoholic Beverages to Children in the Western Pacific and South-East Asia was organized to discuss progress on implementing the WHO Set of Recommendations on Marketing of Foods and Non-alcoholic Beverages to Children and prioritize action for the coming biennium. Policy dialogues on the WHO recommendations for free- sugar intake in adults and children were initiated in MNG, and technical support was provided in developing regulations for front-of-pack labelling on processed foods. WHO provided updated
nutrition-related guidelines on the Electronic Library of Essential Nutrition action (eLENA) to Member States (KHM, CHN, LAO, MNG, PHL, WSM and VNM).
Support was provided to conduct a qualitative research in two areas: (1) the consumption of sugary drinks in schools; and (2) the level of understanding of health professionals, including medical professionals, midwives and nurses on conflicts of interest, as well as their recommendations to
WPR/RC67/3 page 47 Annex combat it in the practice of their profession, especially in the area of nutrition for infants and young children.
Challenges to improving nutrition in Member States include incoherent policies across multiple sectors, industry interference in policy development and implementation, weak health systems and the limited capacity of the workforce to deliver nutrition services. WHO will continue to support Member States to better monitor implementation of national plans and align policies, plans and training curricula with updated guidelines, such as the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition (CIP). In addition, limited financial and human resources remain a key impediment to achieving better nutrition outcomes.
ASSESSMENT OF PROGRAMME OUTPUTS Noncommunicable diseases 2.1.1 Development of national multisectoral policies and plans for implementing interventions to prevent and control noncommunicable diseases facilitated Appraisal: Fully achieved
Comments on achievements The global and regional action plans for NCD prevention and control contributed substantially to the achievement of this output as they served as a guide and reference for countries by highlighting key strategic areas, policy options and targets to achieve by 2025. WHO continued to develop new strategies to convene different sectors for policy discussions and mobilize action.
In order to support Member States on NCD prevention and control, WHO strengthened the development and implementation of policy frameworks and national plans by organizing leadership development programmes. WHO support also included enhancing strategic communications,
providing guiding frameworks and policy options, developing cost-effective and evidence-based interventions, conducting training and joint strategic planning sessions, and providing legal support. As a result, seven countries (COK, FJI, GUM, LAO, NRU, PLW and VNM) drafted and endorsed multisectoral action plans, and eight had draft plans awaiting endorsement. To address the nine global targets to be achieved by 2025, including a target for 10% reduction in tobacco use over five years, regional consultations were organized to support the prioritization of actions for the implementation of the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019) that sought to accelerate implementation of the FCTC.
WPR/RC67/3 page 48 Annex The engagement of other sectors in the development and implementation of NCD-related multisectoral action plans needs continued coordination and advocacy. WHO will continue to provide support in improving policy coherence across sectors in order to ensure that health remains a priority in all policies and plans at the national level. With industry interference (e.g. tobacco and food industries) being a major obstacle in the development of public policy, WHO supported Member States to establish legal frameworks and policies. In the area of tobacco control, WHO has convened regional workshops and consultations on a wide range of issues including tobacco taxation and illicit trade, as well as new emerging issues such as electronic nicotine delivery systems. WHO also supported KOR in the organization of an international symposium on tobacco control and law in 2014. 2.1.2 High-level priority given to the prevention and control of noncommunicable diseases in national health planning processes and development agendas Appraisal: Fully achieved
Comments on achievements Member States have participated in high-level NCD and health promotion meetings and events, such as the Regional Preparatory Meeting for the 9th Global Conference on Health Promotion, the 6th Global Conference of the Alliance for Healthy Cities, the 2014 Joint Forum Economic and Pacific Health Ministers Meeting and the 2015 Small Island Developing States on NCDs, as well as study tours, leadership workshops and advocacy training workshops. During these meetings and events, WHO supported Member States to seek commitment from leaders and policy-makers to ensure NCDs were considered in national planning processes. WHO also worked with policy-makers and As the United Nations
programme managers in developing policies that mainstream health.
Development Assistance Framework (UNDAF) may serve as a guiding framework for countries in the development of national agendas, WHO and United Nations Development Programme provided technical assistance in developing a guidance note on integrating NCDs into the UNDAF process. This will support Member States mainstreaming NCDs as a political priority in the national agenda. 2.1.3: Monitoring framework implemented to report on progress in realizing the commitments made in the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the Global Action Plan for the Prevention and Control of NCDs (2013–2010) Appraisal: Fully achieved
WPR/RC67/3 page 49 Annex
Comments on achievements WHO supported Member States to establish and implement monitoring frameworks for measuring progress based on agreed indicators. To help Member States meet the commitments made in the Political Declaration and the Global Action Plan, WHO provided technical support on strengthening surveillance capacity. Twenty-five countries (AUS, BRN, KHM, CHN, FJI, JPN, KIR, LAO, MYS, MHL, FSM, MNG, NRU, NEZ, NIU, PLW, PNG, PHL, KOR, SGP, SLB, TON, TUV, VUT, and VNM) have responded to the 2015 NCD Country Capacity Survey. To sustain momentum and resources invested in health information systems strengthening and implementation of the monitoring framework, WHO used training resources of WHO collaborating centres. Also, initiatives such as WHO PEN implementation were used as an entry point to secure resources and strengthen health information systems. WHO's efforts included strengthening resource mobilization, identifying
technical partners and establishing technical networks to provide the necessary support to countries.
WHO also provided continued support to monitor NCD risk factors through population surveys, and assisted in the dissemination and use of results to trigger policy action. In collaboration with the United States Centers for Disease Control and Prevention, the Global Adult Tobacco Survey (PHL and VNM) and the Global Youth Tobacco Survey (GYTS) (COK, MAC, MHL, PHL and TKL) were implemented. In addition, the China City Adult Tobacco Survey was launched in 2015, covering 14 cities in China. GYTS analysis workshops were offered to BRN, GUM, FSM, MNG, MNP, PLW and VNM, which conducted GYTS in 2014–2015. Apart from these standardized surveys, two Member States completed their national surveys and released the results covering tobacco indicators (KHM and JPN). Mental health and substance abuse 2.2.1 Countries’ capacity to develop and implement national policies and plans in line with the global Mental Health Action Plan 2013–2020 strengthened Appraisal: Fully achieved
Comments on achievements At the sixty-fifth session of the Regional Committee, a high-level panel discussion was organized to outline the scope and impact of mental disorders in the Western Pacific Region. The Regional Agenda for Implementing the Mental Health Action Plan 2013–2020 in the Western Pacific was subsequently endorsed, providing Members States with a framework to prioritize and accelerate mental health policies and actions.
WPR/RC67/3 page 50 Annex WHO provided technical support to counterparts in KHM, COK, FJI, PYF, KIR, LAO, MHL, FSM, PLW, WSM, VUT and VNM to develop and identify ways to strengthen mental health policies in line with the global Mental Health Action Plan 2013–2020. Seventeen Member States participated in a Regional Workshop on Strengthening Mental Health Policies and Programmes in 2015, and developed a one-year action plan to implement priority key deliverables and build capacity to design a more comprehensive mental health implementation plan using quality improvement tools. Four Pacific island countries (FJI, KIR, MHL and FSM) attended the Pacific Mental Health Policy and Plan Workshop, and finalized the draft national mental health policy and plan that was expected to be endorsed in 2016.
After years of working closely with WHO collaborating centres and academic institutions, the AsiaPacific International Research and Education (ASPIRE) network was launched in April 2014. The informal network aimed to create regional collaborative processes to support the design and development of evidence-based mental health services tailored to individual country needs. The WHO Pacific Islands Mental Health Network (PIMHnet), established in 2007 and funded by the New Zealand Aid Programme, continued to support the development of the national mental health policy and plan in several Pacific island countries.
Mental health remained a low priority in most low- and middle-income countries, as evidenced by the low investment and slow process of policy development and legislation. The absence of a mental health unit in most ministries of health resulted in focal points for mental health being overburdened with multiple tasks. In most cases, these focal points did not have sufficient expertise and capacity to lead policy development and implementation. 2.2.2 Mental health promotion, prevention, treatment and recovery services improved through advocacy, better guidance and tools on integrated mental health services Appraisal: Fully achieved
Comments on achievements It was recognized that disease-focused and curative-care approaches to mental health were necessary but should be pursued in tandem with whole-of-society approaches for promotion of mental health and well-being. The completion of the ATLAS on substance use (2010): Resources for the prevention and treatment of substance use disorders in 2014 resulted in an improved understanding of the magnitude of mental health issues and resources available in individual countries.
WPR/RC67/3 page 51 Annex WHO supported countries to build capacity in mental health service organization and delivery and in suicide prevention through fellowship programmes, training workshops (FJI, KIR, MHL, FSM, PLW, WSM, TKL and VUT) and regional events, including distance mentoring (KHM, CHN, LAO, PHL and VNM). Technical and financial support was provided to CHN for drafting and piloting its postpartum depression guidelines and in the documentation of good practices in multisectoral mental health service, as well as care for people with severe mental disorders. In VNM, technical and financial support was provided to integrate mental health care into general health care, especially at primary health-care level through the development of relevant legislation and demonstration of integrated NCD and mental health service delivery at community level.
WHO co-sponsored the 6th Asia Pacific Regional Conference of the International Association for Suicide Prevention, which became a forum for the exchange of information and sharing of good practices in suicide prevention among Member States in the Region.
Collaboration with existing networks, such as PIMHNet and ASPIRE was strengthened to facilitate sharing of good practices. The Mental Health Gap Action Programme (mhGAP) training, participated in by more than 200 general doctors and nurses in five countries in the Region, was conducted in collaboration with PIMHnet
To promote mental health in the workplace, an informal consultation participated in by PHL, MYS, WSM and TON was conducted in September 2015. Subsequently, a framework and toolkit for mental health in the workplace was drafted to serve as a guide for organizations in implementing mental health workplace interventions.
The WHO World Suicide Report was launched in JPN and later translated into Chinese.
An
intervention tool for suicide in schools was also drafted to give guidance to school administrators on crisis management. Participants from AUS, FJI, MYS, MNG and PHL were supported to attend a two-day workshop on suicide-attempt surveillance systems organized by WHO headquarters. The workshop would enable participants to guide the establishment and strengthening of suicide surveillance systems in their respective countries.
Mental health support was a key component in disaster response and recovery in PHL, SLB and TON. Alcohol and substance abuse were also included in the mhGAP modules for non-specialists in several regions of PHL.
WPR/RC67/3 page 52 Annex 2.2.3 Expansion and strengthening of country strategies, systems and interventions for
disorders due to alcohol and substance use enabled Appraisal: Fully achieved
Comments on achievements WHO provided support to KHM, CHN, FJI, LAO, MNG and VNM in promoting multisectoral action to reduce the harmful use of alcohol, in developing public health-oriented alcohol policies and plans, in building national capacity, and in implementing efficient and cost-effective approaches. The regional network of national focal points was reactivated to facilitate policy dialogues, sharing of best practices and the exchange of information. A resource book and booklet on Young People and Alcohol was published and translated into Chinese, Khmer and Lao. A video was also produced to raise public awareness on alcohol-related harm. A review of policies on alcohol taxation, regulation and marketing strategies used by the alcohol industry in the Region was undertaken, as well as an evaluation of existing mHealth interventions for alcohol harm reduction.
The first phase of a social media contest was initiated in KHM, MNG and PHL, in which local youth were engaged to develop videos intended to inform young people on the harmful effects of alcohol.
Participants from MNG were supported to attend a Capacity Building Workshop on Alcohol Pricing and Taxation Policy Options organized by WHO headquarters. Violence and injuries 2.3.1 Development and implementation of multisectoral plans and programmes to prevent injuries, with a focus on achieving the targets set under the Decade of Action for Road Safety (2011–2020) Appraisal: Fully achieved
Comments on achievements The Regional Action Plan for Violence and Injury Prevention in the Western Pacific (2016–2020) was endorsed at the sixty-sixth session of the Regional Committee in October 2015. Regional capacity development for road safety was strengthened through the following activities: (1) a multisectoral participatory training programme in August 2014 for senior delegates from the police, health and transport sectors from eight countries with the highest road traffic mortality rates in the Region, namely KHM, CHN, LAO, MYS, MNG, PHL, WSM and VNM; (2) capacity development training
WPR/RC67/3 page 53 Annex workshops in Hanoi and Manila from September to October 2015 on violence and injury prevention (including an extensive focus on road safety) utilizing WHO’s Training, Educating and Advancing Collaboration in Health on Violence and Injury Prevention (Teach VIP) curriculum for multisectoral participants from KHM, LAO, MYS, MNG, PHL and VNM; and (3) an immersion training in Auckland in October 2015 on the principles and practices of the Safe Communities model for community-based violence and injury prevention (including road safety) for national and subnational counterparts from FJI, KIR, WSM, SLB and TON.
The Global Status Report on Road Safety 2015 was completed with participation from 23 regional countries, and launched in October 2015 prior to the Second Ministerial Conference on Road Safety held in Brazil in November 2015. A supplementary Regional Status Report was scheduled for release in the first quarter of 2016.
2.3.2 Countries and partners enabled to develop and implement programmes and plans to prevent child injuries Appraisal: Fully achieved
Comments on achievements The launch of the Global report on drowning: Preventing a leading killer in November 2014 highlighted the unrecognized and neglected magnitude of drowning and outlined 10 key actions to prevent it. This publication, the first WHO has dedicated exclusively to drowning, formed the basis of the Organization's ongoing engagement with Member States. A situational assessment had
commenced to review the current status of drowning prevention in priority countries, as well as national preparedness for the implementation of WHO’s recommendations in the global report. By the end of 2015, KHM, FJI, KIR, PLW, SLB and VNM had completed the survey; priority would be given to the remaining countries in 2016. MNG had developed a National Action Plan for the Prevention of Child Injuries, and PHL had commenced capacity development on drowning prevention. WHO hosted regional capacity development training workshops on violence and injury prevention, which included prevention of child injuries and drowning, in September and October 2015, with multisectoral participants from KHM, LAO, MYS, MNG, PHL and VNM. In collaboration with the Safe Communities Foundation of New Zealand, an immersion training on the principles and practices of the Safe Communities model for community-based violence and injury prevention (including child injury prevention) was conducted in Auckland in October 2015, with participation by national and subnational counterparts from FJI, KIR, WSM, SLB and TON. Multicountry training conducted at the World Conference on Drowning Prevention in Penang
WPR/RC67/3 page 54 Annex in November 2015 benefited participants from KHM, CHN, FJI, LAO, MYS, MNG, PLW, PHL, WSM and VNM.
A major challenge at the country level pertained to a lack of both human and financial resources for the provision of technical support to country counterparts. 2.3.3 Development and implementation of policies and programmes to address violence against women, youth and children facilitated Appraisal: Fully achieved
Comments on achievements A Western Pacific and South-East Asia biregional consultation on the draft Global Action Plan on Interpersonal Violence Prevention was held in Bangkok in April 2015. Thereafter, the Regional Action Plan for Violence and Injury Prevention in the Western Pacific (2016–2020), covering all types of intentional and unintentional injuries including child injury prevention, was endorsed at the sixty-sixth session of the Regional Committee in October 2015.
WHO facilitated and supported the participation of 20 countries of the Region in the production of the Global Status Report on Violence Prevention. In many low- and middle-income countries, the required consensus meeting was the first time that multisectoral partners involved in the prevention and response to violence had gathered to deliberate on country situations. Consequently, a regional status report and Western Pacific Region Health Intelligence Information Platform dashboard of key results was developed.
Regional capacity for prevention of violence was strengthened through: (1) capacity development training workshops on violence and injury prevention (with an extensive focus on interpersonal violence) in Hanoi and in Manila in 2015; and (2) immersion training on the principles and practices of the Safe Communities model for community-based violence and injury prevention (including violence against women and children) in collaboration with the Safe Communities Foundation of New Zealand in October 2015.
A short documentary, visually advocating the scale up of action on violence and injury prevention, was produced and made available on the website. Similarly, a series of posters on prevention of violence against women was developed and disseminated to all WHO country offices and uploaded on the website in time for the International Day for the Elimination of Violence Against Women on
WPR/RC67/3 page 55 Annex 25 November 2015. The posters presented a creative visualization of the magnitude, consequences and preventability of interpersonal violence against women.
Disabilities and rehabilitations 2.4.1: Implementation of the recommendations of the World Report on Disability and the Highlevel Meeting of the General Assembly on Disability and Development Appraisal: Fully achieved
Comments on achievements The approach of WHO’s disability programme is encapsulated in the WHO Global Disability Action Plan 2014–2021: Better health for all people with disability. It works to ensure ministries of health undertake actions resulting in health services being accessible and inclusive, and with stronger community-based rehabilitation and assistive-device provision.
WHO provided technical support to KHM, CHN, FJI, KIR, LAO, MYS, FSM, MNG, PHL, WSM, SLB and VUT to improve leadership of ministries of health and high-level strategic planning in disability and rehabilitation and to increase cooperation between the ministries of health and social affairs. In Pacific island countries, significant progress was achieved in the development of
community-based rehabilitation programmes. Across the Region, government investment in national programmes increased, predominantly through the ministries of social affairs.
The ability of governments to prioritize disability work, in particular ministries of health, remained difficult with poor quality and limited availability of national level data in low- and middle-income countries across the Region. There was also limited technical capacity in countries, particularly Pacific island countries, to undertake the work despite funding commitments. Although most
countries in the Region had national disability policies and legislation, limited disability services and financial support hampered meeting these policy objectives.
WPR/RC67/3 page 56 Annex 2.4.2 Countries are able to strengthen the provision of services to reduce disability due to visual impairment and hearing loss through more effective policies and integrated services Appraisal: Fully achieved
Comments on achievements With technical support from WHO, three new survey tools – ECSAT, TADDS and TARSS – were developed, piloted and implemented across the Region to assess capacity of countries’ existing systems to deliver eye care. Efforts were then made to better integrate any planning of eye care services within the broader health services. WHO supported the development of national plans through regional meetings, training activities, epidemiological surveys (MNG and VNM) and the development of disease-specific strategies, such as for unoperated cataracts (PHL and VNM) and diabetic retinopathy (KIR, WSM and SLB). Through expert consultations and in-country assessments, novel approaches to eye care financing were developed and shared with governments in order to improve availability and affordability of eye care services. Nutrition 2.5.1 Countries enabled to develop, implement and monitor action plans based on the maternal, infant and young child nutrition comprehensive implementation plan Appraisal: Partly achieved
Comments on achievements The Action Plan to Reduce the Double Burden of Malnutrition in the Western Pacific Region (2015– 2020), presented in a progress report at the sixty-fifth session of the Regional Committee in 2014, was approved by Member States and widely disseminated among Member States and key stakeholders. Two workshops were subsequently held in 2015 on the implementation and monitoring of the action plan: one in Manila for Asian countries and the other in Nadi, Fiji, for Pacific island countries and areas. Advocacy materials (e.g. Breastfeeding: a winning goal for life and Healthy Weight in
Childhood: a winning goal for life) to support implementation were developed, with some translated into local languages. WPRO website and factsheets were updated, with new webpages, such as those on sugar and childhood obesity. National multisectoral workshops on the double burden of
malnutrition were conducted to raise awareness about the changing nutrition situation and discuss country adaptation of the action plan.
WPR/RC67/3 page 57 Annex A biregional meeting was held in MYS in December 2015 on restricting marketing of foods and nonalcoholic beverages to children to discuss progress on implementing the WHO Set of Recommendations on Marketing and prioritize action for the coming biennium. A draft Regionspecific nutrient profile was developed to support Member States in the implementation of the set of recommendations.
MNG was supported in developing regulations for front-of-pack labelling for processed foods and policy dialogues were held to advocate and foster high-level commitment to a national sugar reduction strategy. In PHL, the draft midterm report on the national Plan of Action on Nutrition was reviewed and updated. A joint WHO–UNICEF–Save the Children technical mission was undertaken in LAO to discuss a nutrition legal framework, and support was provided to finalize the draft regulation on food safety and nutrition in schools.
WHO participated in a number of joint meetings/missions with partners to strengthen networking and to identify joint activities and opportunities for joint resource mobilization.
The review of existing and/or the development of new national action plans depended not only on country capacity, but also on the duration and cycle of existing action plans. The review and/or development of nutrition-related action plans was not a priority for all countries. Limited human resource capacity and financial support, at both the regional and country level, was a barrier to WHO in supporting countries achieve better nutrition outcomes.
2.5.2 Norms and standards on maternal, infant and young child nutrition, population dietary goals, and breastfeeding updated, and policy options for effective nutrition actions for stunting, wasting and anaemia developed Appraisal: Partly achieved
Comments on achievements To increase early initiation of breastfeeding and reduce anaemia, WHO supported countries to link efforts on this front with those to implement early essential newborn care, which promoted delayed cord clamping and skin-to-skin contact. Institutionalization of the Baby Friendly Hospital Initiative was supported in KHM. Also, technical support was provided to select Member States by conducting national workshops on up-to-date nutrition-related guidelines and online tools developed by WHO, including the Global Database on the Implementation of Nutrition Action (GINA) and eLENA, (KHM, CHN, LAO, MNG, PHL, WSM and VNM).
WPR/RC67/3 page 58 Annex Scoping of food labelling, including front-of-pack, and fiscal policies was conducted in all countries in the Region. Qualitative research was conducted in two areas: one on the consumption of sugary drinks in schools and one on the perceptions of health professionals on conflicts of interest in the area of infant and young child nutrition.
Guidance documents such as the Guidelines on Essential Nutrition Actions were translated into Lao and Mongolian. Countries initiated the update of national protocols, including the Management of Severe Acute Malnutrition according to the 2013 WHO updates.
WHO supported Member States in finalizing their food regulations (COK, FJI, KIR, WSM, SLB, TON and TUV). This also included labelling requirements and standards for food fortification (MNG, SLB and VNM).
Impediments to adaptation and implementation of international norms and standards at the country level included weak health systems and limited capacity to deliver essential nutrition services. Policy incoherence in nutrition, as well as industry interference in policy development and implementation, slowed down progress towards global nutrition targets.
CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
Promoting good health at key stages of life, taking into account the need to address social determinants of health (the societal conditions in which people are born, grow, live, work and age) and gender, equity and human rights Summary of progress and achievements Reproductive, maternal, newborn, child and adolescent health
The Western Pacific Region was the first WHO region to present a regional platform for action focused on newborn infants, through the Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020). WHO supported all eight high-burden countries (KHM, CHN, LAO, MNG, PNG, PHL, SLB and VNM) in the introduction and scale up of early essential newborn care (EENC) by developing the Early Essential Newborn Care Clinical Practice Pocket Guide and other tools to improve the skills of health professionals, raise the quality of birthing facilities, upgrade programme planning and mobilize social support for newborn care.
WPR/RC67/3 page 59 Annex With WHO’s support and in line with the Commission on Information and Accountability for Women's and Children’s Health (CoIA), maternal death review programmes in KHM, LAO, PNG, PHL and VNM had progressed from passively collecting data to applying information for improving quality of care.
In 2015, WHO provided technical assistance in conducting maternal care desk reviews to compare the latest evidence-based WHO recommendations/guidelines and national guidelines/protocols on antenatal delivery and postpartum care in eight high-burden countries. KHM, CHN, PNG and VNM are reflecting the identified gap in the national guidelines that are currently being updated. SLB has developed national protocols on normal delivery and emergency obstetric care for the first time in the history of the MOH with technical support from WHO.
In order to promote family planning, early childhood development and adolescent health, efforts were focused on: (1) reviewing the mapping of abortion policies, programmes and services in the Region; (2) reviewing and conducting on-site surveys to identify actions for scaling long-term reversible family planning methods in KHM and PNG; (3) carrying out a systematic review on school-based adolescent health-promoting interventions; and (4) collaborating with relevant technical areas and other stakeholders on the development of a regional action plan for adolescent health in the near future.
With WHO's technical support in the development of guideline documents and tools, countries successfully handled health-facility strengthening activities, such as training and coaching for health workers. Countries adopted consistent programme review approaches to inform development of national maternal and child health programme implementation plans.
Challenges and impediments to strengthening reproductive, maternal, newborn, child and adolescent health (RMNCAH) programmes related largely to limitations in health systems, specifically health worker numbers, capacity and lack of supportive supervision; weak health information systems; and the political environment impacting MOH activities. In addition, insufficient financial and human resources limited regional support to areas where Member States have expressed the greatest needs for assistance, such as newborn health. Ageing and health
WPR/RC67/3 page 60 Annex Following the endorsement of the Regional Framework for Action on Ageing and Health in the Western Pacific (2014–2019) at the sixty-fourth session of the Regional Committee in October 2013, there had been an increase in awareness and requests for support on ageing and health from Member States. WHO’s support to countries, characterized by a strong health systems focus, centred on activities aiming to strengthen awareness, commitment, the evidence base, evidence-informed policymaking and national capacity. At the country level, KHM, CHN, FJI, LAO, MNG, PHL and VNM had advanced work on ageing and health with support from WHO. In addition, strengthening the evidence base on ageing and health, including the implications of population ageing on various health systems dimensions, had been critical to informing policy dialogue and implementation in countries. Gender, equity and human rights-based approaches were continuously integrated across activities on ageing and health, as articulated in the regional framework. Partnerships with key regional stakeholders had been strengthened, enhancing WHO’s technical capacity and voice on ageing and health. Gender, equity and human rights mainstreaming
WHO's approach to gender, equity and human rights (GER) mainstreaming combined evidence building, capacity strengthening and implementation support to promote the application of genderresponsive, equity-enhancing and human rights-based approaches across different health programmes. In response to the growing number of requests for support in this area from Member States, WHO has followed a two-pronged approach. First, efforts were made to mainstream GER across WHO
programmes by strengthening WHO staff capacity, and by facilitating the development and dissemination of regional and country tools and resources. Second, WHO engaged in technical collaboration with several Member States (KHM, CHN, FJI, KIR, LAO, MNG, SLB and VNM) to integrate and monitor GER in their health policies, programmes and actions. Activities included policy advocacy and dialogue, building capacity, strengthening the evidence base and fostering collaboration with key stakeholders.
Gender-based violence (GBV) remained a serious public health concern in many countries in the Region, resulting in increasing political commitment by governments and requests for WHO support. Technical support on gender-based violence was provided to KHM, FJI, KIR, LAO, PNG, SLB and VNM, with particular focus on the health sector response to GBV.
Partnerships were fostered, including through participation in regional events organized by partners on older people's rights and the Beijing+20 process, involvement in activities of the regional United
WPR/RC67/3 page 61 Annex Nations Development Group, including Asia and the Pacific networks on human rights and gender, and collaboration with partners on GBV.
Social determinants of health
WHO's approach combined evidence building, capacity strengthening and implementation support in order to increase country capacity to implement a health-in-all-policies approach, intersectoral action and social participation to address the social determinants of health (SDH), in which a number of Member States (CHN, FJI, KIR, LAO, MNG, TON and VNM) had shown enhanced interest to implement. WHO’s work in this area was strengthened by efforts at the regional level to build partnerships, including collaboration with the Alliance for Healthy Cities and the WHO Kobe Centre, and to expand the evidence base through policy-focused analysis. UHC, NCDs and urban health present emerging focus areas for work on SDH. The inclusion of many determinants of health in the Sustainable Development Goals (SDG) agenda as well as the cross-cutting principle of leaving no one behind creates new opportunities for ministries of health to partner with other sectors and stakeholders to reduce health inequities through SDH policies and actions. Health and environment
WHO supported Member States in strengthening national risk assessment capacity and in developing appropriate response plans to address environmental and occupational hazards to health. WHO facilitated the drafting of environmental health profiles for members of the Regional Forum on Environment and Health in Southeast and East Asian Countries (KHM, LAO, MYS, MNG, PHL, KOR, SGP and VNM). WHO also supported development of country profiles on climate change and health as well as occupational health in selected Member States.
WHO assisted Member States in monitoring the Millennium Development Goal (MDG) targets on water and sanitation and in their participation in the Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS). WHO worked with countries (KHM, CHN, COK, FJI, PYF, LAO, MYS, MNG, PHL, WSM, TON, VUT and VNM) in developing their national water safety plans (WSP). As a result, an estimated additional 25 million people now have access to safer water compared to 2006. Four countries (LAO, MNG, PHL and VNM) made WSP compulsory for
drinking-water suppliers. Six countries (KHM, COK, MNG, PHL, WSM and VUT) updated or are in the process of updating national drinking-water standards based on the WHO drinking-water quality guidelines.
WPR/RC67/3 page 62 Annex Regional and biregional training courses were organized in order to strengthen countries’ capacity to manage environmental health issues and increase knowledge of the impact of climate change on health. Support was provided to develop software on early warning systems to monitor and flag climate vulnerabilities in CHN. Two reports on climate change and health were published: Climate Change and Health in the Western Pacific Region: Synthesis of Evidence, Profiles of Selected Countries and Policy Direction, and a similar report for the Pacific island countries entitled Human Health and Climate Change in Pacific Island Countries.
Collaboration between health and environment and other sectors was strengthened by convening a high-level meeting of the Regional Forum on Environment and Health in southeast and East Asian Countries in Bangkok. WHO supported Member States (BRN, KHM, CHN, JPN, LAO, MYS, MNG, PHL, KOR, SGP and VNM) to participate.
With occupational health being one of the major concerns in the Region, WHO supported Member States in reducing health consequences related to asbestos. Technical support was given to KHM to develop a national profile on asbestos. Through the collaborative effort of WHO and the MOH to eliminate asbestos-related disease (ARD), VNM agreed to the inclusion of chrysotile asbestos in Annex III of the Rotterdam Convention.
Many countries in the Region improved their national programmes on health-care waste management, and a report on Status of Health-care Waste Management in Selected Countries of the Western Pacific Region was published in 2015.
ASSESSMENT OF PROGRAMME OUTPUTS Reproductive, maternal, newborn, child and adolescent health 3.1.1 Further expansion enabled access to and quality of effective interventions from pre-pregnancy to postpartum focusing on the 24-hour period around childbirth Appraisal: Partly achieved
Comments on achievements WHO had focused on strengthening EENC and maternal deaths surveillance and response systems review programmes to achieve this output. The latter was a priority in the Global Strategy for Women's and Children's Health (2010–2015), and remained a priority in the new Global Strategy for Women's, Children's and Adolescent's Health 2016–2030. Using the Early Essential Newborn Care Clinical Practice Pocket Guide that it had developed, WHO worked with high-burden Member States
WPR/RC67/3 page 63 Annex to improve the skills of health professionals, raise the quality of birthing facilities, upgrade programme planning, and mobilize social support for newborn care.
The WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014– 2020) was finalized and aligned with the global newborn action plan. A monitoring and evaluation framework for this Action Plan was also developed and finalized. In line with the action plan, seven of eight priority countries (KHM, CHN, LAO, MNG, PNG, PHL, SLB and VNM) completed a newborn situation analysis and funded 12-month implementation plans for EENC. Five-year national action plans for EENC had been or were being developed in KHM, CHN, LAO, MNG, PNG, PHL and VNM. Across the Region, over 17 000 health facility staff providing delivery and newborn care services have been coached in EENC. To ensure that the correct practices are sustained following coaching, a quality improvement approach for EENC had also been adopted in the priority countries. Quality improvement was introduced in all national hospitals implementing EENC in LAO, MNG, PNG, SLB and VNM.
As per CoIA recommendations, countries had assessed their information systems related to women's and children's health. Efforts to strengthen maternal death reviews were undertaken with WHO support, and results applied to improve quality of care.
Though much success had taken place, accelerating progress in implementing actions of the regional action plan in countries had been inhibited by insufficient financial and human resources, weak capacity in health facilities, as well as weak managerial capacity and political changes resulting in high turnover of staff within ministries of health. 3.1.2 Countries’ capacity strengthened to expand high-quality interventions to improve child health and early child development and end preventable child deaths, including from pneumonia and diarrhoea Appraisal: Fully achieved
Comments on achievements WHO has focused on supporting implementation of the Integrated Management of Childhood Illness (IMCI) and essential child survival interventions to achieve holistic improvement across a range of child survival interventions. WHO had also sought to improve linkages of hospital water and
sanitation and immunization administration with child health programmes. By focusing on these areas, the aim was to ultimately contribute to reductions in under-5 mortality rates, particularly in
WPR/RC67/3 page 64 Annex priority countries (KHM, CHN, LAO, PNG, PHL and VNM). In LAO, an analysis of the current status of IMCI was supported; while in PHL funds were mobilized to support IMCI in the country. Technical guidelines on preterm birth prevention, management and care in western rural areas in CHN has been revised and are waiting for government approval. Surveys on hepatitis B prevalence among children and coverage of the hepatitis B birth dose vaccine had been undertaken in KIR. With WHO support, partnerships on reproductive, maternal, newborn and child health had been strengthened at the subnational level to coordinate and strengthen delivery of interventions. These efforts however, were partly hindered by political changes and turnover of staff working in the MOH.
Technical contributions were also made to the Action Plan to Reduce the Double Burden of Malnutrition in the Western Pacific Region (2015–2020) through efforts to support, protect and promote breastfeeding in the Region. Two studies related to breastfeeding – a review of breastfeeding promotion, protection and support in 11 countries, and an enquiry into infant formula promotion through paediatricians by milk companies in PHL – were targeted for publication.
Staffing in the Regional Office and in country offices to support child health programmes remained insufficient, with no professional staff member in the Regional Office for child health. Funding was another factor limiting the scope of work that could be carried out in the area of child health. 3.1.3 Countries enabled to implement and monitor effective interventions to cover the unmet needs in sexual and reproductive health and to reduce adolescent risk behaviour Appraisal: Fully achieved
Comments on achievements WHO provided technical assistance to countries on activities that aimed to increase coverage of reproductive health services and that included adolescent health within national health priorities, with a view towards ensuring high-level commitment to adolescent health and ensuring that different programmes with adolescent health components worked together with synergy. WHO country offices worked collaboratively with government counterparts to address needs in sexual and reproductive health and adolescent risk behaviours. In CHN, national family-based adolescent health and
development guidelines were established, while similar efforts were underway in KHM. Assessment of youth-friendly services in PHL and VNM are ongoing. WPRO has worked with technical
assistance providers in Pacific island countries to develop the next phase of the STI and HIV response, which encompassed maternal and child health and gender-based violence. In LAO, a smallscale screening programme for cervical cancer was initiated.
WPR/RC67/3 page 65 Annex
Efforts were intensified to promote family planning and adolescent health. A review was undertaken to map abortion policies, programmes and services in the Region. WHO provided technical support for a qualitative study on family planning in KHM and PNG. An adolescent health situational analysis was also carried out, and short fact sheets covering key adolescent health topics were developed. A systematic review was undertaken in 2015 to identify school-based interventions implemented in the Western Pacific Region to promote adolescent health and well-being, and was to be published in a scientific journal. WHO also contributed to a United Nations Population Fund report on the coverage of adolescent health interventions in Asia and the Pacific. Also, preparatory actions were being undertaken towards the development of a regional action plan in the near future.
Main challenges related to engagement of government policies and regulations on sexual and reproductive health, which could restrict activities, as well as insufficient technical and financial resources in WHO country offices. 3.1.4 Research undertaken, and evidence generated and synthesized to design key interventions in reproductive, maternal, newborn, child and adolescent health, and other conditions and issues linked to it Appraisal: Fully achieved
Comments on achievements WHO supported countries through systematic reviews and assessments and by providing technical and financial support for training activities in order to build research capacity and technical knowledge within countries for designing evidence-based interventions to improve RMNCAH. Regional charts based on global data and results related to MDGs 4 and 5 and policy reviews in areas of RMNCAH were developed, and monthly updates on RMNCAH were sent to countries, partners and wider regional networks, including WHO collaborating centres. With WHO support, a qualitative study was designed and undertaken in KHM and PNG in 2015, which sought to identify strategic actions to accelerate reduction of undesired pregnancies and determine the feasibility of scaling longterm reversible methods nationwide, namely implants.
As a result of collaborative work towards improving breastfeeding, a draft tool, Pathways for Effective Action through Regulation and Legislation, was further improved to support integrated approaches to the regulation of marketing of harmful products to children, such as tobacco, alcohol, unhealthy food and breast-milk substitutes.
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In light of limited staffing, networks were established among WHO collaborating centres to leverage their research capacity in supporting and strengthening WHO priority programmes in the Region.
Ageing and health 3.2.1 Countries enabled to develop policies and strategies that foster healthy and active ageing, and improve access to, and coordination of, chronic, long-term and palliative care Appraisal: Fully achieved
Comments on achievements WHO supported activities aiming to strengthen countries' awareness and commitment, as well as evidence-based, evidence-informed policy-making and capacity, on ageing and health as a basis for the development of policies and strategies that foster healthy and active ageing, and that also improve access to and coordination of chronic, long-term and palliative care. Policy-focused advice and technical assistance were provided to KHM, CHN, FJI, MNG, PHL and VNM. In addition, regional reviews and analysis on the health systems implications of population ageing were undertaken, and partnerships with key regional stakeholders on ageing and health were strengthened. In KHM, a review of the national policy on health care for older people was supported in June 2014. In CHN, a knowledge translation project on ageing and health resulted in a national report and ageing assessment, as well as several policy briefs. WHO and CHN’s National Health and Family Planning Commission (NHFPC) convened the first Healthy Ageing Joint Forum in October 2014, and a highlevel policy roundtable on ageing and health in November 2015. In FJI, policy dialogue with the MOH focused on reorientation of health systems to meet the needs of older people and expand palliative care. The national NCD strategy and policy, which addressed problems from ageing-related diseases, has been endorsed in LAO. In MNG, policy dialogue was conducted on the implementation of the government-endorsed National Programme on Healthy Ageing, and the organization of an international conference on the future of gerontology and geriatrics in August 2015 was supported. In PHL, a session at the Department of Health on the health and wellness of senior citizens was supported in October 2015. In VNM, the Association of Southeast Asian Nations (ASEAN) Health Ministers Conference, which included a side event on ageing and health, was organized with WHO's technical support, and two national policy dialogues on the response to health-care needs of older people were conducted in December 2014 and December 2015.
Partnerships on ageing and health were strengthened with Asian Development Bank, HelpAge International Asia-Pacific, International Association of Gerontology and Geriatrics and UNESCAP.
WPR/RC67/3 page 67 Annex Publications on ageing and health were developed and finalized, and material on ageing and health was printed and disseminated to support policy advocacy in countries. Analytical work included reviews of integrated service delivery, essential medicines and health technology, human resources for health, and long-term care. Analysis of the potential of associations of older people to meet their health needs is ongoing. 3.2.2 Technical guidance and innovations that identify and address the needs of older people for improved health care Appraisal: Fully achieved
Comments on achievements Key achievements included regional analyses on ageing and several health systems dimensions (longterm care, health workforce, essential medicines and health technologies, eye health and older people's associations), and a regional fact sheet on ageing and health was released on the 24th International Day of Older Persons 2014. A template for health systems and policy-focused country situational analysis on ageing and health was developed and implemented in KHM, CHN and VNM to inform policy advocacy and policy dialogue. Background papers on gender and ageing and on the right to health of older people were completed for the WHO World Report on Ageing and Health, published in October 2015 for the 25th International Day of Older Persons.
Partnerships were fostered with UNESCAP on long-term care and the rights of older people, with HelpAge International on older people's associations and social care, and with the Alliance for Healthy Cities on age-friendly cities. Technical support was also provided in the organization of a lunchtime session on age-friendly cities at the Sixth International Conference of the Alliance of Healthy Cities and for a regional workshop on health financing and social protection for older people, people with disabilities and people with NCDs in KHM.
WPR/RC67/3 page 68 Annex 3.2.3 Policy dialogue and technical guidance provided to countries focusing on the health of women beyond the reproductive age Appraisal: Fully achieved
Comments on achievements Although this was not a priority focus, opportunities were maximized for policy advocacy and analytical work within ongoing work under other outputs related to this programme area. A draft background paper on gender and ageing was developed for the forthcoming World Report on Ageing, and some sex-disaggregated analysis was included in the regional fact sheet on ageing and health. Gender issues, as well as issues related to older women's health, were raised in policy advocacy and dialogues in KHM, CHN, FJI, LAO, MNG and VNM.
As this was a relatively small area of focus without the allocation of significant funds, and an area in which other stakeholders were leading much of the work, strengthened partnerships across sectors, United Nations partners and other stakeholders, as well as the political will of national counterparts, remains vital to the success of this work programme.
Gender, equity and human rights mainstreaming 3.3.1 Gender, equity and human rights are incorporated in routine strategic and operational planning and monitoring of WHO programmes Appraisal: Fully achieved
Comments on achievements Key achievements include participation and advocacy for GER mainstreaming with other WHO programmes, such as with the Nutrition unit for equity analysis, with the Disability and Rehabilitation and the Maternal, Child and Adolescent units for GBV, with the Tobacco Free Initiative unit for gender and women's empowerment, with Stop TB unit and the Mental Health and Substance Abuse unit for the development of regional plans with due attention to marginalized population groups, and with the Health Systems unit in the context of UHC. Capacity on gender mainstreaming was also strengthened through collaboration with United Nations agencies and nongovernmental organizations, including as part of UNDAF, which facilitated the integration of gender issues in relevant strategies and policy discussion. In MNG, training sessions for WHO, United Nations staff and key focal points of the Ministry of Health and Sports were organized on UHC, health-in-all-policies (HiAP), and gender and human rights in 2014 and 2015. In the South Pacific, GER was incorporated in routine
WPR/RC67/3 page 69 Annex strategic and operational planning and monitoring of WHO programmes through continuing internal and external advocacy. In VNM, staff capacity to mainstream gender and human rights was
strengthened by disseminating key resources and checklists.
WHO also participated as an expert in the development of global tools, such as the GER marker, the methodology to reorient health policies and programmes towards health equity, and human rights criteria and attributes, as well as participation in global GER Network coordination and planning meetings in 2014 and 2015. In addition, a number of regional tools, such as regional fact sheets on gender and health, equity and health and violence against women, as well as eight country fact sheets on gender and health were developed. An Orientation Workshop on Universal Health Coverage and Mainstreaming Gender, Equity, Gender and Human Rights was organized in Manila for Regional Office and country office staff to support capacity-building and the rollout of tools on GER mainstreaming. WHO also participated in regional events organized by partners on older people's rights and the Beijing+20 Asia Pacific review, among others. 3.3.2 Countries’ capacity strengthened to integrate and monitor gender, equity and human rights in their health policies Appraisal: Fully achieved
Comments on achievements There was growing awareness and commitment across countries in the Western Pacific Region to integrate and monitor GER in their health policies, programmes and actions. GBV and violence against women remained serious concerns in many countries in the Region, resulting in increasing requests for WHO support in several Member States. WHO engaged in technical collaboration with several Member States (KHM, CHN, FJI, KIR, LAO, MNG, PNG, SLB and VNM) to integrate and monitor GER in their health policies, programmes and actions. Partnerships were fostered, including through participation in regional events organized by partners on older people's rights and the Beijing+20 process. The regional Beijing+20 review process increased awareness in Member States on gender and women’s rights issues and provided renewed impetus for action. Various analytical and technical documents were developed as a basis for policy advocacy and dialogue on GER, which included three regional fact sheets and eight country fact sheets. A regional capacity-building and training of trainers workshop on health equity monitoring with participation from KHM, CHN, LAO, MNG and VNM was also organized, and Member States’ participation in a biregional consultation on the draft global plan on the health sector response to interpersonal violence, in particular against women and girls, and against children, was facilitated.
WPR/RC67/3 page 70 Annex Social determinants of health 3.4.1 Increased country capacity to implement a health-in-all policies approach, intersectoral action and social participation to address the social determinants of health Appraisal: Fully achieved
Comments on achievements An SDH approach was integrated into a newly developed Western Pacific regional action framework entitled Universal Health Coverage: Moving Towards Better Health, which was endorsed by the sixty-sixth session of the Regional Committee in 2015. This paved the way for implementation of healthy public policies as a core part of UHC. WHO’s work in this area was also strengthened by efforts at the regional level to build partnerships, including with the Alliance for Healthy Cities on age-friendly cities and with the WHO Kobe Centre on development of indicators for age-friendly cities and on updating the 10-steps document on intersectoral action. Evidence to inform policy advocacy and dialogue was strengthened through an analysis of access to health services by migrants in Mekong countries and fact sheets on equity and health, gender and health and violence against women. In collaboration with the Integrated Service Delivery unit, a template for regional analysis on health literacy in the Western Pacific Region was commissioned and a report on health literacy for AUS was drafted.
Seven Member States (CHN, FJI, KIR, LAO, MNG, TON and VNM) showed enhanced interest in implementing a health-in-all-policies approach, intersectoral action and social participation to address the SDH. In CHN, a project on empowering women for smoke-free homes in Tianjin City was implemented with WHO support. In LAO, the NCD strategy and policy, which addressed the reduction of social and health risk factors, was integrated into the Eighth Health Sector Development Plan of the MOH. Strong and extensive advocacy was undertaken to promote tobacco-free environments and increase tobacco taxation. Support was provided to the MOH, other sectors and
the National Assembly in responding to cross-cutting health issues, such as emerging infectious diseases, smoking and other NCDs. In MNG, subnational health capacity-building and planning integrated health-in-all policies and social determinants, together with GER issues, advanced with WHO support. Pacific island countries established a United Nations Pacific Interagency Task Force on NCD to improve coordination between United Nations agencies on NCD prevention and control and to integrate NCD and other health issues into the development agenda of multiple sectors. A health impact assessment was carried out on the Regulations on Marketing Food and Beverages to Younger Children in FJI. Island HEART (the Pacific version of Urban HEART) was piloted in FJI as part of a Healthy Cities initiative. In KIR, training MOH staff on SDH and UHC was conducted with
WPR/RC67/3 page 71 Annex technical input from WHO. In TON, top leaders in the MOH emphasized a health-in-all-policies approach. In VNM, technical support was provided for a study integrating a focus on equity and SDH into national health sector policies and plans to inform policy dialogue on health policy and planning.
3.4.2 Effective guidance to countries to mainstream social determinants of health in all WHO programmes Appraisal: Fully achieved
Comments on achievements A high-level side event on SDGs was organized at the sixty-sixth session of the WHO Regional Committee for the Western Pacific in order to update Member States on the process and status of negotiations on the SDGs with a focus on health as a cross-cutting concern. Thirty posters on the SDGs and the health targets were developed and disseminated. In WHO, efforts were made to address SDH in programme areas such as ageing and health, urban health and UHC. Other
achievements included participation as an expert in the development and updating of global tools such as the methodology to reorient health policies and programmes towards health equity, the 10-step document on intersectoral action by the WHO Kobe Centre and the country framework on HiAP by the Health Promotion department in WHO headquarters, as well as the development of regional tools, such as a fact sheet on equity and health and a regional fact sheet on violence against women. To accelerate and coordinate action on the SDG agenda, the Regional Office created a cross-divisional working group on Gender and Social Determinants and another on the MDGs and SDGs as part of the Standing Committee on Health Information.
At the country level, briefings and orientations were conducted for country office staff during country visits in order to raise awareness of and build capacity for mainstreaming SDH. In LAO, gender and equity issues were integrated across WHO work plans and joint plans with other partners. In MNG, the first meeting of the National Multisectoral Committee on Health was organized in April 2014, and the memorandum of understanding on multisectoral collaboration and HiAP for each ministry's action was discussed and signed.
WPR/RC67/3 page 72 Annex Health and the environment 3.5.1 Country capacity strengthened to assess health risks, develop and implement policies, strategies or regulations for the prevention, mitigation and management of the health impacts of environmental risks Appraisal: Fully achieved
Comments on achievements WHO supported Member States in strengthening their national capacity to assess risk and to develop appropriate response plans to address environmental and occupational hazards to health. These included draft outlines of environmental health profiles of Member States of the Regional Forum on Environment and Health in Southeast and East Asian Countries (KHM, LAO, MYS, MNG, PHL, KOR, SGP and VNM), detailed profiles on climate change and health vulnerability assessments (KHM, CHN, LAO, MYS, PNG, PHL and KOR); and draft occupational health country profiles (VNM).
In water and sanitation, WHO supported Member States to develop and strengthen the legal and institutional framework on drinking-water quality through the WSP mechanism (KHM, CHN, COK, FJI, PYF, LAO, MYS, MNG, PHL, WSM, TON, VUT and VNM), including training on WSP and household water treatment and safe storage systems at the household level. WHO supported Member States in the monitoring and reporting of the MDG targets on water and sanitation (WHO/UNICEF Joint Monitoring Programme Report 2014) and on GLAAS (AUS, KHM, COK, FJI, JPN, LAO, MNG, PHL, TON, VUT and VNM). A new initiative was carried out in PHL that piloted a sanitation safety plan at the district level. Workshops were held to train environmental health officers on water safety planning and health impacts of climate change (COK, FJI, PYF, GUM, KIR, MHL, FSM, NRU, MNP, PLW, WSM, TON and VUT).
On air pollution, WHO collaborated with Member States in developing strategies for the prevention, control and mitigation of the adverse effects of air pollution on health by organizing an informal consultation with air quality and health experts. This consultation enabled stocktaking of existing evidence of the effect of air pollution on health in the Region. As air pollution is becoming a growing concern in urban areas of the Pacific island countries and areas, a health impact assessment of air pollution in mining areas was carried out in NRU.
In the area of climate change, WHO supported Member States (KHM, CHN, LAO, MYS, PNG, PHL and KOR) to develop detailed profiles on climate change and health vulnerability assessments to be
WPR/RC67/3 page 73 Annex published in Climate Change and Health in the Western Pacific Region: Synthesis of Evidence, Profiles of Selected Countries and Policy Direction. A similar report was being drafted for Pacific island countries and areas, including a detailed health vulnerability assessment related to climate change for 13 countries (COK, FJI, KIR, MHL, FSM, NRU, NIU, PLW, WSM, SLB, TON, TUV, and VUT). WPRO, together with SEARO and the German Agency for International Cooperation, organized biregional training on climate change and health in Yogyakarta, Indonesia. Officials attended from the ministries of health and environment from KHM, LAO, PNG, PHL, WSM, TUV and VNM. For the Pacific island countries and areas, a workshop on climate change and vector-borne diseases was held in Suva in February 2015. WHO also supported CHN, MYS and PHL to develop climate and health country profiles as part of the Global Overview of Climate and Health Country Profiles – an advocacy document for the 21st Conference of Parties (COP21) on United Nations Framework Convention on Climate Change meeting held in Paris in December 2015.
With health-care waste being one of the major problems in the Region, WHO supported Member States in publishing the Status of Healthcare Waste Management in Selected Countries of the Western Pacific Region. In LAO, the WHO Training Modules on Basic Healthcare Waste Management was translated and adapted into Lao, and IEC materials on proper segregation of health-care waste and proper management of mercury spills were developed. In MNG, the Environmental Hygiene
Requirements for Healthcare Facilities was launched and training activities were conducted among the health-care personnel in the country.
WHO, in collaboration with the KOR Ministry of Environment, organized the First Regional Training on Health, Environment and Development in 2015, with participants from KHM, CHN, FJI, GUM, LAO, MYS, FSM, MNG, PLW, PHL, WSM and VNM). In FJI, a curriculum on environmental health was developed by Fiji National University in collaboration with the Ministry of Health and WHO for the training of environmental health officers in the Region. WHO also worked closely with the Northern Pacific Environmental Health Association to facilitate training workshops on environmental health held in Pohnpei in the Federated States of Micronesia in May 2014 and in Guam in September 2015.
WPR/RC67/3 page 74 Annex 3.5.2 Norms, standards and guidelines to define environmental and occupational health risks and benefits associated with air quality, chemicals, water and sanitation, radiation, nanotechnologies, and climate change Appraisal: Fully achieved
Comments on achievements In water and sanitation, WHO supported Member States in the development and strengthening of water quality standards and guidelines, especially the legal framework to institute WSP at the national level (KHM, CHN, COK, FJI, PYF, LAO, MNG, PHL, WSM, TON, VUT and VNM). The
development or revision of drinking-water quality standards was also supported select Member States (KHM, CHN, COK, MNG, PHL, WSM and VUT).
In the area of climate change, WHO published Climate Change and Health in the Western Pacific Region: Synthesis of Evidence, Profiles of Selected Countries and Policy Direction, which included a chapter on Policy Direction for the Health Sector Role in Climate Change. This provides policy guidance to Member States to strengthen health sector resilience and health impact assessment tools due to climate change.
On air pollution, WHO worked closely with the Clean Air Asia (one of the partners of the Thematic Working Group on Air Pollution of the Regional Forum on Environment and Health in Southeast and East Asian Countries) to develop a draft Guidance Framework for Better Air Quality in Asian Cities, which was intended to provide guidance in implementing the long-term vision for urban air quality in Asia by 2030.
On occupational health, WHO supported VNM in its efforts to eliminate ARD by including the listing of chrysotile asbestos in Annex III of the Rotterdam Convention and eventual ban of asbestos in its national programme. VNM also developed a National Action Plan for Elimination of Asbestosrelated Diseases based on WHO and International Labour Organization outlines for the development of national programmes for elimination of ARDs.
WPR/RC67/3 page 75 Annex 3.5.3 Public health issues incorporated in multilateral agreements and conventions on the environment and sustainable development Appraisal: Fully achieved
Comments on achievements WHO supported Member States (BRN, KHM, CHN, JPN, LAO, MYS, MNG, PHL, KOR, SGP, and VNM) in convening the high-level meeting of the Regional Forum on Environment and Health in Southeast and East Asian Countries in Bangkok. In collaboration with KOR, WHO supported Member States to participate in thematic working group meetings on Health Impact Assessments in Seoul and in the International Workshop on Children's Environmental Health for Developing Countries in Asia.
CATEGORY 4. HEALTH SYSTEMS
Health systems based on primary health care, supporting universal health coverage Summary of progress and achievements National health policies, strategies and plans
The regional action framework for UHC, Universal Health Coverage: Moving Towards Better Health, was endorsed at the sixty-sixth session of the Regional Committee for the Western Pacific in October 2015. The framework supports national health policy and planning processes in countries to
accelerate progress on UHC. WHO has also worked with national governments in the development and implementation of specific country-based UHC plans and activities, including evidence generation, policy dialogue, technical assistance, experience sharing and capacity-building. Specific achievements by countries in the Region during the biennium include the completion of national health plan reviews in 11 countries, and the institutionalization of national health accounts in eight countries. Legislative and regulatory reform is emerging as a priority intervention in the Region. WHO support in this area is increasing accordingly.
Close collaboration across organizational levels of WHO and with partners to sustain support in countries was clearly identified as the major challenge in making progress. Key assumptions and risks common to all areas of support included coordination and alignment between WHO regional and country offices (including issues of capacity at country offices), aid effectiveness and coordination
WPR/RC67/3 page 76 Annex with development partners, effective leadership, limited capacity and resources at ministries of health, coordination between the ministry of health and subnational government and other health sector stakeholders, frequent changes in leadership within ministries of health, and the impact of politics and elections. Integrated people-centred health services
In the area of service delivery, the main achievements relate to health workforce development and regulation, service quality and patient safety, and the integration of traditional and complementary medicine with national health systems. In the area of health workforce, WPRO supported Member States in updating and strengthening the regional database on the health workforce, developing health workforce plans, human resources for health (HRH) country profiles, and policy briefs on workforce regulation and mobility. WPRO worked closely with countries undergoing health reforms, such as CHN and LAO, providing insight into the development of strategies to strengthen the requirements and retention of primary health-care workers. Three-hundred and thirty individuals benefitted from WPRO’s education and training programmes during the biennium.
In the area of patient safety and quality, a policy roundtable in HOK in 2015 and the Capacity Development Consultation to Improve Patient Safety in the Western Pacific Region in 2014 built country capacity in adverse event reporting and monitoring; the utility of clinical guidelines, professional standards and quality committees; the regulation of quality in health services; and the use of financial incentives to improve quality. In collaboration with WHO collaborating centres, two hospital quality-management courses were conducted in JPN with participants from KHM, FJI, LAO, MNG and VNM. At the country level, WPRO provided support for the revision and/or development of guidelines including MPA guidelines to strengthen primary health-care services in KHM, health facility guidelines in LAO, and primary health-care regulations in MNG. The traditional and complementary medicine agenda was further developed, with concrete plan of action to be followed in the next biennium.
Support was provided to Member States in their efforts to integrate traditional and complementary medicine into their national health systems. This included the development of policies and tools at both the regional and country levels. The expert consultations in Jeju and Manila (2015) prioritized actions in four main domains: traditional medicine (TRM) regulation, education, information and service-delivery models. Substantive country policy and regulation support on TRM was given in KHM, LAO and PNG.
WPR/RC67/3 page 77 Annex Main challenges were associated with evolving population health and health service needs and the difficulty of many health systems to cope with these changes. While many country strategies and plans have a UHC orientation with focus on integration, quality and patient safety, the implementation pace of those strategies has been slow. A narrow focus on qualifications of individuals rather than the workforce in some countries, as well as workforce migration and impact of foreign-trained overseas workforce in small Pacific island countries, has been a particular challenge. In addition, there are persistent knowledge and experience gaps in management and leadership that affect the quality and speed of reform. Inadequate financing, particularly for preventive, public health work, as well as misplaced incentives for people-centred care, were often cited as the barrier to reform. Relatively weak country regulatory capacities and frameworks were among other obstacles for programme development and implementation.
Access to medicines and health technologies and strengthening regulatory capacity
The approval of the Action Agenda for Antimicrobial Resistance in the Western Pacific Region at the sixty-fifth session of the Regional Committee in October 2014, and other subsequent efforts provided opportunities for renewed actions to tackle the irrational use of antimicrobials and other health system factors increasing antimicrobial resistance (AMR). Several countries progressed with the
development of comprehensive multisectoral national action plans to tackle AMR. In the GMS, addressing pharmaceutical system weaknesses by ensuring access to quality malaria health products helped reduce the risk of the emergence and spread of artemisinin-resistant malaria. To preserve the efficacy of artemisinin-based therapies for malaria, the integrity and reliability of national medical product supply chains and logistic information systems had to be improved. During the biennium, there was strong interest on regulatory system strengthening among Member States and other partners as shown by an increasing number of programmes and related activities in countries. New innovative partnerships like the Pandemic Influenza Preparedness Framework became an important source of support for regulatory system strengthening in two resource-constrained countries in the Region. More effective regulation of health technologies contributed to safe use and availability of quality health products and to reduction of risks associated with use of ineffective and poor-quality health products.
Limited institutional capacity and human resources in the national agencies responsible for procurement and supply chain management, regulatory functions and rational use of medicines remained a challenge at the country level and continued advocacy for sufficient national inputs and political support remained a challenge. Inadequate financing mechanisms for national regulatory
WPR/RC67/3 page 78 Annex agencies, procurement agencies and medical stores and/or lack of efficient priority-setting mechanisms also served as barrier to access to essential health technologies. The potential
introduction of new preventive medicines such as new vaccines and curative therapies such as hepatitis treatment posed a challenge, both in terms of financing and efficient supply chains to deliver these equitably to those in need. Health systems information and evidence
Significant progress was made in developing new regional SDGs and UHC monitoring and evaluation frameworks. A set of core indicators was drafted and work was successfully done in undertaken countries (KHM, LAO and PHL) to demonstrate their priorities and the variances in measuring UHC.
Strengthening the research agenda was a priority, and several countries worked and/or institutionalized national online health research management systems (portals) with positive impact on quality and accountability. Major progress was achieved in online data repositories and/or research projects generating evidence for health policies and programmes, leading to policy changes. Established partnerships and networks created opportunities to promote better use of information and communications technology in health in the Region and to discuss relevant themes such as the use of big data and maximizing the potential of health insurance data systems in support of UHC.
A comparative analysis of UHC performance was undertaken using WPRO’s Health Information and Intelligence Platform (HIIP) and draft products for broader consultation. WPRO also collaborated with Organisation for Economic Co-operation and Development (OECD) in producing the report Health at a Glance: Asia/Pacific 2014. The knowledge management tools – WPRO health research portal, Western Pacific Region Index Medicus (WPRIM) and WHO collaborating centre database – were successfully maintained to support and/or establish innovative national systems across selected countries in the Region.
The Asia Pacific Observatory on Health Systems and Policies (APO) continued to generate updated and relevant evidence through a strong pipeline of products. An external evaluation led to important changes in the APO governance structure, and at the end of 2015 partners unanimously agreed to transfer APO from WPRO to SEARO in early 2016.
The essential harmonization and alignment of indicators at the global, regional and country levels remained a challenge. Better coordination of technical support on health information system
WPR/RC67/3 page 79 Annex development and e-Health could improve efficiency. Standardization of health data definitions and use of unique identifiers for patients, providers and facilities should be promoted. Limited domestic contributions and excessive and/or exclusive reliance on donors to support national research priorities posed a major constraint in some Member States.
ASSESSMENT OF PROGRAMME OUTPUTS National health policies, strategies and plans 4.1.1 Advocacy and policy dialogue to support countries to develop comprehensive national health policies, strategies and plans Appraisal: Fully achieved
Comments on achievements A milestone achievement was the endorsement of the regional action framework, Universal Health Coverage: Moving Towards Better Health, at the sixty-sixth session of the Regional Committee for the Western Pacific in October 2015.
Significant progress was made by countries across the Region in relation to the development, implementation, monitoring and review of national strategies, policies and plans. WPRO support was provided to BRN, KHM, FJI, KIR, LAO, MYS, FSM, NRU, PLW, TON, SLB and TUV in the development of national health plans, and to CHN, MHL, FSM, NIU, NRU, PNG, PHL, PYF, SLB, TOK, TON, VNM and WSM on related activities. Other key strategies and policies developed during this period included health financing policy and strategies in KHM LAO, and VNM, and a subnational health development strategy in MNG.
At the regional and global levels, support focused on evidence generation, advice to and facilitation of policy dialogue, and capacity-building activities. Examples of support provided include facilitation of high-level policy dialogue (KHM, CHN, LAO and VNM) health sector reform and health financing policy development (KHM, CHN, LAO, MNG, PHL and VNM), policy dialogue on integration of Global Health Initiatives and concept note development for Gavi and the Global Fund (KHM and LAO), and hospital policy development (PLW and SLB). Capacity-building activities included training on national health plans, strategies and policies (NHPSP) at the national and subnational levels in MNG. Evidence generation included support to review NHPSPs (KHM, LAO, PLW and SLB), household survey analysis on equity in access to health services, financial risk protection (KHM, CHN, LAO, MNG and VNM); and benefit incidence analysis (MNG).
WPR/RC67/3 page 80 Annex 4.1.2 Country capacity to develop and implement legislative, regulatory and financial
frameworks strengthened by generation and use of evidence, norms and standards, and robust monitoring and evaluation Appraisal: Fully achieved
Comments on achievements Achievements were made in relation to development and use of national health counts and other health financing information and the establishment and use of monitoring and evaluation frameworks, as well as programmes of legislative and regulatory reform.
Regional support was provided to KHM, CHN, LAO, FSM, MNG, PNG, TON and VNM on health accounts development including a training workshop on the System of Health Accounts 2011 and health accounts production tool for nine Pacific island countries (FJI, KIR, FSM, PLW, PNG, WSM, SLB, TON and VUT).
Evidence generation for policy-making across the Region was strongly supported and continued to drive the integration of the three levels of the Organization. Reviews, studies and policy briefs in many different aspects of health systems were completed in many Member States and/or at the regional level, with different levels of participation and engagement from WPRO. Activities included regional support on annual health account updates for the World Health Statistics Report and the WHO Global Health Expenditure Database, and publication of health financial country profiles for WPR 1995–2011.
Legislative and regulatory reform was increasingly recognized as an important policy tool for government and had become an increasing focus of support by WPRO at the country and regional levels. Support was provided to specific reform activities in countries as well as regional initiatives. Expert networks within the Region have been developed which provide a platform for sharing experiences and joint learning, and are informed by analytical work. Specific knowledge products were developed on areas of law and health, including: a policy brief on the coherence between legislation and other policy instruments for better health systems performance in PNG; a draft report on hospital legislation development in selected countries; a database of health-related legislation; and a draft comparative analysis on infectious disease control legislation for selected countries in the Region.
WPR/RC67/3 page 81 Annex Integrated people-centred health services 4.2.1: Policy options, tools and technical support to countries for equitable people-centred integrated service delivery and strengthening of public health approaches Appraisal: Fully achieved
Comments on achievements Main achievements relate to setting and implementing a number of service delivery-related programmes and initiatives, particularly with regard to health workforce development and regulation, and the integration of traditional and complementary medicine with national health systems. The endorsement of the regional action framework, Universal Health Coverage: Moving Towards Better Health, at the sixty-sixth session of the Regional Committee for the Western Pacific was an important milestone to spell action domains and actions in relationship to integrated people-centred services.
Of particular significance was a policy brief on health worker mobility in ASEAN, and a policy brief on health workforce regulation that presented policy principles in relation to the design and implementation of an integrated system for the regulation of health practitioners. The important role of hospitals and secondary care institutions was underlined, in particular in working to ensure effective and safe services. This was further discussed at a regional expert consultation on hospital services and management in November 2014. The consultation proposed a technical framework on financing, feedback, regulation, ownership, governance and goals to analyse hospital regulation and management issues. This consultation was important not only as a contribution to the field of hospital services management, but also as a key component of overall strategic direction for WPR countries in connection to the movement towards UHC. This was highlighted in both capacity-building exercises in FJI (training for hospital chief executive officers) and JPN (training for policy-makers and hospital managers).
The integration of traditional and complementary medicine with national health systems has been an overarching agenda of WHO. In 2014, WPRO commissioned the report, Traditional and
Complementary Medicine Integration with National Health Systems, which enabled better understanding of integration. The expert consultation on TRM integration in Jeju, KOR, in May 2015 brought together researchers, government officials and WHO staff to identify priority actions, including regulation, information, education and integrated service-delivery models. Furthermore, an in-house expert consultation at the end of 2015 helped establish an action plan to support Member States in the next biennium and beyond.
WPR/RC67/3 page 82 Annex TRM work in and with countries included support to revise and further develop the national regulatory framework for TRM products in PNG. LAO was supported in strengthening laboratory testing of traditional medicines, and WHO facilitated the midterm review of the national TRM strategy and identified priority actions in KHM. There was also cross-country work on strengthening TRM information systems with WHO collaborating centres, including the development of indicators and TRM dashboards, as well as TRM country profiles.
The major challenge was to connect and promote integrated approaches in the implementation of disease programmes. 4.2.2 Countries enabled to plan and implement strategies that are in line with WHO’s global strategy on HRH and the WHO Global Code of Practice on the International Recruitment of Health Personnel Appraisal: Fully achieved
Comments on achievements During the biennium, WPRO continued to advance implementation of the Regional Strategy on Human Resources for Health 2006-2015. With three countries in the Region being among
57 countries with critical HRH shortages (KHM, LAO and PNG), WPRO support was provided to update and strengthen the regional database on the health workforce, provide expertise where additional capacity was needed in specialized areas of human resource strengthening and quality assurance and adapt to the regional context WHO’s guidelines for transforming and scaling up the education of health personnel.
As more countries in the Region recognized the importance of HRH planning for achieving UHC; WPRO supported the development of HRH plans and the completion of 14 HRH country profiles. A framework for health labour market analysis was also developed. WPRO worked closely with countries undergoing health reform such as CHN and LAO by providing insight into the challenges of HRH and the development of strategies to strengthen the requirements and retention of primary health-care workers.
Health workforce regulation was a key focus for the biennium, and through an informal expert consultation on health workforce regulation held in Melbourne, Australia, it was concluded that regional collaboration was essential as was the development of a standardized approach to regulation in the Region. A policy brief stemming out of the Melbourne consultation has been published.
WPR/RC67/3 page 83 Annex Another key focus of the HRH agenda was health workforce mobility, with efforts made to continue the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. The Pacific health workforce mobility project was commissioned to provide insight into the dynamics and implications of HRH migration in Pacific island countries.
There was also significant progress in WPRO’s education and training programmes, with 330 individuals participating in the fellowships programme, the Global Health Learning Centre, the Health Leadership and Development Initiative and short study tours during the biennium.
An in-house expert consultation was held in December 2015 to prioritize and plan for the 2016–2017 biennium and advance the health workforce agenda.
4.2.3 Guidelines, tools and technical support to countries for improved patient safety and quality of services, and for patient empowerment Appraisal: Fully achieved
Comments on achievements WPRO was active in building Member States' capacity in quality improvement and patient safety through policy roundtables and regional and subregional workshops. In collaboration with WHO collaborating centres, two runs of the hospital quality-management course were conducted in JPN with participants from KHM, FJI, LAO, MNG and VNM. WPRO also conducted a second in-country workshop on Patients for Patient Safety in MYS, in collaboration with the Ministry of Health and the Malaysian Society for Quality in Health, which informed country participants on the usefulness and utility of this WHO global initiative. The Capacity Development Consultation to Improve Patient Safety in the Western Pacific Region, held in June 2014, produced several policy recommendations and good practice points for Member States to consider. The roundtable in HOK was another important milestone in setting patient safety and quality agenda. Close collaboration with SEARO and OECD continued with the implementation of a QoC infrastructure survey among WPR countries during the 2014 meeting, which also led to the publication of Health at a Glance, Asia/Pacific 2014. The 2015 meeting in Kuala Lumpur hosted a side event on Patients for Patient Safety.
At the country level, WPRO provided support for the revision of the MPA Guidelines in KHM, an important step towards strengthening primary health-care services. In LAO, WPRO contributed to the development of health facility guidelines. In MNG, WHO assisted in the review of guidelines and regulations used at primary health-care levels, and conducted assessments of capacity at selected
WPR/RC67/3 page 84 Annex aimag (provincial) and inter-soum (district) hospitals and soum health centres on the provision of emergency and surgical care. In MYS, support was provided in the development of indicators in quality and safety for performance of health-care systems, and national evidence-based clinical practice guidelines. In PHL, training on patient safety and quality of health services, particularly in the typhoon-affected areas, was supported. In PNG, all health facilities in Bougainvillea were
assessed based on the national health service standards. In VNM, WHO provided support in the development of quality indicators and implementation of monitoring of medication errors including appropriate guidelines as part of the overall patient-safety programme. Access to medicines and health technologies and strengthening regulatory capacity 4.3.1: Countries enabled to develop or update, implement, monitor and evaluate national policies on better access to health technologies; and to strengthen evidence-based selection and rational use of health technologies Appraisal: Fully achieved
Comments on achievements The work addressing AMR at the Regional Office and country offices was a major flagship programme with multiple countries (KHM, COK, FJI, LAO, MNG, PHL and WSM) through development and implementation of comprehensive national action plans to combat AMR and improve antibiotic stewardship. Multiple advocacy tools were developed in conjunction with the Action Agenda for Antimicrobial Resistance in the Western Pacific, such as the training package on antimicrobial stewardship in hospitals, and the successful antibiotic awareness campaign in 2015 with multiple high-profile country activities across the Region using innovative campaign methods, such as social media.
A study was conducted to estimate the economic burden associated with AMR in the Western Pacific Region by applying a methodological framework that analyzed data of AMR trends, consumption of antibiotics, and mortality and morbidity attributable to AMR collected from the Region.
WPRO supported BRN, KIR, MHL, MNG, PNG and VNM to revise and update national policies on access, quality, and use of medicines and health technologies. WPRO assisted Member States in various areas from assessing medicine prices and availability to strengthening capacity in policies, regulation and supply chain management on medicines, traditional medicines and health technologies. The meetings on Access to Medicines under Universal Health Coverage in the Asia Pacific Region in September 2014 and September 2015 in Seoul were attended by 14 Member States. The meetings
WPR/RC67/3 page 85 Annex solidified interest and commitments to share knowledge and experiences on medicine selection, pricing and utilization policies that could help achieve equity in access to essential health products under UHC. A workshop on using Health Technology Assessment (HTA) for UHC in August 2015 in Cebu, Philippines, attended by 15 countries, recognized HTA as an important tool for optimal use of resources and decision-making processes. Also, an International Technical Consultation on Tissue and Organ Donation/Transplantation in the Western Pacific Region was held in February 2014 in Seoul, at which recommendations were made for urgent action to increase organ tissue donation according to globally accepted ethical standards. 4.3.2 Implementation of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property Appraisal: Fully achieved
Comments on achievements Addressing trade-related intellectual property rights in the context of regional trade agreements remained a high priority in several countries, due to its potential adverse impact on affordability of innovative health technologies. The approval of the Trans-Pacific Partnership Agreement (TPPA) by several countries in the Region heightened such risk. Countries continue to face problems in
collecting data on research and development (R&D) investments from the private sector, as information was not always shared with governments. Likewise, there was no simple mechanism to collect R&D investment data for research that did not involve human subjects or was not classified as a “clinical trial”. In addition, no official mechanism required Member States to report data to WHO and/or make it publicly accessible. WPRO collaboration with ASEAN Member States continued in terms of technical support and discussions of the impact of TPPA, but limited resources hampered further work.
In KHM, WHO and other United Nations agencies provided technical assistance on trade-related intellectual property rights and on a compulsory licensing law. With WPRO support and as part of a global strategy and plan of action on public health innovation and intellectual property, FJI, LAO, PNG and PHL developed national health research and clinical trial registries, guidelines, and standard operating procedures for the ethical conduct of research. In VNM, WPRO supported the Government in strengthening policy towards public health orientation of its local pharmaceutical production. The analysis of the implications of trade agreements and the application of intellectual property rights to access to essential medicines and technologies assisted this process and strengthened national capacity
WPR/RC67/3 page 86 Annex for the implementation of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).
In collaboration with the hepatitis working group, a survey analysing critical access barriers to new hepatitis medicines across the Region was completed. Likewise, a six-country study (AUS, MYS, MNG, NEZ, PHL and SGP) on the ethical implications of pharmaceutical promotion and potential adverse effects on access to medicines was completed. 4.3.3 Strengthening national regulatory authorities facilitated; norms, standards, guidelines for medical products developed; and quality, safety and efficacy of health technologies ensured through prequalification Appraisal: Fully achieved
Comments on achievements The Region has seen an increasing demand to strengthen regulatory capacity and to reduce the risk of harm from poor-quality pharmaceuticals, vaccines and traditional medicines, especially from developing countries. Development partners have launched several initiatives under the joint
frameworks of the Asia Pacific Leaders Malaria Alliance and the Pandemic Influenza Preparedness Network, and were supported by regulatory agencies from developed countries. National regulatory authorities (NRAs) in the Region launched a regional alliance for assuring the quality of vaccines in collaboration with WHO. WPRO continued to be engaged in global dialogues to shape WHO policies and tools (NRA assessments, prequalification schemes), and subsequent policy dialogues at regional and national levels in order to implement the recommendations arising from World Health Assembly resolution WHA67.20 on Regulatory system strengthening for medical products.
In the area of traditional medicine, WPRO’s efforts focused on safety and the quality of product and practices through adequate regulation and improved data availability.
In KHM, medicines regulation and quality-assurance practices were strengthened through the development and implementation of a series of good practice guidelines (pharmacy, storage, pharmaceutical waste disposal, medicines donations) and standard operating procedures (pharmacovigilance), and participation in technical consultations on medicine pre-qualification. KHM also began the central registration of all vaccines, irrespective of public or private sector use. In CHN, efforts on regulatory work led to its recognition as an advanced international standard regulator and the retention of WHO’s functionality status for vaccines. In FJI, efforts concentrated on
WPR/RC67/3 page 87 Annex regulation mechanisms (product registration and advertisement) and regulatory authorities (traditional medicines, supply chain management, quality assurance and evidence-based planning) and continued capacity development initiatives for laboratory and pharmacy management.
In LAO, pharmacovigilance capacity was strengthened through training and system development. KHM and LAO conducted NRA assessments and developed a comprehensive institutional development plan to strengthen their regulatory systems. MYS conducted global-level training on good practices for medicines and various health technologies, as well as good manufacturing practices inspection and analytical method validation training. In MNG, an assessment of traditional medicine research was conducted and the capacity of MOH staff and traditional medicine schools strengthened through various trainings and workshops. NRU reviewed its standard treatment guidelines and inventory management tools. PNG developed a strategic plan for strengthening medicines regulation including the development of a national medicines quality-control laboratory. consultative processes for medicines legislation reviews were conducted. Furthermore,
In PHL, efforts to strengthen regulatory authorities progressed in three fronts: capacity to report and monitor haemodialysis-related adverse effects; norms for care (formulary manual); and quality assurance for vaccines as PHL has shifted from UNICEF to Government procurement of vaccines for the national immunization programme. PHL’s regulatory system strengthening focused on marketing authorization, clinical trial oversight, regulatory inspections and post-market surveillance including the establishment of NRA lot release of imported vaccines, and vaccine pharmacovigilance including adverse events following immunization. In the Pacific, through the Pacific Open Learning Health Net, several Member States were able to strengthen their NRAs on safety and quality management of laboratory systems. WSM finalized its national laboratory policy and strategic plan, and TUV developed national guidelines for evidence-based selection and the rational use of health technologies. In VNM, the NRA was strengthened through the adoption of internationally established standards and norms and adherence to international harmonization schemes. The regulatory system for vaccines for the first time met with WHO’s predefined criteria for functionality.
WPR/RC67/3 page 88 Annex Health systems information and evidence 4.4.1 Comprehensive monitoring of the global, regional and country health situation, trends and determinants, using global standards, and leadership in the new data generation and analyses of health priorities Appraisal: Fully achieved
Comments on achievements WPRO continued to provide support to Member States (KHM, CHN, LAO, PHL, SLB and VUT) in strengthening national health information systems (HIS) and civil registration and vital statistics systems by improving data collection, analysis and the use for evidence-based decision-making to improve health. Training on data quality analysis and data use was held in KHM, KIR, LAO, MNG and TON. In addition, a data analysis and report writing workshop was held in the Pacific in collaboration with the Secretariat of the Pacific Community to assist with better analysis and use of health information. At the regional and global levels, routine data collection initiatives continued for the Country Health Information Profiles and the Health Information and Intelligence Platform (HIIP). Enhancements were made to HIIP to include the UHC M&E dashboard and additional dashboards, features and functionality based on indicators available.
In line with preparation for the 11th Pacific Health Ministers Meeting, a review of the 20-year journey towards the vision of Healthy Islands was completed with an analysis of key health indicators in the Pacific. 4.4.2 Countries enabled to plan, develop and implement an e-Health strategy Appraisal: Fully achieved
Comments on achievements WPRO supported the development and implementation of national e-Health strategies in eight countries of the Region. Policy dialogue on e-Health was initiated through a series of meetings, training sessions and roundtable discussions through the Region’s networks and peers. An initial eHeath assessment was conducted in KHM. MNG, PNG and VNM reviewed and discussed the strategy and the need for it, while LAO finalized a draft strategy. PHL developed a national e-Health strategy that followed the WHO e-Health framework. In NRU, the e-Health strategy was part of the overall strategic health planning.
WPR/RC67/3 page 90 Annex of the APO from WPRO to SEARO was agreed upon by all partners. The Research Hub Network was renewed through a competitive call for proposals.
4.4.4 Policy options, tools and support provided to define and promote research priorities, and to address priority ethical issues related to public health and to research for health Appraisal: Partly achieved
Comments on ac hiev eme nts As increasing unethical practices continued to pose a major challenge to UHC, WPRO worked on the assessment of ethical issues in routine health service delivery in the Region. With support from
WPRO, substantial progress was made in KHM, FJI, LAO, MNG, PNG and PHL in articulating appropriate policies and establishing health research governance and management systems, including research ethics that provide a solid foundation for future evidence-informed policy-making. However, limited national funding as well as excessive reliance on donor support for national research priorities in some developing countries has negatively impacted on the ability to strengthen national health research systems.
In LAO, a research-reporting platform for sharing research topics was established.
A large
operational research project on community-based health workers, supported by WHO, was used by the MOH in developing the role and functions of village health workers. Improvements continued in the national HIS through the use of web-based applications, which were rolled out nationwide with related training. In MNG, five priority research proposals were selected in collaboration with WPRO, enhancing national-level capacity. Workshops on public health research prioritization and health In PNG, a
systems research were also organized, as well as training on health research portals.
workshop on health research governance was conducted in 2015. In PHL, the Research Institute for Tropical Medicine (RITM) was supported to become a Regional Training Centre, networking with national institutions and developing generic training materials to build health research capacity in the Region. Support was also provided to Food and Drug Administration (FDA) of the Philippines to streamline clinical trial regulations and oversight mechanisms. In VNM, a national health research agenda and ethical standards for clinical trials were developed with support from WPRO.
Two important meetings were organized in 2015: a regional meeting on applied research on health policy and systems to support UHC; and a regional meeting on maximizing the potential of health insurance data systems to support UHC.
WPR/RC67/3 page 91 Annex
CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
Reducing mortality, morbidity and societal disruption resulting from epidemics, natural disasters, conflicts, and environmental and food-related emergencies through prevention, preparedness, response and recovery activities that build resilience and use a multisectoral approach Summary of progress and achievements The Western Pacific Region continues to be a hotspot for emerging infectious diseases and has been prone and vulnerable to emergencies and disasters. Ongoing emerging infectious disease threats, such as H5N1, H7N9, and Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and devastating disasters, such as Typhoon Haiyan and Typhoon Koppu in PHL, flooding in SLB and Cyclone Pam in the Pacific island countries, caused enormous health and socioeconomic impacts. The unprecedented Ebola virus disease (EVD) outbreak in West Africa was declared a public health emergency of international concern in August 2014. Though no confirmed cases of EVD were reported in the Region, this large-scale outbreak tested the level of regional preparedness as well as regional ability to support the global response.
Accelerated efforts were made by Member States, WHO and other partners to tackle the challenges of emerging infectious disease threats, food safety, and emergencies and disasters in the Region. These efforts were guided by the global mandate of the International Health Regulations (2005), or IHR (2005), and the health cluster approach, as well as by four key regional and global strategies and frameworks: the Asia Pacific Strategy for Emerging Diseases (APSED), the Western Pacific
Regional Food Safety Strategy 2011–2015, the Polio Eradication and Endgame Strategic Plan 2013– 2018 and the Western Pacific Regional Framework for Action for Disaster Risk Management for Health. Of the Region’s 27 IHR States Parties, 18 reported meeting IHR core capacity requirements by June 2014. Implementation of APSED enabled Member States to respond effectively to emerging disease threats. WPRO continued to strengthen regional preparedness capacities through the regional surveillance and response platform. The TAG meeting in 2015 reconfirmed APSED’s relevance and recommended that WHO develop an updated APSED. The consultation process for the updated APSED was consequently launched.
WHO coordinated health sector response and recovery from acute emergencies. Through emergency operations centres (EOCs) at WPRO and in country offices, WHO supported response to public health events and emergencies, such as human infection with avian influenza A(H7N9) in CHN, measles and
WPR/RC67/3 page 92 Annex dengue outbreaks in Asia and Pacific island countries and areas, the MERS outbreak in KOR, and the circulating vaccine-derived poliovirus (cVDPV) outbreak in LAO. EVD had become one of the top priorities in the Region. Under the Regional Director’s leadership, the Western Pacific Region Ebola Support Team was deployed to Sierra Leone in West Africa in December 2014. National experts from seven Member States participated in the global response. WPRO further supported
strengthening of preparedness capacities in Member States through the development and implementation of the Ebola Virus Disease: A Framework for Action in the Western Pacific Region and the Western Pacific Regional Framework for Action for Disaster Risk Management for Health. Technical support was provided to Member States in developing or updating and implementing their own national frameworks for action.
Progress was made in implementing the Western Pacific Regional Food Safety Strategy 2011–2015. Efforts focused on the development of regional tools for country adaptation, provision of countryspecific technical assistance, and strengthening multisectoral collaboration and cross-programme linkages to better manage food safety throughout the food chain. Linkage between disaster risk management (INFOSAN) and IHR contact points was strengthened via simulation exercises. Several Member States strengthened their legal frameworks for food safety and quality with new food laws and regulations. Regional and national capacity-building activities, including risk-based food
inspection, were conducted. The Food Safety Cooperation Working Group had served as a regional platform for coordination and information sharing among development partners.
The Region retained its polio-free status during this biennium, and the Polio Endgame in the Western Pacific Region 2013–2018 to implement the global endgame strategy was developed and distributed to Member States. As part of the polio endgame, all 17 Member States that used an all-oral polio vaccine (OPV) schedule in their national routine immunization programme made formal commitments to introduce at least one dose of inactivated polio vaccine (IPV) before the end of 2015. In addition, all Member States using OPV were making preparations for the globally synchronized switch. To support surveillance in priority countries, an integrated vaccine-preventable disease
surveillance review that included an assessment of acute flaccid paralysis surveillance was conducted in LAO in 2015. LAO conducted a rapid response to a type 1 circulating vaccine-derived poliovirus outbreak that was detected in October 2015. In all, polio mass vaccination campaigns were conducted throughout the Region to boost population immunity. In 2014–2015, Member States provided more than 63 million doses of OPV to children through mass vaccination campaigns in KHM, CHN, LAO, MYS, PNG, PHL, VUT and VNM.
WPR/RC67/3 page 93 Annex
ASSESSMENT OF PROGRAMME OUTPUTS Alert and response capacities 5.1.1 Countries enabled to develop core capacities required under IHR (2005) Appraisal: Fully achieved
Comments on achievements WPRO completed the evaluation of APSED that would pave the way for a renewed regional strategy on health security. The evaluation confirmed the strategy's continuing relevance to developing IHR core capacities and significant contributions to collective health security in the Region, including EVD preparedness. With generic core capacity-building under APSED and IHR, EVD and MERS preparedness in the Region was established quickly. These events highlight the need to build
capacities in advance. APSED TAG meetings as well as APSED evaluation and outbreak reviews were conducted to review the progress of APSED/IHR implementation. Of the Region’s 27 IHR States Parties, 18 met the minimum core capacity requirements of IHR (2005) by the June 2014 deadline. Nine others (KHM, FJI, KIR, LAO, FSM, MNG, PNG, SLB and VUT) formally requested a final two-year extension to 2016.
KHM, LAO, MYS, MNG and VNM used the APSED M&E guide to implement their monitoring activities for APSED/IHR. These five Member States also held planning and review meetings in 2015. These meetings resulted in an annual national progress report, a review and update of the national APSED work plans and completion of the IHR monitoring tool. KHM, LAO, MNG and VNM also conducted outbreak reviews to determine strengths and identify gaps. Actions to improve outbreak detection and response were developed and implemented, such as revising procedures, strengthening of notifiable disease surveillance systems and workforce training.
Many Member States recognized that capability levels had increased; however, greater collaboration with concerned ministries and continuous capacity-building were still needed. To further strengthen Member State capacity, WPRO provided continuous technical advice in the areas of surveillance and risk assessment, laboratory strengthening, infection prevention and control, risk communication, and M&E via a series of informal consultations, regional training sessions, IHR exercises and external quality assessment. The annual TAG meeting, outbreak reviews and APSED evaluation served as key mechanisms for Member States, TAG members and WHO to review progress and agree on priority activities for implementation of the work plan. The 2015 TAG meeting reconfirmed APSED’s relevance and recommended that WHO develop an updated APSED. The IHR Pacific meeting served as a critical forum for Pacific island countries and areas.
WPR/RC67/3 page 94 Annex 5.1.2 WHO has the capacity to provide evidence-based and timely policy guidance, risk
assessment, information management and communications for all acute public health emergencies Appraisal: Fully achieved
Comments on achievements WPRO continued to strengthen its regional system for early detection, verification, risk assessment, and information sharing of disease outbreaks and public health emergencies, such as H7N9, MERS and EVD, using an all-hazards approach. During 2014–2015 more than 400 events were detected, discussed and assessed by the Emerging Disease Surveillance and Response unit. Technical support was provided on risk assessment and response for acute public health events and emergencies, such as MERS in KOR, avian influenza A(H7N9) in CHN, measles outbreaks in Asia and in Pacific island countries and areas, dengue and arbovirus outbreaks in Pacific island countries and areas, typhoons Haiyan and Lando in PHL, Cyclone Pam in TUV and VUT, and flash flooding in SLB.
Following the WHO Global Policy Group discussions, the Western Pacific Ebola Support Team was established in December 2014 at the behest of the Regional Director. A team approach was employed to ensure effective work in the field, continuity and sustainability in supporting response efforts, and to provide a platform for national experts to engage in international responses. Regional Office and country office staff members were deployed to West Africa to support global response efforts. The EVD outbreak provided opportunities for the Region to test the capacity for response and preparedness under the Emergency Response Framework (ERF) and APSED. Also, the experience and lessons learnt by Western Pacific Ebola Support Team members helped strengthen preparedness, response and surge capacity in the Region. The Western Pacific Ebola Support Team approach is expected to serve as a model for strategic emergency response.
The regional surveillance, risk assessment and response system was further enhanced through the use of the EOC, the Field Epidemiology Training Programme (FETP) fellowship programme, and maintenance of regional stockpile and logistics. The Western Pacific Surveillance and Response Journal, a regional information platform, contributed to timely information sharing for action. As part of regional preparedness, the regional stockpile of antivirals and personal protective equipment was maintained for deployment, and rapid containment and simulation exercises were conducted. To strengthen capacity, WHO staff received training in ERF.
WPR/RC67/3 page 95 Annex Epidemic- and pandemic-prone diseases 5.2.1 Countries are enabled to develop and implement operational plans, in line with WHO recommendations on strengthening national resilience and preparedness covering pandemic influenza and epidemic and emerging diseases Appraisal: Fully achieved
Comments on achievements The Western Pacific Region continues to be a hotspot of epidemic- and pandemic-prone diseases. Influenza remains one of the priority diseases in the Asia Pacific region with continued detection of avian influenza A(H5N1) virus in humans and animals, the recent outbreak of H7N9 in CHN, and the detection of several new influenza subtypes such as A(H5N6), A(H9N2) and A(H10N8) in humans. In this biennium, WPRO continued to focus on strengthening existing influenza detection and preparedness planning in the context of the strategic direction of APSED to meet the requirements under IHR (2005), and in line with the Pandemic Influenza Preparedness Framework. Rapid
containment exercises that tested and strengthened various procedures related to communication, coordination and decision-making were conducted. In addition, WPRO supported regional laboratory capacities to detect influenza viruses, through procurement and technical assistance, including International Airline Transportation Agency training and co-organized the annual tripartite zoonosis meeting with Food and Agriculture Organization of the United Nations (FAO) and World Organization for Animal Health.
To strengthen influenza surveillance systems, data reporting and response, WPRO held the annual Biregional Meeting of National Influenza Centres and Influenza Surveillance. With 21 national influenza centres in 15 Member States and three WHO Collaborating Centres for Reference and Research on Influenza, the Region has been an active player in the WHO Global Influenza Surveillance and Response System (GISRS). GISRS in the Western Pacific Region was sustained and enhanced to accommodate threats, such as avian influenza, MERS, EVD and other newly emerging diseases. WPRO also developed and is testing an online regional dashboard to display country laboratory and epidemiological influenza data.
At the country level, support was provided to KHM, LAO and Pacific island countries and areas on sentinel influenza surveillance, as well as event-based surveillance through training, stakeholder meetings, information technology infrastructure improvements, specimen shipments and routine surveillance reports. Specific preparedness activities in Member States included the drafting of a pandemic preparedness and response plan in FJI, training for FETP, technical assistance for infection
WPR/RC67/3 page 96 Annex prevention and control in health-care facility isolation units, and rapid response team training in KHM, FJI and LAO. National work plans for emerging infectious diseases were also developed in KHM, LAO and VNM.
5.2.2 Expert guidance and systems support in place for disease control, prevention, treatment, surveillance, risk assessment and risk communication Appraisal: Fully achieved
Comments on achievements WPRO continued to monitor public health events in the Region, sharing information on priority diseases with Member States, conducting risk assessments, and supporting the response to health events and emergencies upon request by Member States. Dissemination of biweekly regional updates on priority diseases (influenza; dengue; and hand, foot and mouth disease) was maintained. Routine risk assessments at global, regional and national levels were conducted for avian influenza and H7N9. Technical support was provided to outbreaks including epidemiological assessments, risk assessments, risk communications, logistics, stockpile mobilization, and prevention and control measures. An informal consultation on strengthening surveillance and response in the Western Pacific Region was held in September 2015, and a Mekong subregional meeting in December 2015, to develop a new strategic framework for acute public health events in the Region for timely and informed decision-making.
The EOC was activated in response to the EVD in West Africa and for EVD preparedness in the Region, as well as in response to MERS in KOR and other outbreaks. MERS in KOR demonstrated the importance of investing in preparedness, even in high-income Member States. A joint KOR– WHO mission assessed the risks posed by the outbreak and made recommendations on response measures. With regard to EVD, the team had monitored and analysed the global and regional situation on a regular basis. Guided by APSED, a framework of action was prepared to guide Member States’ activities. Standard operating procedures were upgraded to better define the
functions of the event management system.
In LAO, event-based surveillance was strengthened through the creation of a hotline for reporting of unusual events and an associated operator’s guide and training materials. LAO also developed its National Health Communication Strategy and Action Plan 2014–2016, and the FETP was strengthened with graduates from all provinces. In response to the polio outbreak, WHO activated its emergency management team; work also continued to mitigate the spread of vaccine-derived polio.
WPR/RC67/3 page 97 Annex In KHM, event-based surveillance sites were established, and protocols, information materials and training tools were developed. December 2014. Event-based surveillance training workshops were held in
Technical support for risk communication was also provided to Member States during outbreak and emergency responses. Capacity-building activities on risk communications including simulation exercises and workshops were conducted in KHM, LAO, MNG and in Pacific island countries and areas. Emergency risk and crisis management 5.3.1 Global Health Cluster and country health clusters reformed in line with the Inter-Agency Standing Committee’s Transformative Agenda Appraisal: Fully achieved
Comments on achievements WPRO provided technical assistance in health cluster coordination, information management, rapid assessments, risk communications and surveillance of outbreak-prone diseases. In addition, financial resources were made available immediately after emergency events for the immediate deployment of critical staff, covering the gap until United Nations Central Emergency Response Fund became available.
Health clusters were activated during the response to Typhoon Haiyan and Typhoon Koppu in PHL, recurrent natural disasters in PNG, flash flooding in SLB and Cyclone Pam in VUT. In PHL and VUT, the coordination of foreign medical teams deployed after the Typhoon Haiyan and Cyclone Pam, as well as use of the health resources availability mapping system (HeRAMS), which informed the strategic decision for recovery of the health sector, were well received by local and national health authorities. In the Pacific, a WHO-led health cluster structure was part of the Pacific Humanitarian Team’s operations, with a strong focus on preparedness. In response to the El Niño weather pattern in the Pacific, technical assistance in health cluster coordination and public health risk assessments was provided to PNG and SLB, respectively.
In these responses, the need for further training was noted on essential tools such as the Health Cluster Monitoring Framework and health-specific rapid assessment tools. For this reason, selected disaster risk management (DRM) focal points in WPRO and WHO country offices participated in the Global Health Cluster Surge Training in 2014 and 2015, and in the Health Cluster Coordination
WPR/RC67/3 page 98 Annex Training in 2015. WPRO also conducted an informal expert consultation on strengthening national and foreign medical teams in response to disasters in September 2015, and the main content of the operational guidance form for emergency medical team national preparedness planning was agreed for testing in 2016. 5.3.2 Health established as a central component of global multisectoral frameworks for
emergency and disaster risk management; national capacities strengthened for all-hazard emergency and disaster risk management for health Appraisal: Fully achieved
Comments on achievements The Western Pacific Regional Framework for Action for Disaster Risk Management for Health was endorsed at the sixty-fifth session of the Regional Committee in October 2014. Following the endorsement, intensive and informal consultations with Member States were held, along with technical workshops, to guide the development and implementation of national plans. A workshop on disaster risk management for health (DRM-H) in Pacific island countries and areas was held to support the development, or update, of national DRM-H plans. Capacity-building and strategic, technical and operational support were provided to KHM, FJI, LAO and SLB. National DRM-H plans were drafted in KHM and LAO, and updated in VUT and VNM. In PHL, a risk assessment was conducted and shared with partners to guide public health sector response to Typhoon Haiyan, and the emergency response capacity of local health officers was assessed Assessments of health facilities, as part of the Safe Hospital Initiative, were conducted in FSM and SLB in 2015. The Informal Expert Consultation on Strengthening National and Foreign Medical Teams in Response to Disasters was held in September 2015. Assessments of health facilities, using HeRAMS, were conducted in a hospital, a health centre, and two sub-centres in PNG in December 2015.
Limited human and financial resources continued to pose a challenge to achieving outputs.
WPR/RC67/3 page 99 Annex 5.3.3 Organizational readiness to fully implement WHO’s Emergency Response Framework Appraisal: Fully achieved
Comments on achievements WHO continued to strengthen organizational readiness to implement ERF throughout this biennium. A regional ERF training workshop was conducted in July 2014 for the Category 5 focal points in the Region, following the APSED TAG meeting. The GER approach was considered during the regional ERF training. Utilization of lessons learnt from actual events, such as Typhoon Haiyan, facilitated the discussion.
A special session on improving WHO country office readiness for emergency response was held in March 2014. In PHL, a toolkit to support implementation of the ERF was developed. Readiness of the WHO country office in PNG was strengthened through a series of exercises and provision of additional human resources. Selected DRM focal points attended training sessions on surge
deployment and health cluster coordination.
Insufficient human and financial resources were a challenge to achieving this output. Resources from other programme areas were mobilized to implement cross-programme activities. 5.3.4 Health sector strategy and plan developed, implemented and reported on all targeted protracted emergency countries by an in-country network of qualified and trained WHO emergency staff members Appraisal: Fully achieved
Comments on achievements WPRO continued to provide technical support to PHL for long-term recovery and rehabilitation from Typhoon Haiyan. Likewise, following civil unrest in Zamboanga City in 2013, WPRO deployed a full-time team member to assess health needs and support local health authorities in leadership, information management and disease surveillance. While security was expected to hinder services, the main impediment to the implementation of the health sector recovery was the lack of funds due to the local Government's difficulties in managing funds released by the central Government. For WHO, limited funds dedicated to recovery under the 12-month humanitarian action plan had been stretched to cover support for the initial phases of recovery.
WPR/RC67/3 page 100 Annex Revision of the Hospital Safety Index (HSI) national tools according to the new generic global version was needed before repeating the HSI assessments in large hospitals and extending it to small hospitals with a simplified version of the revised tool.
Food safety 5.4.1 Support the work of the Codex Alimentarius Commission to develop, and for countries to implement food safety standards, guidelines and recommendations Appraisal: Fully achieved
Comments on achievements WPRO continued to support Member States’ effective participation in WHO/FAO Codex Alimentarius work through attendance in Codex meetings, engagement in electronic working groups and expert groups, adopting Codex text into national policy and legislation, and by sharing country specific data and experiences.
In 2014, the FAO/WHO Coordinating Committee for Asia (CCASIA) and the FAO/WHO Coordinating Committee for North America and the South West Pacific (CCNASWP) met to discuss regional issues pertaining to Codex. CCASIA developed a list of priority actions to strengthen Codex in the Region, while CCNASWP adopted a new strategic plan for CCNASWP for 2014–2019 with the purpose to enhance the effectiveness of CCNASWP in achieving its responsibilities to its members and the Region’s contribution to the Codex Alimentarius Commission. One of the priorities identified by CCNASWP was to strengthen the role of Codex in addressing the growing burden of food-related NCD risk factors in the Pacific. In 2015, a Pacific workshop on nutrition, NCDs and the role of Codex was conducted. Recommendations were brought forward by the CCNASWP chairperson to the Executive Committee of the Codex Alimentarius Commission in July 2015.
WPRO also provided technical assistance to Member States in adopting Codex Alimentarius texts into national legislation and policies, as well as in the development of guidelines and codes of practice in line with Codex. Several Member States in the Region strengthened their legal frameworks for food safety and quality by using Codex Alimentarius standards and guidelines to develop national food laws and regulations. FJI, KIR, MHL, MNG, PNG, SLB and VUT developed new contemporary draft food laws that are undergoing review and consultation at national levels. In 2014, COK adopted new food regulations, while LAO, WSM and TON adopted new food laws in 2014 and 2015, respectively.
WPR/RC67/3 page 101 Annex The expiration of the Codex Trust Fund in 2015 and the initiation of its successor initiative, Codex Trust Fund 2, are expected to change Member State participation in Codex. Few Member States have resources allocated to Codex participation. Codex Trust Fund 2 provides opportunities for Member States to strengthen national Codex structures and capacities, but the challenge of reaching broad participation remains. The high cost of travel and the number of days required to attend meetings overseas are key challenges, especially for small island states in the Pacific. Other challenges include limited technical capacity and human resources in Member States to effectively implement food standards and regulations and for food businesses to comply with necessary requirements. A specific focus on individual country priorities, needs and resources is required. 5.4.2 Multisectoral collaboration to reduce foodborne public health risks, including those
arising at animal-human interface Appraisal: Fully achieved
Comments on achievements Coordination, collaboration and sharing of information among sectors are crucial to preventing foodborne disease outbreaks and protecting consumers from substandard food.
At the regional level, WPRO promoted and coordinated regional collaboration with the agricultural sector on multi-country issues of interest, including animal health. Likewise, WPRO played a key role in facilitating interaction between national IHR focal points and the INFOSAN emergency contact points and in providing support to Member States in developing and implementing risk communications and health promotion strategies on food safety including zoonoses. The meeting on strengthening INFOSAN in Asia and national food safety systems, which was held in November 2015, served as a platform for improved coordination of food control efforts across sectors and national borders. The INFOSAN strategy provided a common framework for strengthening
INFOSAN at country level.
There were, however, variations among Member States with regard to the scope and scale of coordination mechanisms, which ranged from highly developed and comprehensive regulation systems to more basic and informal mechanisms. Multisectoral coordination committees and
mechanisms were established in BRN, CHN, FJI, MYS, WSM, SGP, TON and VNM, while KHM, MNG, PNG and VUT developed multisectoral plans and strategies covering food safety. Other Member States made efforts to integrate food safety issues into other programmes, such as NCDs, nutrition, climate change, disaster risk reduction and health security. In December 2014, the first-ever
WPR/RC67/3 page 102 Annex IHR–INFOSAN communication exercise was completed among Asian Member States with participation from 11 Member States. The exercise aimed to validate the accessibility of national IHR focal points and INFOSAN emergency contact points during foodborne disease emergency events.
A significant step forward to streamline information gathering was the agreement during the 12th session of the CCNASWP and the 18th session of the CCASIA to develop a template for country reporting that met the needs of relevant Codex Alimentarius committees, FAO and WHO, thus improving quality of information and reducing reporting burdens among Member States.
Effective collaboration and coordination among Member States is challenging considering the various levels of development and available resources. Commitment and engagement of various sectors requires clear objectives and defined benefits, which has been difficult to demonstrate for some Member States. 5.4.3 Adequate national capacity to establish and maintain risk-based regulatory frameworks to prevent, monitor, assess and manage foodborne and zoonotic diseases and hazards Appraisal: Fully achieved
Comments on achievements WPRO, together with key partners, provided technical guidance and support to Member States to build capacity in national food safety systems, specifically in implementing risk-based approaches; in establishing and maintaining risk-based regulatory frameworks to target and prevent foodborne diseases; in strengthening alert and response systems for food safety and zoonotic emergencies; and in adapting and adopting guidelines and scientific advice, methods and tools for collecting, analysing and interpreting data related to specific hazards along the food chain. WPRO also provided regional guidance in the development and review of food safety laws and regulations, inspection services, laboratory capacity, training and education, as well as other food safety system components.
Based on information collected through the IHR monitoring questionnaire, Member States showed good progress with nearly 100% compliance with IHR core capacities for food safety related to national risk-based regulatory frameworks. For Pacific island countries and areas, a common regional approach and template was developed and used as reference for drafting harmonized contemporary food legislation. An operational guide for the recall of imported food in the Pacific was developed and piloted in FJI and SLB.
WPR/RC67/3 page 103 Annex Significant progress was made by Member States in strengthening their legal frameworks for food safety and quality. BRN, CHN, COK, FJI, JPN, KIR, LAO, MHL, FSM, MNG, PNG, KOR, WSM, SGP, SLB, TON and VUT revised legal documents or drafted new food laws and regulations to better reflect prevailing risks and international developments. Many Member States in the Region
developed codes of practice, guidance documents and training materials on legislation for distribution to stakeholders in order to ensure effective and consistent enforcement nationally. KHM and PHL were developing codes of practice outlining the requirements for hygiene certificates, while FJI developed standard operating procedures for food establishment grading. FJI and SLB developed system guides for food recalls including standard operating procedures for communication between national IHR focal points and INFOSAN emergency contact points.
Members of the CCNASWP attended a joint FAO/WHO regional technical workshop on developments in Codex relevant to Pacific island countries and areas. For members of the
FAO/WHO Coordinating Committee for Asia, a joint FAO/WHO regional workshop was conducted that provided Member States with common tools and approaches for developing national food recall and traceability systems in line with international best practices.
Limited technical expertise and human resources are common challenges for strengthening national capacity to establish and maintain risk-based regulatory frameworks. Limited access to legal
resources within Member States, particularly in small island states, is also a challenge to enacting draft legislation in a timely manner.
Polio eradication 5.5.1 Direct support to raise population immunity against polio to the required threshold levels in affected and high-risk areas Appraisal: Fully achieved
Comments on achievements WPRO continued to work with Member States to ensure that efforts to increase population immunity against polio in high-risk areas were ongoing. During the biennium, more than 62.9 million children received supplemental OPV doses in KHM, CHN, LAO, MYS, PHL and VNM. Additional doses were provided in outbreak response immunization activities in LAO, as well as in national and subnational supplemental immunization activities (SIAs) in PNG, PHL and VUT. WPRO provided technical support to CHN in conducting a WHO international consultation on polio risk assessment, which showed high routine and supplemental immunization coverage as well as high-quality acute
WPR/RC67/3 page 104 Annex flaccid paralysis surveillance. CHN also conducted border screening of vaccination status of peopel arriving from polio-affected Member States.
The main challenge during the reporting period was the outbreak of circulating vaccine-derived poliovirus type 1 in LAO. Another challenge was the limited financial resources to support SIAs, and some Member State decisions not to integrate polio vaccination in their nationwide measles/rubella SIAs due to limited human resources. The presence of hard-to-reach population groups, coupled with weaknesses in routine vaccination capacities and strategies posed another challenge to sustaining high population immunity. 5.5.2 International consensus established on the cessation of the use of oral polio vaccine type 2 in routine immunization programmes globally Appraisal: Fully achieved
Comments on achievements All OPV-using Member States and areas showed high-level commitment in preparation for the switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV). All 17 Member States using only OPV made a commitment to introduce at least one dose of IPV by the end of 2015. However, some delays occurred because of global vaccine supply shortages.
Regional challenges for the tOPV–bOPV switch related to Member States that self-produce their polio vaccines (CHN and VNM). Adhering to the timelines required by the national legislation to obtain licensure of the products and adequate supplies for the switch could lead to delays in the actual switch dates. However, that challenge was overcome by close cooperation between WHO at all levels and the national health authorities resulting in agreement to import initial stocks of the required vaccines until national registration procedures were completed
5.5.3 Processes established for long-term poliovirus risk management, including containment of all residual polioviruses, and the certification of polio eradication globally Appraisal: Fully achieved
Comments on achievements In 2014, the Regional Certification Commission (RCC) recommended that all Member States update their laboratory containment inventories and take steps to destroy unnecessary wild poliovirus
WPR/RC67/3 page 105 Annex (WPV)/vaccine-derived poliovirus (VDPV) type 2 isolates or potentially infectious materials in order to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of OPV use. In compliance with requirements for laboratory containment, all Member States in the Region finalized preparation for destruction and/or containment as outlined in Phase 1 of the WHO Global Action Plan III.
In 2015, Member States were asked to submit documentation to the RCC for the certification of eradication of WPV type2. Five Member States (AUS, CHN, HOK, JPN, PHL and VNM) in the Region possessed type 2 WPV or VDPV. AUS, CHN, HOK and JPN confirmed designation of a poliovirus-essential facility to handle and store type 2 poliovirus. PHL and VNM confirmed they would destroy VDPV and not designate a poliovirus-essential facility.
5.5.4: Establishment of the polio legacy plan Appraisal: Fully achieved
Comments on ac hiev eme nts Polio legacy planning had been integrated into the regional endgame planning. The Polio Eradication Endgame Strategic Plan 2013–2018 was shared with CHN’s immunization programme, and one peerreviewed international publication on polio eradication history in CHN was published. In 2014, MNG contributed to the global polio legacy plan following finalization of the draft global framework.
Outbreak and crisis response 5.6.1 Implementation of the WHO Emergency Response Framework in acute emergencies with public health consequences Appraisal: Fully achieved
Comments on ac hiev eme nts During the biennium, more than 400 events were detected, and response and recovery efforts were undertaken following outbreaks and major emergencies. These included the MERS outbreak in KOR in May 2015, cVDP1 in LAO in October 2015, measles outbreaks in the Asia Pacific region, dengue and arbovirus outbreaks in Pacific island countries and areas throughout 2014–2015, super Typhoon Haiyan in PHL in November 2013, Cyclone Ian in TON in January 2014, flooding in SLB in April 2014, Cyclone Pam in VUT in March 2015, and Typhoon Lando in PHL in October 2015.
WPR/RC67/3 page 106 Annex For the Typhoon Haiyan response in PHL, WPRO support shifted from responding to the acute needs of affected populations to longer-term recovery and rehabilitation. Assessment of health facility functionality was conducted in cooperation with the Department of Health to determine appropriate fund allocation. Concerning Cyclone Ian in TON, funds were allocated for the provision of curative and preventive medical care, and for the improvement of water hygiene and safety. With regard to the flooding in SLB, WPRO provided technical support by sending a heath cluster coordinator and a risk communications expert, and included financial support. In response to Typhoon Koppu in PHL, WPRO provided technical support on health needs assessment and resource mobilization. Lastly, a health cluster coordinator was deployed to PNG to assist in planning and response to the drought caused by the El Niño weather pattern, and a health sector strategy was subsequently drafted.
The largest MERS outbreak outside the Middle East occurred in KOR. In response, WPRO established event management teams and a joint KOR–WHO mission was conducted in June 2015. Recommendations were made including immediate strengthening of infection prevention and control in health facilities nationally, guidance to health workers on questions to ask patients presenting with fever or respiratory symptoms, and appropriate reporting and monitoring of suspected cases and close contacts.
Technical support was provided to arbovirus outbreaks in Pacific island countries and areas, including deployment of an epidemiologist in PYF and WSM, and a risk communications expert for the dengue outbreak in FJI. For cVDPV1 in LAO, WPRO deployed a surveillance officer, a logistician and a risk communications officer. As requested by Member States, support was provided to outbreaks such as human infection of avian influenza A(H7N9) epidemic in CHN, measles outbreaks in Asia and in Pacific island countries and areas, dengue outbreaks in Asia and Pacific island countries and areas, and imported cases of MERS infection in MYS and PHL.
As a part of the global response to EVD outbreak, WPRO proactively engaged Member States and partners in: (1) strengthening Member State preparedness in the Region; (2) ensuring WHO’s regional outbreak and response system and capacity were in place; and (3) supporting the global EVD response in West Africa. Guided by APSED, a Regional Framework for Action for Ebola Virus Disease Preparedness, was developed. A survey involving 26 IHR national focal points (NFPs) was
conducted to assess the overall level of regional preparedness, and a regional EVD simulation exercise involving 23 NFPs was conducted to test Member State readiness for EVD response. Based on priority needs, a number of regional and subregional training workshops and meetings were convened to strengthen EVD preparedness. These activities were carried out in the context of IHR
WPR/RC67/3 page 107 Annex core capacity-building using APSED as a regional tool. EOCs were also activated with an Ebola Emergency Support Team in place to assist Member States with EVD preparedness and response activities. WPRO provided technical support to 21 Member States in their preparedness for a
potential EVD case in the Region. A WHO Global Outbreak and Alert Response Network (GOARN) pre-deployment training for EVD was held in AUS with RedR Australia and GOARN for people who might be deployed from the Region.
CATEGORY 6. CORPORATE SERVICES/ENABLING FUNCTIONS Summary of progress and achievements Leadership and governance
WHO's leadership role in coordinating the health sector and other actors was strengthened. For example, the First Regional Forum of WHO Collaborating Centres in the Western Pacific was convened in November 2014 with 196 participants from 135 collaborating centres across 10 countries in the Region. Also, 112 memorandums of understanding were signed in the biennium. In
governance, the Regional Committee for the Western Pacific endorsed eight resolutions at its sixtyfifth session in October 2014 and seven at its sixty-sixth session in October 2015. Regional reform continued with a focus on keeping countries at the centre of WHO's work. Recommendations from external assessments were implemented, resulting in more tailored technical cooperation with countries. The Region also introduced midterm reviews of county cooperation strategies (CCSs) and increased interaction between the Regional Office and country offices in CCS development. Transparency, accountability and risk management
Following the global strengthening of compliance, risk management and transparency, WPRO implemented initiatives (including enhanced dashboards for monitoring transactions, checklists for references and updated templates) and took part in Organization-wide exercises, completing and updating the internal control self-assessment checklist and risk register. Promotion of ethical
behaviour, decent conduct and fairness is ongoing. WPRO actively participated in the evaluation of WHO presence in countries led by WHO headquarters. The Programme Management Officer (PMO) Network and the Regional Administration Network (RAN) were engaged in information dissemination and implementation of compliance, internal controls and risk management activities. The creation of the Compliance and Risk Management Officer position would also increase the focus on areas for improvement.
WPR/RC67/3 page 108 Annex
Strategic planning, resource coordination and reporting
WPRO strengthened technical coordination across technical programmes. Overall programme budget (PB) management, including further improvement of implementation, human resources (HR), and awards management and monitoring had been strengthened, thanks to enhanced management mechanisms such as the Programme Committee, the PMOs Network, and the mini-Programme Committee at Budget Centre level, etc. Resource management was further strengthened through regular HR analysis and projections of voluntary contributions. A strategic review was conducted and a decision made by senior management for effective and strategic use of flexible funds to fill the funding gap of underfunded priority activities identified in 2014–2015, and to ensure key staff funding requirements. The PB 2014–2015 implementation rate by expenditure reached 96% for all resources and base programme resources, giving the Western Pacific Region the highest implementation among major offices. WPRO continued to demonstrate best practices in this respect. Country and regional priorities for 2016–2017 were identified through bottom-up planning. Highlevel and operational planning for PB 2016–2017 was successfully completed by the global deadlines. Enhanced donor-report monitoring and the development of generic templates improved the quality and timeliness of proposals and reports. Management and administration
In keeping with global management reform, the Region's initiatives and process improvements were set in place while ensuring that support and services were delivered in an efficient and timely manner. Significant activities included improving and strengthening internal controls in the Regional Office and country offices, maintaining the active implementation of staff rotation and mobility, monitoring and managing staff performance, and participating in the internal control exercises spearheaded by WHO headquarters. Vital in the successful implementation and meeting of programme objectives was enabling and equipping RAN, which sustained the key processes and updated information exchange, and ensured that key controls and compliance were adhered to both at the regional and country office levels.
WPR/RC67/3 page 109 Annex Strategic communications
WPRO launched social media accounts on Facebook, Twitter and YouTube in 2015. Training for Regional Office staff on "cutting the jargon" was held in 2014. Production of information products was recentralized and strengthened to ensure quality control, compliance with WHO’s multilingual mandate and adherence to WHO copyright policy. Tools and training were developed to guide staff creating information products. Access to WHO information was strengthened via the Institutional Repository of Information Sharing (IRIS), which included documents in Chinese, English, French and local languages. The Western Pacific Region Index Medicus (WPRIM) was used as a platform to improve visibility and dissemination of information products produced by Member States. All lowincome countries in the Region were provided with improved access to scientific documents through the HINARI Access to Research in Health Programme and supportive training.
ASSESSMENT OF PROGRAMME OUTPUTS Leadership and governance 6.1.1 Effective WHO leadership and management in place Appraisal: Fully achieved
Comments on achievements WPRO’s senior management worked to strengthen the Organization’s convening role in relation to cross-border and multisectoral issues through enhanced collaboration with the WHO Regional Office for South-East Asia (SEARO) and by leading country offices and technical units in engagement with stakeholders beyond the health sector. Under the leadership of the Regional Director, the first WHO Collaborating Centre Forum was convened in November 2014 in the WHO Regional Office for the Western Pacific. In all, 196 representatives attended – 181 in Manila and 15 via videoconference – from 135 collaborating centres in 10 countries in the Region. Under the Regional Director
Development Programme, which funded innovative priorities and supported Member States facing emergencies, a session on NCDs was organized during the Small Islands Developing States meeting in Samoa.
With regard to CCSs, WPRO introduced the midterm CCS review and innovative process in renewal of CCS. The CCS defines the medium-term vision of WHO's technical cooperation with Member States and ensures alignment with national health policies, strategies and plans. In addition, the CCS identifies priorities that would continue to serve as a practical guide for strengthening WHO leadership at the country level. The CCS also defines the way WPRO delivers support to Member
WPR/RC67/3 page 110 Annex States and coordinates efforts of multiple sectors and partners to achieve national health goals and objectives. In order to ensure alignment between CCS priorities and PB priorities, interaction
between the Regional Office and country offices through the programme area network was strengthened. One of the challenges encountered was the shifting of paradigms for staff in ensuring that the prioritization was based on strategic foresight and intensive technical discussions. WPRO continued to support country offices in effectively performing their functions, particularly in exercising strong leadership at the country level.
Several consultations of WHO Representatives (WRs) and Country Liaison Officers (CLOs) were convened in 2014–2015. The reform implementation plan – Keeping Countries at the Centre – was approved by the Regional Director in December 2014. Since that time, senior management and the Country Support Unit (CSU) had spearheaded its implementation to ensure that country needs and priorities were met. 6.1.2 Effective engagement with other stakeholders in building a common health agenda that responds to countries and areas’ priorities Appraisal: Fully achieved
Comments on achievements Recognizing the importance of strategic partnerships in ensuring the implementation of the PB and the 12th General Programme of Work (GPW), increasing efforts were made to strengthen engagement with key stakeholders in order to build a common health agenda responsive to countries’ and areas’ priorities. WPRO focused on nurturing partnerships with Region-specific groupings, for example, a biregional agreement between WPR and SEAR with ASEAN for 2014–2017 was signed in September 2014. In addition, WPRO helped to advance the work around WHO’s framework of engagement with non-State actors through the development of the electronic Global Engagement Management (GEM) register aimed at enhancing coordination with non-State actors and increasing organizational transparency.
In view of the changing landscape and magnitude of public health challenges, WPRO has explored new ways of working by strengthening partnerships with the WHO collaborating centres network. Hence, the first Regional Forum of WHO Collaborating Centres in the Western Pacific was convened.
Concerted efforts were undertaken in countries with WHO presence to ensure close partnership with respective health authorities, other government sectors, United Nations agencies and other partners.
WPR/RC67/3 page 111 Annex Partner dialogues were convened in several countries in the Region (such as LAO) to improve the coordination of resources and programmes in support of Member States.
The health actor mapping exercise undertaken from late 2013 to early 2014 showed an increase in the number of health actors in the Western Pacific Region. The initial mapping included more than 1500 actors working in the health sphere across 14 countries in the Region. This exercise highlighted the ever-increasing importance of WHO’s convening role to minimize the fragmentation and duplication of efforts at the country level. The dramatic increase in health actors could poses challenges because WHO often competes with such entities for resources. However, the situation is also an opportunity for WHO to harness efforts and play a coordinating role for greater impact. Also at the regional level, during sessions of the Regional Committee for the Western Pacific, the number of nongovernmental organizations, intergovernmental organizations and United Nations agencies attending has increased exponentially over the past five years, along with the number of statements submitted for delivery. 6.1.3 WHO governance strengthened with effective oversight of the sessions of the governing bodies, and efficient, aligned agendas Appraisal: Fully achieved
Comments on achievements Improvements to governance structures at the regional level resulted in better coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee. WHO Representatives in countries supported governments by ensuring better coordination and implementation of decisions stemming from WHO governing bodies.
The sixty-fifth and sixty-sixth sessions of the WHO Regional Committee for the Western Pacific were successfully held during the biennium in the Philippines (October 2014) and Guam (October 2015). Member States endorsed a total of 15 resolutions (eight during sixty-fifth session and seven during the sixty-sixth). To ensure efficient alignment of the regional agenda with global governing bodies, the Regional Committee continued to have a mandatory item entitled Coordination of the work of the World Health Assembly, the Executive Board and the Regional Committee. Discussions under this agenda item pertained to the framework of engagement with non-State actors and strategic budget space allocation. The sixty-fifth and sixty-sixth sessions of the Regional Committee were also broadcast to enable remote participation of Member States. Regional Committee documents were also electronically disseminated.
WPR/RC67/3 page 112 Annex In other forums, WPRO ensured alignment with global agenda and priorities as per the 12th GPW and the PB, such as the implementation of the recommendations from the external assessments in order to strengthen WHO’s effectiveness and evidence-based results of programme delivery, particularly at the country level. WPRO also provided timely and comprehensive briefings to Member States, such as the high-level Ebola briefing for the diplomatic corps in October 2014.
Furthermore, representatives of the diplomatic community, United Nations agencies and multilateral organizations attended World Health Day celebrations at the Regional Office in April 2014 and 2015. The festivities included advocacy centred on each day's theme as well as promotion of the broader work and reforms of WHO, including enhanced collaboration among stakeholders for more unified approaches to the Region’s health issues.
A pilot project to share and access information online via SharePoint (mainly translated working documents) with French-speaking representatives to the Regional Committee was initiated in 2014. The initiative was well received by representatives, thus documentation no longer had to be printed and disseminated for succeeding Regional Committee meetings. In an effort to reduce printing and dissemination costs, the Go Green Initiative was introduced. In order to support Member States in accessing WPR information products, an electronic catalogue was created with a special section highlighting those documents relating to the agenda of the annual sessions of the Regional Committee. 6.1.4 Integration of WHO reform into the work of the Organization Appraisal: Fully achieved
Comments on achievements WPRO has worked hard to implement the WHO reform agenda and has continued to pursue reform towards improving the Organization’s programme delivery, governance and management. These efforts contributed to the improvement of health outcomes in Member States by strengthening several programmes and their management and ensuring that countries were at the centre of WHO’s work. One example was building capacity in intercountry collaboration, such as in the GMS, and through subnational engagements. At the regional level, the Global Health Learning Centre was launched to develop the communication and public health problem-solving skills of government officials from the Region. In addition, the first Regional Forum of WHO Collaborating Centres in the Western Pacific was successfully convened in November 2014. Cross programme collaboration among technical staff was strengthened through the establishment of the PMO roster and induction training, regular regional
WPR/RC67/3 page 113 Annex updates to WHO country offices, and through the improvement of videoconferencing facilities across the Region in order to facilitate programme dialogues and collaboration. However, challenges were met with regard to availability of resources to implement activities, in particular, within some of the smaller teams and country offices.
To better reflect the team approach used in the Western Pacific Region, WPRO developed a new organigram. Country intelligence was also regularly reported to further improve support to countries. The provision of timely and relevant advice to countries was also initiated through the new mission report management system. Transparency, accountability and risk management 6.2.1 Accountability ensured through strengthened corporate risk management and evaluation at all levels of the Organization Appraisal: Fully achieved
Comments on achievements WPRO actively participated in the global effort led by the Office of Compliance, Risk Management and Ethics at WHO headquarters in identifying risks across all budget centres and the completion of the risk register. This included participation in risk identification, mitigation and escalation. Further, the Regional Administration Network and the Programme Management Network continued to be strong forums for ensuring that compliance, risk and accountability were discussed and reinforced throughout the Region. For more effective monitoring and compliance, staff members were
continually equipped and updated with WHO rules, policies and regulations. Regular reviews of processes, templates, etc. were undertaken and promoted to ensure compliance. Compliance and Risk Management Officer had been created, and recruitment is ongoing. The post of
6.2.2 Implementation of WHO’s evaluation policy across the Organization Appraisal: Fully achieved
Comments on achievements The Organization-wide Evaluation Work Plan 2014–2015, approved by the Executive Board at its 135th session, included two work plans related to the Western Pacific Region: (1) WHO presence in countries; and (2) mobility and rotation. CSU/WPRO participated as part of the Evaluation
Management Group, which undertook evaluation of WHO’s presence in countries. Eight countries were selected for in-depth review, which included KHM from the Region. With regard to mobility
WPR/RC67/3 page 114 Annex and rotation, the internal evaluation was conducted during the previous biennium. WPRO submitted four evaluation work plans for 2016–2017 to the Executive Board, namely: (1) evaluation of the regional reform agenda – Keeping Countries at the Centre; (2) evaluation of the health systems strengthening project in KHM; (3) evaluation of the demonstration project on NCDs and mental health service delivery at community level in VNM; and (4) evaluation of the implementation of regional action plans on NCDs and health throughout the life-course in the Western Pacific Region. The report on the evaluation of WHO’s presence in countries is now at the final draft stage at WHO headquarters. 6.2.3 Ethical behaviour, decent conduct and fairness promoted across the Organization Appraisal: Fully achieved
Comments on achievements Through various forms of communication and networks, it was ensured that relevant policies are accessible to staff members in the Region. Updates on policies and processes were relayed to staff through various improved forms of communication, such as briefings of new staff, email communication, information/handbook circulars, “brown bag” lunch sessions, the WPRO Intranet, etc. The Regional Administration Network, the PMOs Network, and the WRs and CLOs consultation meetings provided good venues to discuss policy updates and processes to address staff concerns.
The close coordination of the Staff Association and WHO administration, not just in the Regional Office but also in country offices, allowed for better equipping of staff and for mitigating issues. Through various forums in offices, open discussions with supervisors and colleagues were encouraged to enable staff members to address possible concerns at the onset and to have a more positive working environment. Different regional working committees and focal points were also available and tapped, as necessary, serving also as channels and venues for various staff-related concerns. Strategic planning, resource coordination and reporting 6.3.1 Results-based management framework in place including an accountability system for WHO’s corporate performance assessment Appraisal: Fully achieved
Comments on achievements High-level planning for PB 2016–2017, which included regional and country priorities, was completed in a timely manner through a robust bottom-up planning process for review by the
WPR/RC67/3 page 115 Annex Regional Committee and the Executive Board. Initial HR plans were completed to feed into the PB version for the World Health Assembly by the global deadline. Operational planning based on results of high-level planning and World Health Assembly-approved budget envelope was completed with work plans approved for the Region by the global deadline. The first tranche of flexible funds were distributed to all budget centres in mid-December 2015 for early implementation of PB 2016–2017. Midterm and end-of-biennium assessments for PB 2014–2015 were conducted according to global guidelines.
Some of the challenges encountered were: (1) the limited number of country priorities and lack of flexible and predictable resources made it difficult for some country budget centres to align the plan with all identified country priorities; (2) time constraints made it difficult for country budget centres to have more thorough bottom- up planning with governments and partners for a more meaningful plan, especially for those without a WHO country presence; (3) the rapidly changing environment and evolving health needs, including unpredictability of future financing, made it difficult to pursue long-term plans; (4) substantial reduction in the One United Nations Plan funding coupled with the ever-increasing complexity in the application and selection methods resulted in some positions being abolished or being left vacant; and (5) lack of country budget centre-specific output indicators posed difficulty in conducting quality midterm and biennium assessments for PB 2014–2015. 6.3.2: Alignment of WHO financing with agreed priorities, facilitated through strengthened resource mobilization, coordination and management Appraisal: Fully achieved
Comments on achievements WPRO’s PB implementation rate by expenditure reached 96%, both for all resources and base programme resources, which was the highest among all major offices. This was attributed mainly to the strengthened PB management mechanism in the Region, comprising of the Programme Committee, PMOs Network annual meetings, and tele and videoconferences, and mini-Programme Committee or Senior Management Group meetings at the budget centre level.
The management of resources improved at regional and budget centre levels through the conduct of regular comprehensive PB status analyses, as well as HR and voluntary contributions projection analyses. HR funding status and vulnerability had improved, thus ensuring 100% funding for all staff, through the implementation of new policies and approaches on HR management for both regional and country budget centres, such as centralized management of key staff of technical divisions using
WPR/RC67/3 page 116 Annex flexible funds and prioritization of flexible funds for key staff in country offices. Based on the results of a strategic review, a detailed plan was developed for strategic allocation of flexible resources to fill the funding gaps in priority activities under PB 2014–2015, including key staff funding requirements. The knowledge and skills of staff on PB management, at both regional and country levels, was further improved through the conduct of annual Global Management System (GSM) training focusing on PB/awards and HR management, coaching and in-country support provided by the Programme Development and Operations (PDO) unit.
The coordination of resource mobilization efforts at both the regional and country levels was improved through regional and country mechanisms such as the PMOs Network, and through training and experience and practice sharing. Also, in an effort to ensure alignment and funding of
underfunded priority programmes, numerous high-level meetings with donors and partners were held throughout the biennium. Significant progress has also been made in the area of donor reporting, with the development of new standardized proposal and reporting templates, which incorporate PB linkages as to ensure alignment of activities, as well as the implementation of an automated system for tracking the submission of reports to donors. The total amount of available resources for PB 2014– 2015 reached 90% against its budget envelope, one of the two highest among WHO regional offices at the end of 2015. WPRO remained an active member of the global Coordinated Resource
Mobilization Team and had also been involved in the second Financing Dialogue (November 2015) and in bilateral meetings among Member States in the lead up to the February 2016 dialogue. WPRO continued to actively participate in the ongoing work on the Framework of Engagement with nonState Actors, which included the development of the GEM tool, aimed at improving resource mobilization efforts across the three levels of the Organization. Management and administration 6.4.1 Sound financial practices managed through an adequate control framework, accurate accounting, expenditure tracking and the timely recording of income Appraisal: Fully achieved
Comments on achievements Administrative and financial support services were provided to budget centres in order to ensure accuracy of transactions. Regular coordination with the Regional Office and country offices was maintained to ensure internal controls were in place, the reconciling of items was reduced and accurate accounting entries were recorded. The Global Service Centre (GSC) was also supported in
WPR/RC67/3 page 117 Annex their review of other accounts. Possible improvements in controls and compliance were discussed regularly during RAN meetings and the WRs and CLOs consultation meetings.
Substantial improvement was achieved in the monitoring of overdue direct financial cooperation (DFCs) resulting in a “No (zero) overdue DFCs” at the end of December 2015. This improvement in DFC submission had an impact not just at the regional level, but also at the global level, with WHO’s auditors recommending WPRO's approach to other offices. Closure of audit recommendations for internal and external audit reports (final version) was received during 2015. In coordination with the PDO unit, and close follow-ups with budget centres, a reasonable implementation rate (95%) for PB 2014–2015 was attained, and a smooth 2014–2015 biennial closure of accounts was completed per schedule. All imprest accounts for the Region were reconciled with an “A rating” (no unreconciled items older than 90 days) as at end December 2015.
6.4.2 Effective and efficient human resources management in place to recruit and support a motivated, experienced and competent workforce in an environment conducive to learning and excellence Appraisal: Fully achieved
Comments on achievements WPRO has continued to actively pursue gender balance in the Region through improved recruitment practices and internal awareness-raising. Over the past several years, the percentage of female professional staff members (on fixed or continuing appointments) has increased to 38%. Also in senior management, the number of females has increased with four of seven current WPRO cabinet Directors being female. Although we continue to recruit the most qualified person for each and every post, given current trends, practices and awareness-raising, gender parity of professional staff in the Western Pacific Region is within reach in the near future.
WPRO also continued to target identification of qualified candidates from under-represented and unrepresented countries for international professional posts in the Region. We have seen the
importance of geographical distribution of staff. We consider the diversity of our staff to be a tremendous asset: current international professional staff members are nationals of 42 countries, with more than half from outside the Region.
WPR/RC67/3 page 118 Annex Regarding staff mobility, WPRO has made considerable progress. Of the original list of 38 staff members targeted for mobility after having been in place five years or more when the regional mobility process was launched, all have moved off the list as of December 2015.
In the Western Pacific Region, we have been fully committed to the global harmonized staff selection process put in place as part of HR reform. In 2015 we finalized the vast majority of recruitments within the 180-day time frame criteria put forth in the Programme Budget Performance Assessment.
The performance management and development system (PMDS) is seen as an important tool in ensuring that staff performance has a standard place in communications between subordinates and supervisors. Because of its importance, we take timely completion of the staff evaluation processes seriously, with regular monitoring and follow-up to ensure compliance. On the completion target of 29 February 2016, Western Pacific Regional staff had completed 96% of 2015 evaluations for the approximately 650 staff in the Region. 6.4.3 Efficient and effective computing infrastructure, network and communications services, corporate and health-related systems and applications, and end-user support and training service provided Appraisal: Fully achieved
Comments on achievements Significant effort focused on both enhancing the network infrastructure and the deployment of transparent connectivity and collaboration solutions. In the business solutions area, administrative and technical applications were developed for the regional, interregional and global levels. The deployment of new technologies increased reliability, especially enhanced connectivity with many country offices. The implementation of cloud-based collaboration and videoconferencing solutions allowed for the participation of all offices in single meetings and the broadcast of sessions of the Regional Committee via WebEx. The gradual rollout of the global security architecture and the completion of the rollout of global email to the majority of locations ensured increased compliance with global initiatives. From a collaboration perspective, the rollout of telephony via computers and the introduction of transparent access technologies further enhanced remote working arrangements. In addition, these improvements provided critical support for emergency operations.
Collaboration at interregional and global levels, including participation and implementation of proposals made at the WHO Information Technology Global Meeting, ensured increased alignment.
WPR/RC67/3 page 119 Annex The infrastructure that served the entire Region and communications with WHO headquarters continued to be reinforced, and new standards were introduced and enforced at the end-user level. Application solutions at the global, interregional and country levels, including significant work in governance and with respect to emergency response, were continuously provided. Work on
management dashboards continued with results seen particularly in administration and compliance, an area that continued to require global coordination to reduce duplication and ensure integrity of data. 6.4.4 Provision of operational and logistics support, procurement, infrastructure maintenance and asset management, and of a secure environment for WHO’s staff and property, in compliance with United Nations Minimum Operating Security Standards and Minimum Operating Residential Security Standards Appraisal: Fully achieved
Comments on achievements To successfully implement the various operational and logistical activities in the Region, the Regional Office and country offices maintained close coordination with various United Nations agencies, governments, Member States and headquarters, including GSC. Continuous and timely monitoring of activities, including security concerns, updated and correct reporting of assets, and ensuring compliance with the rules and policies, were essential in maintaining, and strengthening the quality of services provided.
Planning and monitoring were crucial in ensuring that the continuing processes (logistics, security, travel, registry, conferences/meetings, and infrastructure maintenance, operation and support) were working properly and that available information was accessible in times of emergency. Through RAN, close coordination between the country offices and the Regional Office was made possible.
Apart from maintaining and continually improving processes, and updating policies, if necessary, the comprehensive Business Continuity Plan was one of the significant endeavours of the Region for this biennium.
WPR/RC67/3 page 120 Annex Strategic communications 6.5.1 Improved communication by WHO staff leading to a better understanding of the Organization’s actions and impact Appraisal: Partly achieved
Comments on achievements WPRO’s Public Information Office (PIO) strived to enhance WHO's visibility throughout the Region by promoting all activities and initiatives. At the regional level, training on effective communication – Cutting the Jargon – was conducted for communication focal points in 2014. The workshop aimed to strengthen writing and presentation skills. At the country level, in addition to support provided in the promotion of WHO's activities, capacity-building training sessions were conducted. In VNM, training was conducted on communications and risk communications skills in 2014, and communications and social media training was conducted with support from WHO headquarters communications colleagues in 2015. In MNG, capacity-building on communications and social media was conducted in December 2015. In addition to the countries that received training,
communications staff members from the Regional Office and country offices undertook communications training at WHO headquarters (e.g. Emergency Communications Network).
Other activities undertaken during the biennium included: (1) World Health Day, 7 April 2014 (vector-borne diseases) and 7 April 2015 (food safety), one of WHO’s flagship
events/communications campaigns to increase awareness of an area of public health concern; (2) Ebola briefing for the diplomatic corps (September 2014); (3) press conference during the sixtysixth session of the Regional Committee for the Western Pacific (October 2015) to ensure media coverage and the timely dissemination of public information; and (4) participation in the WHO Global Communications Forum (December 2015) to ensure communications at the regional level were in alignment with those at the global level.
The absence of a permanent Public Information Officer (from 2014 to 2015) affected the implementation of activities. Despite this, some of the major achievements in this biennium included: (1) launch of WPRO social media accounts (e.g. Facebook, Twitter and YouTube channel); (2) deployment of communications staff to support responses to various public health emergencies and disasters including Cyclone Pam in VUT, the polio outbreak in LAO, the HIV outbreak in KHM, and the Ebola outbreaks in West Africa; (3) management of communications and media inquiries for the MERS-CoV outbreak in KOR, including provision of needed communication support on messaging; (4) launch of the Quick Guide on the Publication Process in collaboration with the
WPR/RC67/3 page 121 Annex Publications unit; and (5) effective communication support and guidance for the production of audiovisual and print materials, including the creation of the LAO country office website.
6.5.2 Development and efficient maintenance of innovative communication platforms Appraisal: Fully achieved
Comments on achievements At the Regional Office, the development and efficient maintenance of innovative communication platforms has been a priority. WPRO's social media accounts enabled WHO to reach wider audiences in Member States and beyond, and regularly engage them in a timely manner while assessing the impact of activities using built-in social media tools and analytics. Full implementation of these platforms will allow further needs for other innovative platforms to be identified. Consultation with country offices continued on how to support them in accessing and adopting platforms to amplify the dissemination of WHO's work.
Access to WPRO’s information products in official languages and versions appropriate to the Region has increased, as well as broader dissemination of governing body documents in Chinese, French and English. Production of regional training materials and regional serial and flagship information
products and reports, including dissemination in relevant languages, continued while ensuring quality and copyright compliance. The number of Pacific countries participating in and contributing to the WPRIM database had increased with FJI and PNG as new contributors. The regional issuance of WHO/WPRO institutional information products through IRIS was launched in three official languages (Chinese, French and English). Recording of all WPRO-approved information products and governing bodies material into IRIS in English, French, Chinese and local languages was ongoing. With regard to capacity-building, training was provided to low- and middle-income
countries on access to medical, technical and scientific literature through HINARI in KHM and in the Pacific with COK, FJI, KIR, NIU, SMA, TON and TUV. Likewise, training was conducted for WHO staff to access the Global Information Full Text project. The photo library database project was developed in collaboration with country offices and Member States.
Although some countries, such as CHN, LAO and VNM, have improved in the area of communications, most countries continue to face many challenges in implementing innovative communications approaches, often due to limited human resources and capacities. Regarding access to various health literature resources, less-than-optimal Internet connections remain a challenge for some countries and areas since most WHO resources are accessed electronically.