SEA/RC53/13 Rev.1 - Proposed Programme Budget 2002-2003

REGIONAL COMMITTEE

Provisional Agenda item 7

Fifty-third Session

SEA/RC53/13 (Rev.1)

22 August 2000

PROPOSED PROGRAMME BUDGET 2002-2003 PART II

A long-standing concern while preparing programme budgets for successive biennia has been (a) to ensure that Member Countries clearly understand the WHO Secretariat’ s objectives, and (b) to match these objectives with the plans and aspirations of Member Countries. In this regard, the Strategic Budget for 2002-2003 marks a significant departure from previous biennia, both in its content and in the way it has been prepared. Extensive consultations have taken place between the staff of the regional offices and WHO headquarters in the formulation of WHO’ s policy framework and corporate priorities. As a key instrument in advancing the process of reform and change in WHO, the Strategic Budget for 2002-2003 (Part I) has also been developed jointly through consultations between WHO headquarters and all the six regions. The present document, which should be read in conjunction with the WHO Strategic Budget for 2002-2003 (Part I), responds to the need to spell out the regional perspective and the proposed areas for priority action. It outlines, in the light of the overall strategic framework for PB 2002-2003, the issues and challenges facing the South-East Asia Region in the coming biennium, as well as specific priority areas for the countries and the Region, as a whole.

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CONTENTS 1. 2. 3. Regional Situation ....................................................................................................... 1 Regional Strategies and Priority Action........................................................................ 4 Resource Indication..................................................................................................... 9

Annex - Issues and Challenges and Broad Regional Strategies in 35 Areas of Work 1.1 Communicable Disease Surveillance ........................................................................ 11 1.2 Communicable Disease Prevention, Eradication and Control .................................... 12 1.3 Research and Product Development for Communicable Diseases............................. 12 1.4 Malaria ...................................................................................................................... 13 1.5 Tuberculosis.............................................................................................................. 14 2.1 Surveillance, Prevention and Management of Noncommunicable Diseases .............. 15 2.2 Tobacco .................................................................................................................... 16 3.1 Child and Adolescent Health ..................................................................................... 17 3.2 Research and Programme Development in Reproductive Health .............................. 17 3.3 Making Pregnancy Safer ........................................................................................... 18 3.4 Women’ s Health........................................................................................................ 19 3.5 HIV/AIDS .................................................................................................................. 20 4.1 Sustainable Development.......................................................................................... 21 4.2 Nutrition .................................................................................................................... 22 4.3 Health and Environment............................................................................................ 23 4.4 Food Safety............................................................................................................... 24 4.5 Emergency Preparedness and Response .................................................................. 25 5.1 Health Promotion ...................................................................................................... 25 5.2 Disability/Injury Prevention and Rehabilitation ........................................................... 26 5.3 Mental Health and Substance Abuse ......................................................................... 28 6.1 Essential Medicines: Access, Quality and Rational Use ............................................. 29 6.2 Immunization and Vaccine Development................................................................... 29 6.3 Blood Safety and Clinical Technology ....................................................................... 30 7.1 Evidence for Health Policy ........................................................................................ 32 7.2 Health Information Management and Dissemination.................................................. 32

SEA/RC53/13 (Rev.1) Page ii 7.3 Research Policy and Promotion................................................................................. 33 7.4 Organization of Health Services ................................................................................ 34 8.1 Governing Bodies...................................................................................................... 35 8.2 Resource Mobilization and External Cooperation and Partnerships ........................... 36 9.1 Budget and Management Reform.............................................................................. 37 9.2 Human Resources Development ............................................................................... 37 9.3 Financial Management .............................................................................................. 38 9.4 Informatics and Infrastructure Services ..................................................................... 39 10.1 Regional Director’ s Office.......................................................................................... 41 10.2 Regional Director’ s Development Programme ........................................................... 42

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1.

REGIONAL SITUATION

1.1 Health Development The South-East Asia Region is undergoing a rapid epidemiological transition, resulting in a double burden of disease. While communicable diseases are still the major killers and cripplers, noncommunicable diseases are emerging as a leading cause of morbidity, disability and mortality. The population of the Region continues to grow rapidly and is expected to cross 1.5 billion by the end of 2000. In addition, the Region has nearly half of the world's poor and elderly. The economic crisis in the late 1990s has also affected health development in the Region. Despite these problems, the Region has made significant progress in the areas of increasing life expectancy, reducing infant and child mortality as well as combating communicable diseases. There has been considerable reduction in morbidity and mortality due to vaccine-preventable diseases such as polio, measles, tetanus, whooping cough and diphtheria. With the expansion of coverage with multi-drug therapy, leprosy cases have declined and the disease is on the verge of elimination. The Region has already been declared free of guineaworm disease. Even with the above achievements, the Region still bears a heavy share of the global burden of disease. This is due in part to the very large population and low economic status in most countries. Worldwide, nearly 40% of all maternal deaths, 41%, of all deaths due to infectious diseases, 40% of tuberculosis cases, 70% of the poliomyelitis cases occur in this Region. Similarly, the Region accounts for 25% of the hepatitis B cases, over 15% of HIV/AIDS infections and about 35% of blindness. Infant mortality rates in some countries are still high, ranging between 80 and 100 per 1000 live births. An analysis of under-five mortality rates shows a similar pattern. Protein-energy malnutrition and deficiencies of micronutrients such as iodine, vitamin A and iron are also major public health problems. All countries are striving to ensure universal access to quality health care by initiating reforms in their health systems. These initiatives include strengthening the health infrastructure, equitable health care financing, decentralized decision-making and governance, promoting private sector participation and increasing the involvement of the nongovernmental sector. Rapid expansion of international trade in the wake of liberalization has affected health care in the Region, especially in countries with weak trade practices and legislation. In many countries, quality drugs are not accessible to a large proportion of people. On the other hand, there is the challenge of irrational and indiscriminate prescribing practices, often leading to multi-drug resistance and adverse drug reactions. The adverse effects of tobacco and alcohol consumption on overall morbidity and mortality, especially among poor families, are also a cause for serious concern. Neuropsychiatric diseases account for ten per cent of the burden from noncommunicable diseases. Depression is the most common cause of disability worldwide, including in the South-East Asia Region. Heavy investments in diagnostic and hospital facilities including long-term care have to be incurred to take care of the situation created by substance abuse.

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1.2 Progress in WHO Collaboration with Member States WHO collaborative programmes during the last decade have made significant contributions in supporting health development efforts in the countries of the Region. The lessons learnt from these efforts would guide the formulation and implementation of future collaborative programmes in the Member Countries. The lessons include, among others: • High-level health advocacy for supporting the development of sound national policies and strategies has resulted in bringing health to the centre of development activities. Promotion of technical cooperation among countries has resulted in general health development, development of joint disease control operations, and the establishment of training programmes. • Partnerships with regional organizations such as ASEAN and SAARC have helped in strengthening health development efforts in communicable disease control, nutrition, and providing access to essential drugs. These partnerships have also resulted in disease reduction, improvement in the quality of services, and overall health sector development, including human resources. • Strengthened partnerships with governments, nongovernmental organizations and leading technical institutions have promoted national capacity development. • Maintaining a high level of child immunization coverage against vaccinepreventable diseases has resulted in a substantial reduction of mortality and morbidity due to these diseases. • The organization of a series of national immunization days synchronized among neighbouring countries has resulted in increasing the coverage and strengthening immunization networks for other vaccine-preventable diseases. WHO’ s role in mobilizing partners for this crucial phase has been critical. • All countries of the Region have prepared national plans of action for HIV/AIDS control. The resources, however, are grossly insufficient, requiring greater coordination among UN co-sponsors to ensure enhanced and sustained political commitment. Surveillance needs to be expanded to include STI and behavioural aspects. • All countries have accepted the WHO-recommended DOTS strategy for tuberculosis control. The experience of successful partnership with the private sector and mobilizing bilateral and multilateral funding will be useful in future collaboration. The Region is beginning to develop capacity to monitor multi-drug resistance. • The Roll Back Malaria initiative has received political commitment at the highest level. Bi-regional cooperation has helped in strengthening cross-border surveillance of communicable diseases, and in achieving consensus on technical issues and in developing case definitions, milestones and key indicators. • The Region has been certified to have eradicated guineaworm disease. Eradication has resulted from a combined strategy of stepwell conversion,

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provision of safe water sources, and massive social mobilization and education efforts. • The outbreak of human plague in India in 1994 caused national panic and international concern. The lack of scientific information contributed to rumours, speculation and imposition of trade and travel restrictions by many countries. The situation, which was brought under control, gave impetus to strengthen national surveillance and response systems and their linkages with WHO networks worldwide. • Tobacco consumption among women and youth is rising in the Region. The Tobacco Free Initiative and World No Tobacco Days are used to draw public attention to the dangers inherent in tobacco use. There is a need to intensify media campaigns to counter the promotional activities of tobacco manufacturers, including their extensive advertising and sponsorship of sports and cultural activities. • WHO’ s support through the provision of technical expertise, training of primary health care workers, development of infrastructure, and strengthening of medical institutions has resulted in a substantial reduction in the incidence of preventable blindness in several countries. • The joint planning and management of WHO collaborative programmes by the Member Countries and the WHO Secretariat, through the Regional Committee and the Consultative Committee on Programme Development and Management (CCPDM), has played a significant role in improving the implementation of programmes. • The joint Government/WHO coordination mechanisms continue to play a key role in guiding the planning, implementation and evaluation of WHO programmes and in blending these programmes and those supported by other development partners, in the national health development efforts. • As a tool of health sector reform, country health profiles and national health accounts were developed. Six countries submitted their country profiles. The main features of the country profile are: the health expenditure pattern, mechanism of health financing, public-private mix and regulatory mechanism. • The newly-developed standards of midwifery practice for safe motherhood have helped countries in enhancing and ensuring the quality of midwifery care. They also facilitate increased accessibility to selected life-saving interventions for women in the rural and remote areas. These standards are well received internationally. Actions are being taken by WHO/HQ to further refine them for global application. • In promoting gender mainstreaming in health policy and programmes, WHO/SEARO, through country collaboration, has developed a database disaggregated by sex, age, and other variables, employing the life-span approach. These data are presented in the Regional Health Report 1998, “ Focus on Women” .

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2.

REGIONAL STRATEGIES AND PRIORITY ACTION (also see Annex)

2.1 Regional Framework The countries of the South-East Asia Region of WHO are mostly developing nations facing the daunting challenges of poverty, lack of sanitation and a high prevalence of infectious diseases. The basic and essential health services, particularly for the vulnerable sections of population, are inadequate. The Health Ministers of the Region, committing themselves to improve the health status of their populations, adopted the “ Declaration on Health Development in the South-East Asia Region in the 21st Century” . The Declaration, subsequently endorsed by the Regional Committee, reaffirmed the unwavering commitment of the Member Countries, inter alia, to ensure universal access to quality health care; to accord the highest priority to alleviate the burdens of disease, disability, premature death and suffering afflicting people, especially the poor; to invest in women's health and development to eliminate gender discrimination and disparities; to strengthen existing partnerships and to forge new ones for health development at all levels, and to develop regional self-reliance. At their meeting, health parliamentarians from the Region, noting the gaps in health status between the countries and among population groups within countries, also pledged to reduce the negative implications on health status by the globalization phenomenon; advocate and take appropriate legislative measures to enhance the social safety net; to find alternative ways of health care financing in both the private and public sectors, including the establishment of trust funds for the poor and vulnerable, and to promote a smooth transition of the decentralization process. The Regional Conference on Public Health in South-East Asia in the 21st Century, held in Calcutta, India, in November 1999, noted the progress as well as the considerable gaps in public health practice, education and training, and research in the Region. The Conference adopted a Declaration, with a view to enhancing health development in the Region, endorsing the promotion of public health as a discipline and as an essential requirement for health development; recognizing the leadership role of public health in formulating and implementing evidence-based healthy public policies; strengthening and reforming public health education and training, and research as supported by the networking of institutions, and the use of information technology for improving human resources development. The regional framework will, therefore, focus on the above strategic approaches, reflecting the WHO Corporate Strategy and its core functions. WHO would continue to contribute through its technical expertise, where it has a comparative advantage and can respond meaningfully to support health development efforts of the countries of the Region. 2.2 Issues and Challenges The foremost challenges for WHO collaboration with and in Member Countries are to: • Articulate and advocate evidence-based policies and strategies: It is imperative to ensure that policy and decision makers have access to evidencebased information for formulating and implementing strategies to improve the health care delivery system. Steps will be taken to further develop SEARO's capacity to critically analyze, organize and disseminate information on

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epidemiological surveillance and other health information to support decisionmaking. • Maintain high-level of technical expertise for catalyzsing change: The existing concerns and the emerging complex challenges in the field of public health demand a high level of technical expertise and support to Member Countries in improving the health status of their people.The Regional Office will, therefore, address these challenges by strengthening its collaboration with the network of WHO Collaborating Centres in the Region and with external agencies. Through this collaboration, the Regional Office will provide technical solutions suited to the needs of the Member Countries . Action to exchange experts among countries and facilitate rotation of staff between the WHO Country Offices, the Regional Office and WHO Headquarters will be promoted. • Enhance national and regional partnerships: The determinants of ill health cover multisectoral concerns. It is imperative therefore, to strengthen existing partnerships and forge new ones for health development at all levels. Efforts will be made to foster interaction between health planning, policies and actions with other government and nongovernmental sectors. These sectors will be urged to include health concerns in their agendas. • Sustain national and regional health development capability: Strategies will be formulated to further develop and strengthen the capacity of each Member Country in the South-East Asia Region in health development through the development of health and medical sciences, medical technology and health care services. Regional self-reliance in health development will be promoted through regional solidarity and intercountry cooperation. Life expectancy in the Region has risen steadily. As a result, the proportion of elderly people in the population is also accelerating rapidly. The Region, with its high population, also accounts for a major proportion of the global disease burden. Thus, WHO’ s collaborative activities will concentrate on reducing excess mortality, morbidity and disability due to communicable and noncommunicable diseases, especially among the poor and vulnerable population. The major determinants and appropriate interventions for the prevention and control of such diseases will be identified and implemented widely. WHO’ s comparative advantage, particularly in relation to the production of public goods, building consensus around policies, strategies, norms and standards and initiating and managing negotiations and sustaining national, regional and global partnerships, will be pursued more vigorously. • Resource mobilization: WHO will enhance its efforts to support countries in their efforts to mobilize resources internally and from existing and potential development partners for their health development efforts. 2.3 Specific priority areas for 2002-2003 Specific priorities as outlined below are an amalgamation of global and regional priorities. In

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view of the particular disease burden being faced by the countries of the Region, a regional perspective has been added to supplement global priorities. In determining regional priorities, each of the Member Countries of the Region provided a list of country priorities. These priorities were reviewed to ensure consistency with respect to the WHO “ Core Functions” and “ Strategic Directions” and then aggregated into regional priorities, thus ensuring a regionally appropriate programme in the context of “ One WHO.” The focus during the biennium 2002-2003 would, therefore, be on the following main areas: Malaria Synchronizing with the efforts made by WHO Headquarters to roll back malaria by intensifying advocacy for political commitment, support will be provided in the elaboration of national plans of action. These will be based on situational analysis, development of technical resource networks and community mobilization. From the regional perspective, priority will be given to address the problem of multidrug resistance through the Mekong delta project and through partnerships. Using intercountry mechanisms, the problems relating to border malaria will be tackled. Biological control of vectors and comprehensive control of vector-borne diseases will be intensified. HIV/AIDS Global efforts will be fully supported through collaboration with UNAIDS for sustaining political commitment and for mobilizing resources. The programme will further strengthen technical support for STI syndromic management, blood safety, disease surveillance and research, prevention of mother to child transmission, and care of people living with HIV/AIDS, including management of opportunistic infections and counselling. The regional priority will include emphasis on surveillance, especially of behaviour surveillance and STI. This will help refine the plans of action and monitor the epidemic. Operational research will be promoted to focus on priority areas including behavioural and social interventions. Partnerships will be developed to encourage the private sector to participate in syndromic management of STI. The HIV/AIDS control programme will develop partnerships with other programmes to address the numerous social and medical problems. Tuberculosis Support will be provided to sustain political commitment to achieve the global targets through expansion of DOTS. The quality of DOTS implementation will be enhanced by capacity building through in-depth country reviews, improvement of laboratory diagnosis and strengthening of programme management. Specific attention will be paid to the problem of HIV/TB co-infection. Monitoring of drug resistance will be established. Partnerships with NGOs and the private sector will be further strengthened. Operational research will be promoted and the findings used through development of linkages between researchers and the programme. Maternal Health (Making Pregnancy Safer) One area of continuing concern in the Region is the low status of women. The health

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consequences of the low status of women are reflected in every aspect of their lives, and in their inadequate access to health promoting and life-saving interventions. WHO’ s support will be continued to address the high maternal mortality ratios. Through its Safe Motherhood Initiative and the regional reproductive health strategy, WHO’ s support will be continued. The standards of midwifery practices for safe motherhood will be refined for wider application. In addition, reduction of morbidity and mortality of children will remain an important strategy within the maternal and child health programmes. Tobacco Tobacco consumption is increasing in the Region, with diseases and deaths attributable to tobacco use becoming a cause for serious concern. Alerted to the health dangers, most countries are making significant progress in promoting tobacco control measures. Technical support will be provided to strengthen national capacity for comprehensive tobacco control programme management including participation in the Framework Convention for Tobacco Control (FCTC) process. TFI advocacy activities both at the regional and country levels will be further enhanced. Priority areas for operational research will be identified and supported for the improvement of programme implementation. Community-based anti-tobacco and cessation intervention programmes will be expanded. Major Communicable Diseases Collaboration with Member Countries will focus on the adoption of an integrated approach to control priority communicable diseases among the poor, vulnerable and inaccessible populations. Efforts to control the increasing epidemics of dengue/DHF and the outbreak of filariasis will be intensified. Enhancing the regional and national capacity to reduce case fatality will be emphasized. Control efforts against kala azar, a re-emerging problem, will also be intensified. Promotion of the use of treatment schedules based on research findings is necessary. Use of intercountry mechanisms to address the cross-border problem of kala azar will be further promoted. Poliomyelitis will continue to remain a priority, as some of the countries would not be in a position to eradicate it by 2000. The programme is envisaged to continue beyond 2003. Through the Health and Environment Initiative, eight countries of the Region have developed national health and environmental plans of action. The Regional Office has been promoting the concept of healthy cities since 1992, to address priority health and wellbeing issues. Environmental problems, resulting from rapid population growth and urbanization are challenging the ability of governments to provide adequate services to the increasing number of urban residents posing a serious challenge to health development. The delivery of basic services such as water supply and sanitation, are straining national resources. WHO has been supporting the countries in their efforts to strengthen institutional capacity to assess and manage health hazards due to air, water and land pollution and to ensure the quality of drinking water. Other areas in which WHO has been providing support include the management of wastes from medical facilities and the promotion of chemical safety.

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Cancer, Cardiovascular Diseases and Diabetes There are clear signs that these diseases are assuming serious proportions. There is a sharp increase in cardiovascular diseases. Mortality from cancer is also on the increase. Another lifestyle-related disease, diabetes mellitus, has emerged as an important public health problem in the Region. Blindness is also a serious problem: the Region accounts for nearly one-third of the blind people in the world. Member Countries will be supported in developing national NCD control programmes. Emphasis will be given to the establishment/strengthening of surveillance of cardiovascular diseases, cancer, diabetes mellitus and their risk factors. Initiation of integrated communitybased prevention projects will be supported, initially in three countries. Regional networks of NCD prevention will be established for sharing experience and improving strategies and later expanded to cover more areas and countries. Mental Health Support will be provided to develop/implement national mental health policies with emphasis on community-based programmes in mental health and substance dependence, including prevention of ill-effects from alcohol. A regional profile of the burden from neuropsychiatric disorders will be developed. Innovative community-based management programmes, which are culturally sensitive and reach out to all groups including marginalized groups, will be developed. Food Safety The World Health Assembly called upon all Member States to address deep concerns that foodborne illnesses associated with microbial pathogens, biotoxins and chemical contaminants in food represent a serious threat to the health of millions of people in the world. It is recognized that foodborne diseases significantly affect people’ s health and wellbeing and have economic consequences for individuals, families, communities, businesses and countries. Ensuring the safety of food and harmonizing the efforts of all stakeholders in the food chain requires effective food safety systems. In most developing countries, however, these systems remain weak. The Assembly urged Member States to integrate food safety as one of their essential public health and public nutrition functions, and to provide adequate resources to establish and strengthen systematic and sustainable food safety programmes at all levels of the food chain. Furthermore, this should be carried out in close collaboration with national applied nutrition and epidemiological surveillance programmes. Safe Blood Blood safety in the Region is of major concern since there is limited access to safe blood. Blood transfusion services in most countries face problems that hamper the availability of safe blood. Lack of a national policy or lack of effective implementation and inadequate trained human resources to undertake transfusion services are primarily responsible for this

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situation. The development of health laboratory services and the integration of quality assurance parameters in the functioning of these laboratories have been carried out in all countries. Technical support in the development of laboratory programmes, training of personnel and provision of supplies and equipment was provided by WHO. WHO will provide technical support in formulating and implementing national policies on blood safety for safe blood transfusion. Strengthening of blood transfusion services, quality assurance programmes in health laboratory services, and advocacy for accreditation of laboratories will also be supported. Health Systems Strengthening the provision of primary health care (PHC) has remained a priority for the Region ever since its enunciation in the Alma Ata Declaration. WHO’ s assistance to Member Countries to restructure their health systems based on PHC has helped to achieve equitable, affordable, accessible, sustainable and good quality health care. Through decentralization and community participation, district health systems have been strengthened. WHO has undertaken a number of steps directed at enhancing intercountry cooperation and collaboration in the Region. WHO’ s support will be aimed at strengthening national capacity on health policy planning and management for the provision of effective and efficient health services that are responsive to the community’ s needs, particularly the poor and vulnerable. Strengthening national capacity for health sector reform that leads to equity in health care and developing capacity to plan, produce and manage a cost-effective mix of human resources for health to provide equitable, integrated and quality health care will also be supported.

3.

RESOURCE INDICATION

WHO/HQ has recently developed its Corporate Strategy to address the challenges of rapid evolution of international health. The Programme Budget 2002-2003 is a key instrument for advancing the process of change and reform in WHO. Both in its content and in the way it is being prepared, it reflects a significant departure from previous biennia. In order to emphasize "One WHO Budget" - more programme-oriented and with a focus on resultsbased budgeting - PB 2002-2003 is initially being presented, with total country and RO/intercountry allocations. In addition to the Regular budget proposed allocation, efforts will be made during the biennium 2002-2003 to mobilize approximately US$100.5 million extrabudgetary resources for various priority programmes.

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The proposed resource indication for the biennium 2002-2003 under Regular budget and extrabudgetary sources is summarized as follows:

Organizational Level Country activities Regional/ ICP activities Total

Proposed allocation (US$) RB Funds 61,538,000 31,484,000 93,022,000 EB Funds 68,485,000 32,015,000 100,500,000 Total 130,023,000 63,499,000 193,522,000

Individual country allocations under Regular Budget will be presented to the 54th session of the Regional Committee, after the World Health Assembly meeting in May 2001 has approved the Programme Budget.

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Annex ISSUES AND CHALLENGES AND BROAD REGIONAL STRATEGIES IN 35 AREAS OF WORK 1.1 Communicable Disease Surveillance Issues and Challenges The burden of communicable diseases in the countries of the SEA Region is a continuing challenge because of the resultant high mortality and disability, which leads to the worsening of poverty and economic loss. Population growth, socioeconomic problems, increased travel and trade and ecological changes create conditions favourable for emergence and re-emergence of communicable diseases. Antimicrobial drug resistance is adversely affecting effective treatment and control of diseases. In the countries of the Region, disease surveillance is weak, except for selected programmes like poliomyelitis and HIV/AIDS, in which special efforts have been made. Since the weak health infrastructures and poor resources cannot sustain surveillance of the large number of communicable diseases, it is necessary to focus on selected diseases and use multidisease surveillance. A useful approach is to hasten the development of the Geographical Information System (GIS). Surveillance has to be linked to effective response, which must be consistent and timely, to control outbreaks and epidemics. As a result of globalization and increasing trade and travel, there is growing concern about the global spread of epidemics. International health regulations are consequently being revised to address this situation. Broad Regional Strategies • Advocacy for sustained political will in support of disease surveillance and response, establishment of national task forces to help strengthen disease surveillance and monitoring of antimicrobial drug resistance. International health regulations will be increasingly used to cover major international concerns. • National and regional capacity building through training courses (FETP short courses and two year course, epidemic preparedness and response training), strengthening of laboratories and WHO Collaborating Centres and informationsharing using information technology. • Adoption of multi-disease surveillance using an integrated approach. The response component will be stressed with reference to poor and vulnerable populations, including women and children, migrants and refugees. • Establishing networks of institutions comprising of laboratories, WHO collaborating centres and others to collaborate in disease surveillance including emerging diseases, zoonoses and antimicrobial drug resistance. • Use of database on priority communicable diseases and adoption of GIS. This will be the basis of better preparedness to predict, recognize and respond to epidemics.

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1.2 Communicable Disease Prevention, Eradication and Control Issues and challenges Communicable diseases continue to be the most common killers of children and young adults in the countries of the SEA Region. They are estimated to account for upto 45% of mortality in developing countries. Besides high mortality associated with communicable diseases, the burden of disability is also increasing. These factors affect human development and worsen poverty, which affects about one-third of the population. The threat of antimicrobial drug resistance is making communicable disease control even more difficult. Insufficient political commitment, inadequate resources and poor accessibility to control and treatment of communicable diseases are the major constraints. Some countries in the Region are also seriously threatened with kala-azar and increasing epidemics of dengue/DHF. The experience gained in the Region in combating these diseases can be useful in other Regions facing similar problems. The Region has eradicated guineaworm disease. Considerable gains have been made with regard to the elimination of leprosy. A record number of leprosy patients have been successfully treated. Yet, the elimination targets are likely to be achieved by India, Myanmar and Nepal only by 2003. Broad Regional Strategies • Advocacy for sustained political commitment in the eradication/elimination of leprosy, lymphatic filariasis and urban rabies. Advocacy will be enhanced to support an integrated approach to selected priority communicable diseases with the focus on increasing access to the poor and vulnerable population groups. • Elimination of leprosy in India, Myanmar, and Nepal and the integration of leprosy diagnosis and treatment in general health services in all countries of the Region. • Initiation of lymphatic filariasis elimination efforts in first-use districts in endemic countries with close monitoring to document the experience to be used during the expansion phase of the elimination. • Integrated control of priority communicable diseases of public health importance to be implemented in districts with poor access. This approach will increase the access to health care for poor and vulnerable populations.

• Focus on control of dengue/DHF, kala-azar and soil-transmitted helminthic infections. Utilization of available technologies with close monitoring of outcomes to be ensured. The experience will be shared with countries in other Regions afflicted with these problems. Comprehensive control of vector-borne diseases using an integrated approach through capacity building, increasing use of impregnated bednets and biological control of vectors. 1.3 Research and Product Development for Communicable Diseases Issues and Challenges All Member Countries are implementing nation-wide programmes for control of vector-borne diseases, tuberculosis, HIV/AIDS, and leprosy. Despite significant inputs of resources over the last three decades by the national governments, WHO and other organizations,

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communicable diseases remain a major burden. The Special Programme for Research and Training in Tropical Diseases (TDR) has made important contributions in the control of communicable diseases and has now expanded its mandate to include dengue and tuberculosis, in addition to the previously identified eight diseases. New technology and concepts in health care are not finding significant application since they are expensive, and therefore poor countries cannot afford to use them widely. Transfer of technology requires enormous resources and trained manpower, which are scarce. As a consequence, very useful findings have not been utilized optimally. Public health is facing the challenge of developing synergy between researchers, policy makers and those responsible for disease control programmes. Expertise in public health, which includes researchers, public health specialists and health policy planners, is scattered in the Region and lacks functional linkages. These linkages need to be established in a cost-effective manner. Broad Regional Strategies • Strengthen national institutions through capacity building, training, increased use of information technology, and identification of problems and research priorities. • Support operational research, including field testing of new products and technologies for cost-effective and sustainable control measures. Collaboration will be established with TDR and other funding agencies for field operational research. Technical support will be provided with the goal of serving the poor and marginalized. • Establish network of researchers, institutions at national and regional levels. Database of researchers, technical resource groups and institutions will be established to facilitate information exchange and transfer of technology. • Promote linkage of research activities with policy makers and disease control programmes. Periodical reviews of research priorities to determine how and to what extent the research is impacting the control programmes. 1.4 Malaria Issues and Challenges During the last 10 years, there has been no perceptible decline in the problem of malaria in the Region. It is estimated that there are about 27 million cases of malaria every year and about 30 000 deaths. The disease is a major cause of poverty, owing to high treatment costs and decreased productivity. The problem of P. falciparum malaria is increasing with the Region becoming an epicentre for multi-drug resistance. There are focal epidemics of the disease. Malaria in the Region is partly related to unplanned development and increased cross-border migration. Also, the resources for malaria control in the Region are insufficient. Malaria control efforts are often fragmented. Political commitment is not substantial and the capacity to deal with the problem is limited. The control efforts have not been mainstreamed, resulting in limited community participation. The programme has made efforts for building capacity. Partnerships have been built, though these need to be

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expanded. Cross-border malaria is declining in the border districts of Myanmar and Thailand. As a result of advocacy, the Roll Back Malaria initiative has been endorsed by the ministers of health. A beginning has been made in establishing technical resource networks. Partnerships are being built to work intensively through the Mekong project to address the problem of multidrug resistance in six countries from the South-East Asia and Western-Pacific Regions. Broad Regional Strategies • Sustain political advocacy to obtain the required resources and solicit commitment from academia, the private sector, NGOs, industry, and intersectoral partners. • Address the problem of cross-border malaria and multi-drug resistance through the Mekong RBM project. Support other countries facing a substantial malaria problem through RBM. • Focus on high risk and vulnerable groups like women and children, migrants and refugees, the poor and those with limited access to health care. • Maximize the use of available technology to address the problems in countries of the Region. The technical resource networks will be utilized for early diagnosis and prompt treatment (DPR) and transmission risk reduction (TRR) through mainstreaming of the control efforts and through surveillance including the use of the Geographical Information System (GIS). • Increase the national and regional capacity through training, provision of diagnostic facilities, RBM guidelines and follow up using the network of institutions and WHO collaborating centres.

• The Roll Back Malaria initiative will be fully established in the first-use districts in all endemic countries and expanded, based on the carefully documented experience gained in the first-use districts. 1.5 Tuberculosis Issues and Challenges Tuberculosis is one of the major killer diseases in the Region and is a serious impediment to human development. The disease afflicts people mainly in the 20-45 year age group and is estimated to result in an annual loss of about US $ 4 billion. This is despite the availability of DOTS, a cost-effective strategy recommended by WHO. The main concerns in TB control are its association with HIV/AIDS, and the development of multi-drug resistance. There are five countries in the Region which account for 38% of the global burden of TB. The WHO targets of 85% cure rate and 70% case detection in newlyinfected persons are likely to be reached before 2005. All the countries in the Region have adopted DOTS strategy. The coverage with DOTS in the countries increased remarkably from 14% in 1998 to 30% by March 2000, despite the resource constraints and the countries’ weak health infrastructure. About 500 000 patients have been treated with cure rates exceeding 80%. Rapid expansion of the DOTS strategy while maintaining the quality, is the greatest challenge for the programme.

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Broad Regional Strategies • Enhance technical support to countries with high burden through regular monitoring missions and in-depth country reviews; organization of programme managers’ meetings for exchange of information and promoting operational research. • Strengthen national capacity by supporting intercountry and national training courses on TB control, leadership and strategic management training, improving laboratory microscopy and setting up laboratories to monitor multi-drug resistance. • Promote advocacy for enhancing and sustaining political commitment and, mobilization of resources through partnerships with the private sector, NGOs and industry. • Ensure regular drug supplies and drug management, by facilitating intercountry cooperation for bulk purchase and/or import of raw material for local production and assist in resource mobilization, making use of the global fund for TB. • Enhance coordination with key programmes including disease surveillance, laboratory support, essential drugs, health education, women’ s health and HIV/AIDS control. 2.1 Surveillance, Prevention and Management of Noncommunicable Diseases Issues and Challenges Most countries in the Region are undergoing significant social and demographic changes. There is rapid urbanization, expanding industrialization, rising income and improved health care. Seven out of ten countries have life expectancy at birth at over 60 years. Circulatory diseases, cancer, diabetes mellitus and accidents are becoming leading causes of morbidity and mortality. It is estimated that by 2025, there will be nearly 80 million diabetics in the Region - the highest among all WHO Regions. Unfortunately, noncommunicable diseases (NCDs) have so far been addressed with tertiary care, which is expensive and often only palliative. There is very little awareness that NCDs are amenable to primary prevention. Political commitment for NCD control is still inadequate. Control measures and clinical management of these diseases in most countries of the Region are also inadequate. The need for strengthening NCD programmes as part of national health development was emphasized during the 50th session of the Regional Committee in September 1997. During 1999-2001, SEARO has set up a foundation for the development of a comprehensive NCD surveillance system. Region-wide collection of information on major NCDs has been initiated. Broad Regional Strategies • Strengthening and expanding interventions based on an integrated approach of health promotion in the prevention of major NCDs and introducing them into the national primary health care services.

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• Improving the knowledge and skills of health professionals in health promotion and prevention of NCDs and, simultaneously, improving the knowledge of communities, family members and caretakers on NCD risk factors and their modification. • Strengthening surveillance of NCDs and their risk factors, within the framework of a national surveillance system. • Promoting research on cost-effectiveness of prevention, and management of noncommunicable diseases. • Establishing partnerships with other supporting agencies and NGOs for the promotion of noncommunicable disease prevention and control in the Region.

• Establishing networks among countries, WHO Collaborating Centres, professional organizations (Regional Network), among other WHO Regional Offices and WHO HQ (Global Forum) in sharing information, exchanging expertise and coordinating planning and implementation activities. 2.2 Tobacco Issues and Challenges Currently, tobacco kills 4 million people a year globally. Tobacco-related morbidity and mortality in the Region is unacceptably high. The tar and nicotine contents of tobacco products in the Region (e.g. bidis, kreteks and white cigarettes) are comparatively high and consequently cause more damage to smokers. Two countries in the Region have adopted comprehensive national tobacco control policies. There are many measures currently implemented in other countries of the Region such as warning labels, restriction of advertising in specific media and at specific locations, bans on sponsorships, prohibition of smoking in public places and public transport, public education and the declaration of specific tobacco free islands and districts. However, the impact of these measures has so far been limited. Tobacco is a socioeconomic and developmental issue. Multi-sectoral collaborative efforts are urgently needed to address the problem. A wide range of measures addressing a broad array of issues related to tobacco control need to be taken together to reduce tobacco consumption. Broad Regional Strategy • Develop regional consensus for tobacco control. WHO will advocate, at the highest level, to develop, strengthen and maintain regional consensus and concerted efforts on tobacco control. Individual governments should initiate action to achieve consensus within the countries on tobacco control.

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3.1 Child and Adolescent Health Issues and Challenges Globally, nearly 11.6 million children die before reaching five years of age and 70% of these deaths occur due to diarrhoea, pneumonia, measles, malaria and malnutrition. About 40% of the deaths attributable to those diseases occur in SEAR countries. Many adolescents die through violence, complications of pregnancy and illnesses that are either preventable or treatable. Adolescent health has not received adequate attention until recently in many developing countries, including those of the South-East Asia Region. It is obvious that neither maternal and child health programmes nor school health services adequately address the special needs of adolescents. For improving survival among children under five years of age, the Integrated Management of Childhood Illness (IMCI) was adopted during the World Health Assembly (resolution WHA48.12) in May 1995. IMCI strategy is considered a cost-effective approach for redressing the unacceptable high burden of disease in this age group. In SEAR, this strategy has been implemented in target countries with high under-five mortality rates. For older children, school is an important entry point for preventive, promotive and curative health care. The major problems to be addressed during this period include malnutrition, malaria, chronic otitis, media and visual and auditory disorders. Life skills promoted at this age enable adolescents to deal with different issues later. Adolescents in the Region face problems due to early marriage and child bearing. Other risky behaviours include smoking, alcohol use, substance abuse and violence. Therefore, the need for a safe and supportive environment for children and adolescents cannot be overemphasized. Broad Regional Strategies • Develop an integrated approach to child and adolescent health and encourage its inclusion in the national policies of Member countries. • Enhance national capacity in IMCI through training, institutional strengthening and promoting strategic management skills. • Improve family knowledge and practices on the home care of childhood diseases and on the promotion of child and adolescent health and development. This will be done through the involvement of community support groups, basic health workers and doctors. • Incorporate the IMCI approach into the curricula of medical schools and training institutions for health personnel. • Expand the integrated package of child and adolescent-friendly health services through mobilization of resources from donors including multilateral and bilateral agencies. 3.2 Research and Programme Development in Reproductive Health

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Issues and Challenges According to WHO estimates, reproductive ill-health accounts for 33% of the total disease burden in women as compared to 12.3% for males of the same age. It is known that malnutrition and anaemia, adolescent fertility and pregnancies with associated risks, the rising incidence of STDs and HIV/AIDS in pregnant women, reproductive tract infections, and deaths due to abortion contribute significantly to maternal morbidity and mortality in countries of the Region. Maternal mortality is still high in all countries of the Region, except in Sri Lanka and Thailand. Many countries have identified reproductive health as a priority issue and there are many partners supporting the national reproductive health programmes. However, providing support in a coordinated manner is a challenge to countries. Similarly, providing need-based technical support to countries is a challenge to WHO. Broad Regional Strategies • The International Conference on Population and Development (ICPD) held in Cairo in 1994 placed reproductive health high among the programmes of national governments, international organizations as well as NGOs. The Conference also emphasized the need for empowerment of women and involvement of young people in the development and implementation of programmes and services reaching out to the poor and the marginalized groups. • The World Health Assembly adopted a resolution (WHA48.10) which endorsed the ICPD programme of action and outlined the global reproductive health (RH) strategy and WHO’ s advocacy role, technical support to countries, research and normative functions in support of ICPD’ s Programme of Action. • The Regional Reproductive Health Strategy was developed in 1995 for operationalizing ICPD’ s Plan of Action and the global RH strategy. The RH strategy identified essential RH package by levels of care, building on and adding newer components. The essential RH package includes safe motherhood, family planning, prevention and management of complication of abortion, RTI/STD, HIV and adolescent reproductive health. Countries have adapted the RH strategy and developed their own national reproductive health strategies. • The strategy for WHO/SEARO for the next two years will be to assist countries in implementing their national RH strategies. 3.3 Making Pregnancy Safer Issues and Challenges Though maternal and child health programmes have existed since the 1960s in most countries, the emphasis was on child survival activities; maternal health was neglected. The Safe Motherhood initiative was launched in 1987 in Nairobi to draw the world’ s attention to a largely neglected, but extremely serious public health problem of maternal death and disability. Of the estimated global annual total of 584 000 maternal deaths, all but 6 000, i.e., 98%, take place in the developing world. In the countries of the South-East Asia Region,

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the maternal mortality rate (MMR) is extremely high, except in Sri Lanka and Thailand. SEAR contributes 40% of the global total of maternal deaths. Women die from haemorrhage, infection, hypertensive disorder of pregnancy, obstructed labour, unsafe abortion and a range of diseases that are aggravated by pregnancy - such as malaria, hepatitis, rheumatic heart disease and diabetes. Underlying the medical causes, there are socioeconomic factors as well, including women’ s status. These factors lead to delays in deciding to seek care and in reaching appropriate facilities. Broad Regional Strategies • Recently, the UN General Assembly Special Session on Population and Development (UNGASS), emphasized the need to intensify efforts at all levels for reduction of the prevailing high maternal mortality. Following the UNGASS resolution, major international agencies including WHO, UNICEF, UNFPA and the World Bank renewed their support for maternal health programmes in developing countries. The joint statement highlighted the consensus reached by agencies that maternal mortality is not only a health disadvantage, but a social disadvantage. Following these developments, WHO launched the initiative of Making Pregnancy Safer [MPS] in February 2000 which calls for massive increases in the proportion of women, particularly women from disadvantaged, poor populations, who can access essential maternal and newborn health care. • The WHO MPS initiative is for renewed commitment for reduction of maternal mortality through trained attendance, strengthening health system and promoting and widening partnerships at various levels - with families, communities, donors, civil societies, etc.

• Therefore, the regional strategies will be to work with high MMR countries to carry out operational research to generate evidence-based information involving interventions to strengthen the health system as well as improving family and community practices, which would be expanded. 3.4 Women’ s Health Issues and Challenges Although there is a growing awareness of equal rights for women, girls and women still have less than equal status compared to men in countries of the Region. Gender discrimination is still a major public health problem with the health consequences of gender discrimination reflected in every aspect of life. Girls and women constitute 48.8 per cent of the Region’ s population, making it the only Region in the world where men outnumber women, indicating a deep-rooted cultural practice of son preference. Over one-third of all deaths among adult women in the Region are due to reproductive health problems. Over 70% of pregnant women in the Region suffer from nutritional anaemia. In some countries, 40- 50% girls are married and become pregnant before they are 20. These statistics reflect the continued neglect of women’ s health, which is a serious impediment to socioeconomic development and poverty reduction in the countries of the

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Region. This issue is being realized in the Region by all levels of decision-making within the public and private sectors including civil society. The regional health ministers in the 1997 Regional Declaration for Health Development in the 21st Century have reaffirmed their commitment to invest in women’ s health and development to eliminate gender disparities in health. Health interventions alone do not have a lasting impact on women’ s empowerment, unless backed by sociocultural, economic and political empowerment, particularly in ensuring equal access to and use of other determinants of health. One of the basic prerequisites of a gender approach to health is information, in particular, data disaggregated by sex, age and other relevant variables. Broad Regional Strategy • The main regional strategy for promoting women’ s health is gender mainstreaming. This process would entail developing tools and guidelines for assessing the implications for women and men of any planned actions including legislation, policies or programmes in the health sector at all levels. This strategy will be persued for making women’ s concerns and experiences an integral dimension in the design, implementation, monitoring and evaluation of health sector policies and programmes within and outside WHO programmes so that women and men benefit equally, and so that inequality is not perpetuated. 3.5 HIV/AIDS Issues and Challenges The HIV epidemic is spreading rapidly in countries of the SEA Region. Currently, the estimate of HIV-positive cases in the Region is 5.5 million. India, Myanmar and Thailand are the worst affected. The dual epidemic of HIV/AIDS and TB is threatening human development through adverse socioeconomic impact. WHO estimates that AIDS cases in the Region will increase during the new millenium. Most countries in the Region are implementing national AIDS prevention programmes. Emphasis is being placed on behavioural change, STD prevention, blood safety, disease surveillance, and care of HIV/AIDS infected persons. The challenge is to encourage behavioural change and ensure that HIV/AIDS care is accessible to the affected persons. For this, sustained political commitment and resources will be required. At the same time, the partnerships with UNAIDS and its co-sponsors, donors, NGOs and the private sector will need to be strengthened. Broad Regional Strategies • Collaborate with UNAIDS and its co-sponsors to sustain political commitment. Enhance advocacy in order to mobilize the required resources, and provide policy support for HIV/AIDS control programmes in the Member Countries. • Provide technical support to strengthen STI management, ensure blood safety, prevent mother-to-child transmission, enhance disease surveillance and provide credible care for HIV/AIDS patients including voluntary testing and counselling.

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• Strengthen HIV/AIDS surveillance and research with emphasis on behavioural surveillance and surveillance of STI. Monitoring of the control programme will be intensified and country reviews will be organized to provide a feedback and improve country plans of action. • Build capacity through training, increased use of information technology, and regular meetings of programme managers to foster exchange of experience. Information technology will be utilized to disseminate the publications widely through effective use of the internet. To raise the profile of the HIV/AIDS control programmes, advocacy will be undertaken with elected representatives, professional associations and regional fora. • Stimulate/enhance intersectoral collaboration and solicit partnerships with the private sector, NGOs and industry. 4.1 Sustainable Development Issues and Challenges The approach to sustainable health development in SEAR countries is beset with daunting challenges. As the inter-linkages between environment and health are being increasingly recognized by all concerned, there is a growing realization that the environmental conditions in most SEAR countries are rapidly deteriorating. This may be attributed to the unmindful exploitation of natural resources, and inadequate attention to the provision of safe drinking water, basic sanitation and clean air etc. Further, traditional environmental health concerns relating to air, water and air pollution are being compounded by increasing amounts of harmful chemicals and toxic wastes - a by-product of growing industrialization. Unplanned urbanization also is aggravating the situation. Above all, widespread poverty and related unacceptably high levels of illiteracy in many SEAR countries is responsible for the very high incidence of malnutrition and anaemia among adults, girls and women in the reproductive age group, which perpetuates ill-health and disease. Poverty is also linked with environmental degradation and pollution. Notwithstanding the formidable challenges, countries in the Region have made notable advances in health development, as reflected by the steadily growing life expectancy at birth, declining infant and child mortality and relative control over malaria and other diseases. Guineaworm disease has recently been eradicated from the Region, which is now at the threshold of eradicating poliomyelitis and eliminating leprosy. Growing attention towards environmental concerns and policies and programmes for poverty reduction are, no doubt, making sustainable health development possible within the existing constraints. Broad Regional Strategies Following the lead provided by WHO/HQ in establishing a new cluster for Sustainable Development and Healthy Environment (SDE), and a Department of Health in Sustainable Development (HSD) under it, the Regional Office has formed a Department of SDE with a unit of HSD under it. • The initiative on health and environment commenced in 1993 with the formulation of WHO’ s Regional Strategic Plan of Action for Health and Environment, which prompted the preparation of national plans of action for health and environment.

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Most SEAR countries have initiated action towards the development of such plans. These efforts are enabling the countries to properly evaluate and address problems relating to water supply and sanitation, outdoor and indoor air pollution, solid and hazardous waste disposal, food safety, chemical safety and housingrelated concerns. • There is a growing realization among the countries that health contributes to economic development in several ways: good health contributes to the enhancement of productivity, increases school enrolment and learning ability of the children, makes it possible to access hitherto inaccessible areas for economic exploitation, and frees resources from treating illnesses and diseases to productive uses. As the poor disproportionately suffer from ill-health and disease, it is now well established that investment in health benefits the poor by contributing towards the alleviation of their poverty. • The Regional Office, at the instance of the Health Ministers, brought out a “ Monograph on Poverty and Health” in 1997. It, inter-alia, demonstrates that macro economic policies that place equal emphasis on accelerating the rate of growth and distributing the benefits of such growth equitably through investment in health education, produce the best results for sustainable development as also health development and poverty reduction. • While WHO/HQ is holding a wide range of consultations for developing a global policy framework on health and poverty reduction, the Regional Office is stimulating debate on the issues involved at the country level. The plan is to assist a couple of countries (Sri Lanka and Nepal) to develop their national strategies on health and poverty reduction, and thereafter to develop a regional strategy. 4.2 Nutrition Issues and Challenges The WHO South-East Asia Region is among the most populated regions in the world. It is home to over 1.4 billion people or one-fourth of the global population. Providing adequate and appropriate food and nutrition to the people is one of the most formidable challenges. The major nutritional disorders in the Region include protein-energy malnutrition and deficiencies of micronutrients such as iron, iodine and vitamin A. Low birthweight continues to cause concern in most countries of the Region especially affecting undernourished and adolescent mothers. Undernutrition continues to be a major problem with unacceptably high levels of moderate to severe stunting. Iron deficiency anaemia is also a major problem, particularly in women of childbearing age and children under five years. Vitamin A deficiency, while generally on the decline, is still a major public health problem as are iron deficiency disorders. Other nutritional deficiencies of emerging global public health importance include zinc deficiency associated with growth retardation and impaired immune function, folate deficiency, which causes widespread megaloblastic anaemia of pregnancy and is associated with neural tube defects in high-risk groups, and calcium deficiency associated with osteoporosis. Noncommunicable diseases related to diet and life-style are also becoming major causes of concern in some countries of the Region.

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A future concern is the epidemiological transition taking place in the countries and the need to must develop multi-faceted nutrition programmes that address undernutrition and infectious diseases as well as diet-related chronic diseases like diabetes, obesity, cardiovascular diseases and certain diet-related cancers. Broad Regional Strategies In consonance with WHO’ s commitments to the goals and strategies of the World Declaration and Plans of Action for Nutrition (NPAN) in 1992, seven priority areas have been identified by Member Countries. These are: • Protection, promotion and support for breastfeeding and appropriate and safe complementary feeding for infants and young children • Assessment, monitoring, prevention and reduction of protein-energy malnutrition • Assessment, monitoring, prevention and elimination of micronutrient malnutrition • Nutrition in emergencies • Nutritional support to sick children • Programme support in planning, policy formulation and implementation in regard to adolescent girls and maternal nutrition • Capacity building in community-based nutrition action research for better health, in collaboration with four collaborating centres and the members of the SouthEast Asia Nutrition Research-cum-action Network. 4.3 Health and Environment Issues and Challenges While there is a need to continue the analyses of disease burden begun in the 2000-2001 biennium, convincing information already exists that environmental risk factors are among the greatest causes of disease in the South-East Asia Region. Worldwide, diarrhoea causes about 3 million deaths per year. In SEAR, over 200 billion diarrhoea episodes per year occur in children under five years of age, caused by inadequate water, sanitation and hygiene, and food safety, with malnutrition being an underlying cause. A global evaluation of water supply and sanitation conducted by WHO and UNICEF in 1999 concluded that Asia has the lowest coverage of these basic services among all regions of the world. It is estimated that indoor air pollution in India alone is responsible for 500 000 deaths per year, and urban air pollution some 85 000. Extrapolated to all of SEAR, the total number of deaths due to indoor and urban air pollution may be of the order of 1 million annually.

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Broad Regional Strategies Common strategies which will cut across all areas of environmental health will include the furtherance of evidence-based research, the building of partnerships through traditional and innovative alliances, and mobilization of extrabudgetary resources. Specific strategies also will be pursued for specific environmental risk factors. • Community-based approaches to water system surveillance and control will continue to be promoted as a strategy for improving drinking water quality. • Support will be given for the preparation of national water and sanitation plans aimed at increasing coverage, which will serve as frameworks for planning specific government and donor-driven projects. • Research aimed at identifying ways and means of increasing the demand for sanitation services, and achieving sustainability of water, sanitation and hygiene interventions will be supported. • National capacities will be strengthened to assess the health impact of both urban and indoor air pollution as well as the proposed intervention strategies. 4.4 Food Safety Issues and Challenges Foodborne diseases are common in most countries of the Region. A large percentage of mortality and morbidity due to diarrhoea can be prevented if microbial contamination of food and water is controlled. The increasing use of chemicals in agriculture and food processing industries have added new health concerns from chemical contamination of food. A number of countries have entered the international food trade and are exporting and/or importing food. While several countries in the Region have food legislation, welldefined national food safety policies and strategies have yet to be developed in many countries. Broad Regional Strategies • Assist Member Countries in developing national policies and programmes in food safety and improve the national capacity for monitoring, assessing and controlling food safety; • Provide training in foodborne disease surveillance and control as well as in analytical methods for food contamination; consumer education and information dissemination; • Promote operational research for understanding gaps in knowledge and testing interventions, and • Collaborate with other international organizations to work towards including food safety as one of the essential public health components. The goal is to develop sustainable integrated food safety systems for health risk reduction.

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4.5 Emergency Preparedness and Response Issues and Challenges Natural disasters and complex emergencies will continue to adversely affect the health of people in the South-East Asia Region in 2002-2003. Estimates suggest that 38% of the people affected and 57% of the people killed by natural disasters during the last decade were from South-East Asia. Rapid industrialization and urbanization are taking place in the Region while large groups of people still live in poverty. Armed conflicts continue to affect several countries in the Region. The result is a complex environment with the potential of severe public health consequences of emergencies and natural disasters. Increased capacity, technical expertise and self-reliance of Member Countries in the Region is needed to prevent and prepare for disasters and, mitigating their health consequences. Broad Regional Strategies The strategies will reflect the emphasis on WHO’ s role as a technical agency in emergency and disaster situations. They will be based on the experiences gained from ongoing projects in the Region on disaster preparedness and management. Extrabudgetary resources will be mobilized through active collaboration with donors and international agencies. • Provide technical support to institutionalized focal points in the Ministry of Health in the Member Countries and WHO country offices. • Disseminate the best public health practices in emergencies and training material on vulnerability reduction to government authorities and collaborating agencies. • Support the use of “ emergencies, hazard and vulnerability” mapping. Ensure that response is based on adequate health assessment. • Promote operational research on disaster and emergency response. • Improve administrative mechanisms within SEARO to respond more effectively to requests for assistance in emergencies. • Promote active partnership with donors, UN agencies, other international organizations, and NGOs on disaster prevention, mitigation and response. 5.1 Health Promotion Issues and Challenges Health promotion has emerged as a viable approach and a tool for comprehensive and equitable health development. The shift of focus from health education to health promotion was catalyzed by the Ottawa Conference and sustained by the outcomes of the subsequent international conferences on health promotion. The four policy orientations of the Ninth GPW, namely, integrating health and human development in public policies, ensuring equitable access to health services, promoting and protecting health and preventing and controlling specific health problems, further strengthened the focus and

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expected outcomes of health promotion. An increasing number of health personnel are being exposed to health promotion concepts and practices. Health promotion strategies have been integrated into many health and development programmes. Intensified focus on the “ healthy settings approach” has paved the way for partnerships with government sectors other than health, NGOs and the private sector. Further advocacy to put health promotion on the public health and health development agendas is urgently needed. Partnerships with sectors other than health, the private sector and NGOs need to be built to promote healthy public policies, particularly in relation to WHO priority areas. Broad Regional Strategies • Advocacy aimed at obtaining political commitment and creating a supportive environment will be strengthened. • Sustainable partnerships revolving around priority health programmes and health development issues will be built. • Operational research and research on behavioural pathways will be given special attention. • The existing health education infrastructure in the Region will be strengthened through training and resource mobilization. • Tapping different means of resource will be actively explored through intensified advocacy. • Partnership-building will be used as a platform for capacity-building. • Existing alliances and networks for health promotion, both at national and international levels, will be mobilized. • New approaches will be piloted as an integral part of community-based projects. • The overall programme will be evaluated in terms of the extent to which implementation in the Region has catalyzed action. 5.2 Disability/Injury Prevention and Rehabilitation Issues and Challenges Significant social changes have influenced the disability situation globally; an increase in the prevalence of disability can be expected. Increased life expectancy has contributed to a growing population of older persons and, as a result, there are an increasing number of persons with disabilities. Injuries are also increasing due to violence, conflict and traffic accidents. The social changes occurring at the global level are reflected equally in SouthEast Asia and are having an impact on the disability situation.

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It is estimated that, currently, there are approximately 15 million blind people in the Region or one-third of the blind population of the world. The number would double by 2020. In 1995, there were 120 million people in the world with impaired hearing. A substantial proportion of these people live in countries of the Region. The Region also has an estimated one million leprosy cases, which represent 72% of the world's total. The prevalence of severe mental disorders has been estimated to be 5 -10 per 1 000 population in various countries of the Region. It is estimated that the number of elderly population in the Region will increase to about 250 million by the year 2025. WHO, in collaboration with other UN Agencies and INGO partners, has drawn up global strategies for addressing the above problems. In SEAR, regional strategies for prevention and control of blindness (Vision 2020), deafness, injury, disability and rehabilitation have been developed as a framework for the development of national plans of action. Broad Regional Strategies • Injury and violence prevention: (1) development of a regional strategy and national programmes on prevention of injuries; (2) strengthening advocacy and awareness; (3) strengthening inter-agency collaboration; (4) establishing and strengthening regional and national surveillance on injuries and violence; and (5) supporting the development of legislation in preventing injuries and violence. • Community based rehabilitation (CBR): (1) establishment of critical links between the donor and multilateral and implementing agencies active in disability issues and rehabilitation; (2) establishment and promotion of regional networking between WHO, international developmental organizations, UN agencies, institutions, centres of excellence, collaborating centres, international experts, professional societies, and INGOs; (3) promoting research, evaluation and education on CBR and appropriate technology to identify key concepts, approaches and models for practice; (4) production of education/training materials on relevant issues pertaining to the detection, treatment and rehabilitation of disabilities, as well as on the management of CBR by national health personnel; and (5) coordination with WHO headquarters and country offices for informationsharing on policy and priority issues. • Prevention of blindness: (1) dissemination and advocacy; (2) development of a regional strategy and plans of action; (3) strengthening human resources in the area of eye health; (4) strengthening infrastructure development and technology; (5) supporting collaborative efforts in reducing avoidable blindness cases; (6) resource mobilization, and (7) strengthening evidence for information and policy. • Prevention of deafness: (1) improving evidence for deafness and hearing impairment, particularly on epidemiological, economic and social aspects; (2) strengthening preventive measures of hearing impairment from chronic otitis media; (3) development of primary ear care as a part of PHC, and (4) support development of national prevention of deafness programme. • Ageing and health: (1) support Member Countries in the formulation of a national policy on ageing and health; (2) strengthen collection and analysis of ageingrelated information for advocacy, policy/programme development and for decision making; (3) disseminate health-related ageing information to ageing individuals,

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all disciplines of all health care professionals and policy-makers to promote appropriate services, advice and practices on healthy ageing; (4) develop an advocacy strategy with close collaboration among government agencies, NGOs and the media, aiming at influencing public opinion and encouraging support for community-based programmes for healthy ageing; (5) promote research in the areas of epidemiology, pattern of ageing population and determinants of healthy ageing; and (6) improve capabilities of health care providers on the care of the elderly. 5.3 Mental Health and Substance Abuse Issues and Challenges In the Member Countries of the Region, mental health activities have generally concentrated on hospital-based psychiatry. However, there is increasing awareness of the need to shift the emphasis to community-based mental health programmes. The Region is particularly affected by the problem of substance abuse. Part of the notorious “ Golden Triangle” (Myanmar, Laos, Thailand) falls within the Region. India has become a major transshipment point for hard drugs from Pakistan. The ill-effects of excessive consumption of alcohol have become a major public health problem in the Region. There is an urgent need to sensitize governments on the importance of mental health and to clearly define the goals and objectives of a communitybased mental health programme. Mental health services should be integrated into the overall primary health care system along with innovative community-based programmes. There is also an urgent need to sensitize governments on the importance of substance dependence, including the ill-effects of alcohol, and to clearly define the goals and objectives to control substance dependence. Broad Regional Strategies • Community mental health: (1) development/ implementation of mental health policy; (2) development of a regional profile of burden from and surveillance for mental disorders; (3) innovative community-based management programmes and development of educational material; (4) launching of advocacy and awareness campaigns, and (5) support for research on indigenous practices and medications. • Control of substance dependence: (1) facilitation of collaboration between Member Countries and Substance Abuse (SAB) WHO/HQ; (2) development of a regional profile of burden from substance dependence; (3) regional capacitybuilding, advocacy and awareness campaigns; (4) innovative community-based management programmes and development of training material; (5) support for research on unique local issues related to substance dependence; and (6) support for research on indigenous practices and herbs. • The goal of the regional policy on the control of ill-effects of alcohol is to achieve a sustained reduction in per capita consumption of alcohol, based on national multisectoral approaches and mobilization of civil society.

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6.1 Essential Medicines: Access, Quality and Rational Use Issues and Challenges WHO is collaborating with all countries in the Region in developing their national drug programmes. The availability and accessibility of essential drugs for primary health care are improving, as the economic aspects of drug supply and management is being strengthened in the Region. Formulation of the dosage forms of essential drugs and their manufacture according to good manufacturing practices have facilitated the availability of essential drugs. The WHO Certification Scheme for the quality of pharmaceutical products moving in international commerce is being used more frequently as a means to ensure the quality of drugs. Exchange of drug information through electronic mail with respect to registered drugs has become functional between and among countries of the South-East Asia and Western Pacific Regions such as Indonesia, Malaysia, Philippines, Singapore and Thailand. The major challenge is to ensure that essential drugs of good quality, safety and efficacy are available, accessible and affordable in all countries of the Region, especially at the PHC level. Additionally, medicines, including essential drugs, must be used rationally. With the emergence of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement, access to patented drugs against emerging and re-emerging diseases such as HIV/AIDS, malaria, tuberculosis and noncommunicable diseases such as cardiovascular diseases, diabetes mellitus and geriatric conditions needs to be provided through appropriate policy and guidelines, intersectoral collaboration and further development of human resources. Broad Regional Strategies • Increasing access to essential drugs in PHC for most countries of the Region with improvement in cost-sharing for drugs in countries such as Indonesia, Myanmar, Nepal and Thailand. • Strengthening of quality assurance of drugs, especially essential drugs, including regulatory control. Strengthening of GMP in the production of essential drugs will be pursued. • Improvement in the rational use of drugs through training of human resources and development and dissemination of authentic drug information to health care professionals will be carried out. The latter would include development or revision of standard treatment guidelines and national formularies, revision of essential drugs lists and development of ADR monitoring centres, e.g. in India and Bangladesh. • Strengthening of national drug policies and their monitoring in countries such as Bangladesh, DPR Korea, India, Indonesia, Maldives, Myanmar and Sri Lanka will be carried out. Quality assurance with focus on laboratory quality control and post-marketing surveillance, promotion of the WHO certification scheme and essential drugs management and supply will also be promoted. 6.2 Immunization and Vaccine Development Issues and Challenges WHO is collaborating with countries in SEAR in further developing their immunization

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programmes and reducing the burden of vaccine-preventable disease. The primary challenge in 2002-2003 will be to continue polio campaigns and surveillance until eradication is certified. Intensive national immunization days throughout the Region should eliminate wild poliovirus circulation, but dedicated efforts must be sustained to reach certification and containment. Continued advocacy and resources will be essential. The specific challenge will be to continue the quality of national immunization days and improve AFP surveillance while maintaining the enthusiasm of health workers, volunteers, and government officials at all levels. Although polio remains a clear priority, a further challenge in the Region is to simultaneously improve routine immunization programmes and even add new vaccines where appropriate. Sustaining and improving national and regional health development capacity in this regard is essential. Increasing and maintaining immunization coverage requires constant effort and resources, particularly for social mobilization, cold chain maintenance, and worker training. Additional financial and technical resources are required if new vaccines such as hepatitis B are to be introduced. The new Global Alliance on Vaccines and Immunizations (GAVI) offers some potential sources for these requirements, but the programme must be implemented in a manner that is technically sound and ensures local initiative. Broad Regional strategies • Continue advocacy and support for polio campaigns. • Provide necessary support for countries to reach certification status and develop lab containment policies. • Assist Member States in setting priorities for vaccine-preventable disease programmes. • Assist Member States in determining appropriate financing mechanisms, including providing technical assistance for developing GAVI proposals. • Strengthen existing polio surveillance networks and expand to include other vaccine preventable diseases. • Provide technical assistance where necessary to expand virologic laboratory capacities and expertise beyond polio. • Develop capacity for vaccine development by providing training in vaccine quality assessment and capacity to conduct clinical trials. • Strengthen EPI management skills at all levels. • Develop an increased priority for immunization safety through advocacy and intense training in safe injection practices. 6.3 Blood Safety and Clinical Technology Issues and Challenges

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Millions of lives are saved each year through blood transfusions. However, in many developing countries people die due to lack of blood and blood products while many millions more are at risk of being infected by untested blood transfusions. In many countries, the lack of adequate blood donor recruitment services, combined with the epidemiological status of certain diseases leads to high prevalence rates of infections in donated blood. Overuse and misuse of blood are also factors to be addressed. Regionally there is still a need to address issues of blood and blood products and injections to ensure that they are safe, accessible and available at reasonable cost, used appropriately and provided within the context of a sustainable health care system. Equitable and safe blood transfusion and injections are not readily available, and this impacts mostly on women, children and trauma victims, especially the poor. In most developing countries, a lack of quality management of blood transfusion services, injections, diagnostic imaging, clinical and laboratory technology services adversely affects the quality of care to the patients. A particular area of concern is increasing drug resistance to human and veterinary medicines. The monitoring of antimicrobial resistance requires urgent action in both disciplines at national and regional levels. Diagnostic imaging/radiotherapy and clinical laboratory services in most developing countries suffer from lack of skilled manpower, inappropriate equipment and poor quality assurance. Medical equipment and devices are inappropriately used, or do not function correctly. Consumables and reagents of reliable quality are not available in sufficient quantities. Most countries have poor infection control and waste management systems. Broad Regional Strategies • The establishment of a coordinated blood transfusion service that can provide adequate and timely supplies of safe blood for all patients in need; • The collection of blood only from low-risk populations and the use of stringent donor selection procedures; • The screening of all donated blood for transfusion-transmittable infections, including HIV, hepatitis viruses, syphilis and other infectious agents, and blood grouping, compatibility testing and processing of blood; • A reduction in unnecessary transfusions through the appropriate clinical use of blood, including the use of intravenous replacement fluids and other simple alternatives to transfusion, wherever possible; • Integration of quality management in various aspects of blood banking, and • Development of regional strategies for laboratory technology; – assessment and procurement; – strengthening management of public health laboratory network in countries; – promotion of adherence to internationally-accepted laboratory standards as a means of ensuring quality management;

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– capacity-building to strengthen antimicrobial resistance monitoring network and development of regional referral centres for disease surveillance, and – plan of action for development of diagnostic imaging services at the peripheral level. 7.1 Evidence for Health Policy Issues and Challenges The direction of the health system and mode of operation of health system performance are invariably linked to evidence-based decisions made on the available information derived from the health information management system (HIMS) of the country. In this context, the key challenge is finding ways and means to improve and strengthen the HIMS. The following components in the HIMS are inherently linked to each other, viz., the medical record system of the hospitals and health centres; methods of classification of morbidity and mortality; the logistic, administrative and technical capacity of those involved in HIMS; and the flexibility and practicality of the framework of the HIMS currently in existence. Assessing the overall health needs of the population, which will also encompass the inequity in distribution of health care services, is one of the challenges needing attention. The appropriateness and responsiveness of the existing national health policy is an issue which should be reviewed in the context of the countries’ science and research policies. The overriding challenge facing all countries of the Region is management and optimum utilization of the available information so that the decisions taken are pertinent and useful to the country. Broad Regional Strategies • Strengthening national health information management systems for improved planning and management of the national health system; • Providing technical support to the countries in using appropriate tools and methods for evidence-based decision making in activities relating to health system performance, and • Promoting and creating an organizational culture which encourages strategic thinking, using reliable information emanating from the dynamic and responsive health information management system. 7.2 Health Information Management and Dissemination Issues and Challenges Proper management of health information materials including formal publications, reports, documents and unpublished materials, in terms of their sources, collection, processing, storage, dissemination and retrieval.

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Harnessing the fast growing area of information technology and exploiting the same to the fullest potential and advantage, with appropriately trained human resources, in the management of health information. The need for marketing and dissemination of WHO publications, production and translation of WHO books and documents, conforming to the identified needs of the Region. Broad Regional Strategies • Developing databases of information resources, especially in WHO priority subject areas with national and regional scope; • Developing and maintaining a virtual HELLIS Library through integration of WHO Library with HELLIS member libraries in the Region; • Developing standards, guidelines, prototypes and modules to promote concerted information management activities for Member Countries in the Region, including organization of “ product-oriented’ national and regional training workshops to facilitate action plans; • Enhancing national capacity in terms of medical writing and editing in all countries of the Region; • Enhancing the marketing and dissemination of WHO publications by appointing more distributors, awarding reproduction rights and fostering translation of WHO publications into local languages of the Region, and • Making the WHO reports and information in Regional Health Forum widely available electronically, by putting them on the SEARO website. 7.3 Research Policy and Promotion Issues and Challenges WHO’ s regional research programme will continue to face the ever-increasing burden and challenge imposed by the dramatic impact on human health and disease by the continuing conceptual and interventional advances, combined with the unprecedented advances in biological, medical and social sciences as well as information technology and explosion of knowledge and health gains made so far. Being home to almost a quarter of the world’ s population, SEAR has a far more formidable challenge in tackling its health problems, particularly in view of the increasing impact of globalization and multilateral trade agreements affecting health. Therefore, in addressing the Region’ s five foremost challenges to health WHO has to focus its research agenda on the following main and important issues: • Closing the gaps and inequities in health in countries of the Region; • Creating conditions that promote health and self-reliance;

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• Ensuring basic health services to all, especially the poor, women and other vulnerable groups; • Upholding and enforcing health ethics; • Placing health at the centre of development, and • Ensuring that the fruits of health research benefit the poor in an equitable and sustainable manner. Broad Regional Strategies • Focusing research not only on science-based and technology-driven approaches, but on the strengths and weaknesses of the existing health infrastructure; • Aiming at a multidisciplinary research agenda, with balance and relevance in research promotion and development activities; • Closing the gaps between researchers, programme managers, health care providers and policy-makers by enhancing the role of SEA-ACHR which fosters research between countries, and promoting research within countries through the linkage of research policies and strategies among health and medical research councils and analogous bodies; • Promoting health research for soliciting evidence-based information on inequities, taking into account the geographical and gender differences and the disadvantaged; • Enhancing the national capacity and role of centres of expertise and national centres of excellence; • Promoting networking of WHO collaborating centres, national research institutes and analogous bodies; • Promoting partnership with regional and global research networks and fora to address areas of health research and management, and

• Strengthening the national capacity for ethical review mechanisms, and assisting in the development of national operational guidelines for ethical review committees. 7.4 Organization of Health Services Issues and Challenges A well-organized health service should be affordable, easily accessible, acceptable and effective. The provision of appropriate manpower and effective policies of the government are other important needs. Since the Declaration of Alma-Ata and the widespread adoption of the goal of Health For All (HFA) through the primary health care (PHC) approach, there has been much

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improvement in some of the key health indicators such as life expectancy, MMR and IMR in the countries of the Region. During the last decade, many countries of the Region have overall organized their public sectors while have done so only in the health sector. The increasing number of old people, violence, accidents and injuries are problems in almost all countries of the Region. In spite of best efforts, many countries now face and will continue to face significant challenges in the organization and delivery of health services. These include: • Insufficient development of the capacity of governments to undertake a stewardship role in critical provision and resource development areas such as ensuring quality of providers; • Services delivery; fragmented health care delivery systems leading to insufficient coverage and inequitable access; • Inefficiencies in the allocation of resources and the management of services; imbalances in the composition and distribution of human resources for health, and • The increasing knowledge in health and medical technologies and the emergence of sophisticated private health facilities challenge the efforts to provide services to poor, marginalized and unserved or under-served people. The commitments made in this regard by the health ministers in the Regional Declaration on Health Development have been helpful. Broad Regional Strategies • To tackle the persisting problems and manage the emerging challenges, the regional focus should be on building management capacity and developing tools to strengthen the performance of their health systems, and • To improve evidence-based information for increasing the cost-effectiveness, quality and equity of health systems within a limited resource base. 8.1 Governing Bodies Issues and Challenges The Regional Committee for South-East Asia is entrusted with important responsibilities through Article 50 of the Constitution. Foremost among them is the formulation of policies and strategies of an exclusively regional character within the framework of the policy and programme orientations of the General Programme of Work (GPW) and other guidance of the World Health Assembly (WHA) related to WHO priorities. In formulating such policies and strategies, the Committee is also guided by the resolutions and decisions of the World Health Assembly and the Executive Board. The Consultative Committee on Programme Development and Management (CCPDM), an advisory body to the Regional Director, considers issues relevant to programme development and management at country, intercountry and regional levels, and also discusses certain issues on request by the Regional Committee or the Regional Director.

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Broad Regional Strategies The broad regional strategies adopted to achieve the objectives include ensuring that: • The Regional Committee supervises the activities of the Organization in the Region; reviews and endorses the proposed Programme budget of the Region; provides guidance to the Regional Director on issues that are considered critical to health development in the Region; and, most importantly, the Committee gives direction to Member States for coordinated action on issues that may affect the regional character of the Organization as a result of the reforms being implemented. • The CCPDM reviews the implementation of the collaborative programmes in the Member Countries and the regional intercountry programme in the context of the policy orientations and strategic priorities of the Regional Committee. It critically examines the Programme budget of the ensuing biennium; reviews the regional health situation paying particular attention to specific health issues affecting the Region; as also the World Health Assembly and Executive Board resolutions having regional implications. 8.2 Resource Mobilization and External Cooperation and Partnerships Issues and Challenges Sweeping socio-economic changes taking place in the world pose new challenges for the health sector in the Region, which has the greatest share of the global disease burden. In order to deal with these ever-increasing multisectoral health concerns, cooperation and coordination with external partners at all levels - intergovernmental, governmental and nongovernmental, are of paramount importance to health development in the Region. The operational linkages with these partners, especially the partnership with the UN system and major donor agencies, regional and sub-regional intergovernmental organizations and NGOs need to be sustained and further strengthened to promote an effective health dimension to social, economic, environmental and development policy. External resources have always been a matter of concern for the South-East Asia Region which does not have any donor country. Countries of the Region rely increasingly on extrabudgetary resources, given that the shortage of resources continues to be a major constraint in the pursuit of national health development goals. The recent economic crisis in many South-East Asian countries and the depleting overseas development assistance has further compounded the situation. Extrabudgetary resources are also becoming a more essential component of WHO assistance to the countries due to the sustained zero real growth in the WHO regular budget. Broad Regional Strategies • To face these challenges during the 2000-2001 biennium, WHO at regional and country levels needs to make concerted efforts to develop and improve collaboration and partnership with UN and donor agencies, intergovernmental, governmental and nongovernmental organizations, and civil societies at regional,

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sub-regional and country levels. WHO will develop and strengthen operational networks with all the above partners for health development. • Building up and strengthening the capacity of WHO and ministries of health are key issues for resource mobilization in this respect. • WHO will continue to strengthen national capacity for external resource mobilization and management through support for health sector review, assessment of priority external assistance requirements, development of aidworthy programmes and projects for external funding and organization of donor meetings, and provision of information and training for effective resource mobilization, aid coordination and management. 9.1 Budget and Management Reform Issues and Challenges The governing bodies of the Organization have emphasized that the work of WHO should be more strategic and result-oriented, with transparency and accountability. WHO’ s corporate strategy and core functions have clearly underlined the role of the WHO Secretariat and the functions to be undertaken with countries. The Country Cooperation Strategy (CCS) which is under preparation in the Region will highlight these aspects and would be used as a framework of WHO collaboration with countries. CCS will be used as the basis for preparation of Programme budget and work plans during 2002-2005. WHO’ s managerial process, especially in programme management, including monitoring and evaluation, will be established through the Activity Management System (AMS). Qualitative assessment of proposals for implementation would be undertaken by an internal review unit which will coordinate with technical units and WHO country offices to help in qualitative improvement of the work of WHO. Staff will be trained and oriented in WHO programme development and management processes. New reforms, their implementation and improvement would be the outcome of such efforts. Broad Regional Strategies • Orient all WHO staff, both at regional and country levels, as well as relevant national staff, to implement the WHO Corporate Strategy and country cooperation strategies; • Develop management information systems including Activity Management System (AMS) to monitor and evaluate the performance of WHO collaborative programmes, and • Technically review the implementation of the collaborative programmes towards improvement in the quality of the work of WHO. 9.2 Human Resources Development

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Issues and Challenges In the achievement of its objective, the functions of WHO focus, among other things, on the quality of technical assistance to the Member Countries. In the fulfilment of this objective, it is paramount to have an efficient team of professionals for promoting higher technical excellence. This has to be achieved by improving recruitment procedures. At the same time, the mandates of the governing bodies have to be kept in mind to meet the targets in achieving a rational geographical distribution of staff and gender equity. This is a challenge in the development of human resources. Broad Regional Strategies • Greater use of field staff on sub-regional basis: The role of WHO field staff is currently confined to assisting the Member Countries to which they are assigned. Their contribution can be enhanced by mutual exchange of technical expertise between Member Countries and Regions, especially in areas where common problems relating to the health sector are experienced. The mobility policy of the Organization needs to be seriously implemented. • Decentralization of IC staff to the field: Staff working in intercountry projects can play a better role by directly involving themselves with the problems of the countries and visiting the field to provide additional technical backstopping required to meet emergencies and priorities of the countries. • Reorientation of staff profiles to specializations now in demand: The emergence of new diseases and constant evolution of scientific knowledge should be recognized and staff profiles updated accordingly. • Improvement of staff accountability: Realizing that individual action in the right direction is the collective strength of the Organization, strategic decisions need to be evolved and checks and balances introduced to determine accountability for the decisions taken. • Introduction of more flexible contracting arrangements: Staff members should be made responsible for the end results of their action in the course of performance of their duties. In order to induce more performance-based results, the existing contract mechanism needs simplification. The ‘ contract reforms’process is under way at WHO/HQ. Once implemented, it is hoped that this would be cost-effective and attract well-qualified staff. • Recruitment of more generalists with broad technical expertise: Recruiting more generalists, as opposed to specialists, will facilitate better inter-programme and intersectoral cooperation, and prove cost-effective as well. • Enhanced staff development and training: Staff Development and Training (SDT) plays an important role in improving skills and directing the actions of all staff. Updating of knowledge, job-specific training, team building and training on leadership skills are essential components to face the new challenges of the Organization. 9.3 Financial Management

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Issues and Challenges During the 1998-1999 biennium, financial implementation targets were set in order to meet urgent programme requirements in line with the WHO corporate strategy. They required active monitoring to ensure speedy obligation of funds. The WHA appropriation resolution (WHA52.20) approved the budget for 2000-2001 at the same nominal level as the previous biennium without adjustments in respect of estimated cost increases and currency fluctuations. In addition, the Director-General was requested to identify savings to the tune of US $50 million for reallocation to priority programmes, out of which the South-East Asia Regional Office was expected to generate US $ 5.2 million. The implementation of targets will need to be achieved in conformity with financial rules and regulations, keeping in mind the balancing of competing interests of budget ownership while managing funds in support of individual country, intercountry and regional programmes. The external auditors visited the Regional Office in July 1999. They also visited the country office in Thailand for an overall evaluation of key operational controls, as well as an assessment of the practices and performance measures facilitating the successful attainment of WHO objectives. The internal auditors visited DPR Korea and the country offices of Nepal and India to review internal control systems. Their annual visit to the Regional Office in March focused on programme implementation and financial control issues. Broad Regional Strategies • In order to achieve planned technical programme implementation within the WHO corporate strategy, the financial services will continue to provide timely financial information and support to technical staff, as well as contribute to dissemination of latest trends and thinking in financial management with increased training in the processing and monitoring of financial activities. • Within the released budget for the 2000-2001 biennium, efficiency shifts and cost absorption targets of US $ 5.2 million were identified, with US $ 500 000 proposed to be shifted to priority areas. These targets include setting regional caps on travel, study tours, fellowships and procurements. • To maintain budget transparency, periodic analysis and projections leading to the achievement of strategic technical planning at country, intercountry and regional office levels. • To comply with the recommendations made by auditors during their visits in order to achieve efficiency, timely implementation, and cost-effectiveness in WHO activities. 9.4 Informatics and Infrastructure Services

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Issues and Challenges WHO’ s corporate strategy identifies the Organization’ s priorities and the six core functions of the Secretariat in pursuing these priorities. They include management of information and development of new technologies for health care management and service delivery. Building stronger links between the centralized informatics systems and the programmes will improve the focus on the real needs, render economies of scale, and help identify synergies between various programmes. The increased budget cuts have made it imperative for WHO to become even more efficient and deliver greater value for money. Optimal use of informatics capabilities is essential to render processes more efficiently. Much work has been done to standardize IT resources, upgrade informatics infrastructure, enhance connectivity and development of information systems. Extensive use of an integrated information system in day-to-day work will help in automating processes, strengthen productivity, enhance analytical capabilities, and make WHO’ s work more targeted. Sharing of knowledge and information among various offices is a key element to achieve the Organization's mandate and realize the concept of “ One WHO” . With the current demands, it is essential to implement new technologies and have staff trained as required. Internet and Intranet websites have been established. Internet connectivity has been enhanced in the Regional Office and the country offices. Communication has greatly improved with the use of Global Private Network (GPN), the new telephone exchange installed in the Regional Office and reliable email facility throughout the Region. As a next step, secure inter-office connectivity between the Regional Office and the country offices needs to be established. The Executive Board, in its resolution EB103.R6, reiterated that a strategic approach to results-based budgeting required clear statements of objectives and results allied to continuous monitoring of progress, assessment of results, and reporting of achievements to governing bodies. The Activity Management System (AMS) is the tool for planning, implementation, monitoring and evaluation of the WHO collaborative programme. Basic services such as local transport, travel, mailing, and building management, have to continue to be provided in the face of rising prices within a rapidly-changing environment. WHO’ s core functions call for greater focus on the activities carried out by the Organization. It is perceived that the provision of supplies and equipment is one area of WHO operations where a close look is necessary, especially in terms of what is supplied. The global review of WHO’ s Supply Services has emphasized the need for systematically adopting the latest technology and E-procurement tools with a view to establishing a more cost-effective, transparent and quicker procurement process. This will be a major challenge requiring drastic review of procedures and working style. Broad Regional Strategies • Efforts will be made to identify, adapt and implement relevant information systems used by other Regions that meet SEAR needs. New information systems will be

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developed only if adaptations of existing applications are not feasible or will not fully meet SEAR requirements. Before venturing into new developments, the costeffectiveness of customizing off-the-shelf software will be explored. The document management system currently used by some units in the Regional Office will be implemented as the officewide standard for document archival, which will also help to free storage space for use as offices. • The IT standards established during the biennium 1998-99 will be updated. • New methods will be designed and staff trained in these new methods while reducing reliance on own resources through outsourcing - in a longer term change profile of staff. With regard to travel, increased direct contracts with airlines as “ preferred carriers” will permit regional and global negotiations and reduction in prices. • Reviewing and reorganizing the supply set-up, both at regional and country levels and training the staff concerned in quick implementation of new procurement systems and procedures. Devising mechanisms to monitor the nature of supplies provided to Member Countries. 10.1 Regional Director’ s Office Issues and Challenges The introduction of the WHO corporate strategy poses an important challenge in the ensuing biennium, to the development of a corporate approach to manage WHO’ s collaboration with its Member Countries in the Region focusing on priorities while fostering regional solidarity and cooperation. Such an approach will also draw upon the complementary strengths of WHO headquarters, other regional offices and country offices. Further, in order to respond effectively and promptly to the needs of Member Countries in the Region, the Regional Director will be called upon to provide political and technical leadership in the Region in order to plan, execute and effectively evaluate WHO’ s collaborative programmes at regional and country levels as well as to manage and support administrative services. Some of the important issues and challenges being addressed by the RD’ s Office are responding effectively and promptly to the needs of Member Countries; making WHO collaborative programmes more effective; developing decentralized ways of working with country offices, in keeping with local specificity as well as the regional perspective; strengthening the country offices; enhancing the level and scope of liaison with country offices by crystallizing critical information with regard to country needs and requirements, especially in emergencies, and coordinating responses to all emergency situations involving disasters and epidemics, as well as the resultant health needs of displaced populations. Broad Regional Strategies • Ensuring that the strategic directions, positions and values encapsulated in WHO’ s corporate and regional strategies are duly respected.

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• Using the WHO country cooperation strategy (CCS) as a means of critically reviewing and refining WHO’ s work in countries by identifying key issues with regard to working in and with countries. • Analyzing country-specific developmental challenges and health needs; the activities and approaches of other developmental partners, and WHO’ s relative strengths and weaknesses in the countries concerned. • Realizing that one-fourth of the world’ s population lives in this Region, accompanied by a heavy burden of communicable and noncommuniable diseases and low literacy levels, provide ongoing information to the media about health issues, and optimally utilize the information and advocacy potential of the media. • Playing a coordinating role between the media and the technical experts. 10.2 Regional Director’ s Development Programme Issues and Challenges There are occasions when some special needs of the Member Countries, in areas not covered by specific programme activities, such as situations arising from a health emergency, or those with a potential for further development, will have to be met. The Regional Director’ s Development Programme is used to provide assistance to the Member Countries during and following such unforeseen emergencies and also to support innovative initiatives in Member Countries. Broad Regional Strategies The broad regional strategies that will be adopted to meet these challenges will include: • Providing support to innovative programmes or initiating technical cooperation activities having a high degree of relevance for the implementation of their HFA strategies, including those activities which are likely to attract substantial external resources. • Providing support to meet emergency situations created by natural calamities such as floods, cyclones, fire, volcanic eruptions, large-scale accidents, and epidemic outbreaks. • Supporting advocacy efforts for health.

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REGIONAL COMMITTEE

Provisional Agenda item 7

Fifty-third Session Corr.1

SEA/RC53/13

(Rev.1)

29 August 2000

PROPOSED PROGRAMME BUDGET 2002-2003 PART II Corrigendum

In the document SEA/RC53/13 (Rev.1) dated 22 August 2000, please make the following change: Page 7 – after para 3, insert Environmental Health Risks as sub-heading.