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Draft proposed programme budget 2010-2011

December 31, 2008 World Health Organization

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WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL REGIONAL COMMITTEE WPR/RC59/4

Fifty-ninth session Manila, Philippines 22 - 26 September 2008 Provisional agenda item 10

26 August 2008 ORIGINAL: ENGLISH

DRAFT PROPOSED PROGRAMME BUDGET 2010-2011

From the 2008-2009 biennium a six-year Medium-term Strategic Plan

encompassing three biennial budget periods has been incorporated into WHO's results-

based management framework. The Medium-term Strategic Plan 2008-2013 is organized

around 13 cross-cutting strategic objectives and was endorsed by the Sixtieth World Health

Assembly in May 2007.1 The aim is to provide a more flexible programme structure that

better reflects the needs of countries and regions and facilitates more effective collaboration

across all levels of the Organization. The introduction to the amended version of the

Medium-term Strategic Plan 2008-2013 is given in Annex 1 and the complete document is

available on the WHO Regional Committee Internet page. It includes revisions of or

additions to the explanatory text for several strategic objectives, as well as refinement or

deletion of indicators following along the lines of the Draft Proposed Programme Budget

2010-2011.

The Draft Proposed Programme Budget 2010-2011 (Annex 2) will be the second

biennial budget under the plan and the sixth biennial budget to follow an Organization-wide

results-based approach. The Organization-wide expected results of the Draft Proposed

Programme Budget 2010-2011 are the outcomes to which the WHO Secretariat collectively

(country offices, regional offices and Headquarters) is committed over the biennium; they

form the basis for estimating and costing resource requirements.

The content and format of the Programme Budget 2010-2011 will be similar to the

Programme Budget 2008-2009, ensuring continuity and comparability across the biennia.

The focus has been on fine-tuning the indicators and preparing realistic targets for 2011.

Resolution WHA60.11

WPR/RC59/4 page 2

The Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region

(Annex 3) provides the operational direction for WHO in the Region for the two-year

period beginning in 2010. It will be developed in close collaboration with WHO country

offices, the Regional Office and WHO Headquarters and will be aligned with the

Organization-wide Programme Budget 2010-2011.

The Regional Committee is asked to comment on the Draft Proposed Programme

Budget 2010-2011 and accompanying budgetary information. The Committee's views will

be forwarded to the Director-General and, together with those from other regional

committees, will be taken into account when the Proposed Programme Budget 2010-2011 is

finalized and submitted to the global governing bodies.

The views of the Regional

Committee on the Draft Proposed Programme Budget 2010-2011 of the Western Pacific

Region will be taken into account when the Regional Director submits the Proposed

Programme Budget 2010-2011 of the Western Pacific Region to the sixtieth session of the

WHO Regional Committee for the Western Pacific in 2009.

WPR/RC59/4 page 3

1. INTRODUCTION

In May 2006, the Fifty-ninth World Health Assembly approved the Eleventh General Programme of Work2 covering the 10-year period 2006-2015, coinciding with the time frame for achieving the Millennium Development Goals. The Eleventh General Programme of Work outlines a strategic framework and direction for the work of WHO, both Member States and the Secretariat, and a platform for dialogue with WHO partners in global health. The Fifty-ninth World Health Assembly directed that the Eleventh General Programme of Work be implemented through the development of a six-year Medium-term Strategic Plan 2008-2013, with biennial programme budgets agreed with the governing bodies. The introduction to the amended version of the Medium-term Strategic Plan 2008-2013 is given in Annex 1 and the complete document is available on the WHO Regional Committee Internet page http://www.wpro.who.int/rcm/en/rc59/documents/

The Draft Proposed Programme Budget 2010-2011 (Annex 2) will be the second biennial budget under the Medium-term Strategic Plan 2008-2013 and the sixth biennial budget to follow an Organization-wide results-based approach. The Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region (Annex 3) will provide the operational direction for WHO in the Region for the two-year period beginning in 2010, the second biennial programme budget under the Medium-term Strategic Plan of the Western Pacific Region, 2008-2013. The Proposed Programme Budget 2010-2011 of the Western Pacific Region will be presented to the sixtieth session of the WHO Regional Committee for the Western Pacific in 2009. The content and format of the Proposed Programme Budget 2010-2011 of the Western Pacific Region will be similar to the Programme Budget 2008-2009 of the Western Pacific Region, ensuring continuity and comparability across biennia.

2. MEDIUM-TERM STRATEGIC PLAN 2008-2013, AMENDED (DRAFT)

From the 2008-2009 biennium a six-year Medium-term Strategic Plan encompassing three biennial budget periods has been incorporated into WHO's results-based management framework. The Medium-term Strategic Plan 2008-2013 is organized around 13 cross-cutting strategic objectives and was endorsed by the Sixtieth World Health Assembly in May 2007.3 The aim is to provide a 2 3

Document WHA A59/25 Resolution WHA60.11

WPR/RC59/4 page 4

more flexible programme structure that better reflects the needs of countries and regions and facilitates more effective collaboration across all levels of the Organization. The amended version of the Medium-term Strategic Plan 2008-2013 includes revisions of or additions to the explanatory text for several strategic objectives, as well as refinement or deletion of indicators following along the lines of the Draft Proposed Programme Budget 2010-2011.

3. DRAFT PROPOSED PROGRAMME BUDGET 2010-2011

The Draft Proposed Programme Budget 2010-2011 will be the second biennial budget under the Medium-term Strategic Plan 2008-2013 and the sixth biennial budget to follow an Organization-wide results-based approach. The Organization-wide expected results of the Draft Proposed Programme Budget 2010-2011 are the outcomes to which the WHO Secretariat collectively (country offices, regional offices and Headquarters) is committed over the biennium; they form the basis for estimating and costing resource requirements.

4. DRAFT PROPOSED PROGRAMME BUDGET 2010-2011 OF THE WESTERN PACIFIC REGION

The Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region provides the operational direction for WHO in the Region for the two-year period beginning in 2010, the second biennial programme budget under the Medium-term Strategic Plan 2008-2013. The Proposed Programme Budget 2010-2011 of the Western Pacific Region will be presented to the sixtieth session of the WHO Regional Committee for the Western Pacific in 2009. The content and format of the Proposed Programme Budget 2010-2011 of the Western Pacific Region will be similar to the Programme Budget 2008-2009 of the Western Pacific Region, ensuring continuity and comparability across biennia. It will be developed in close collaboration with WHO country offices, the Regional Office and WHO Headquarters and will be aligned with the Organization-wide Programme Budget 2010-2011. In preparing the Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region, the regional orientation was provided by WHO in the Western Pacific Region: a Framework

WPR/RC59/4 page 5

for Action.4 This framework was endorsed as a set of guiding principles for WHO's work in the Region in the early years of the 21st century by the fiftieth session of the Regional Committee.5 The Regional Director was requested by the Regional Committee to work closely with Member States to implement the approaches outlined in the Framework for Action, with particular attention to least developed countries.

5. ACTION EXPECTED FROM THE REGIONAL COMMITTEE

The Regional Committee is asked to comment on the Draft Proposed Programme Budget 2010-2011 and accompanying budgetary information. The Committee's views will be forwarded to the Director-General and, together with those from other regional committees, will be taken into account when the Proposed Programme Budget 2010-2011 is finalized and submitted to the global governing bodies. The views of the Regional Committee on the Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region will be taken into account when the Regional Director submits the Proposed Programme Budget 2010-2011 of the Western Pacific Region to the sixtieth session of the WHO Regional Committee for the Western Pacific in 2009.

4 5

Document WPR/RC50/2 Resolution WPR/RC50.R3

WPR/RC59/4 ANNEX 3

WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION

DRAFT PROPOSED PROGRAMME BUDGET 2010-2011 OF THE WESTERN PACIFIC REGION

(MANILA, 2008

The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

TABLE OF CONTENTS

page Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region Strategic Objective SO 1 To reduce the health, social and economic burden of communicable diseases. 3 1

SO 2 SO 3

To combat HIV/AIDS, tuberculosis and malaria. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence, injuries and visual impairment. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health. To improve nutrition, food safety and food security, throughout the life-course, and in support of public health and sustainable development. To improve health services through better governance, financing, staffing and management informed by reliable and accessible evidence and research. To ensure improved access, quality and use of medical products and technologies. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. To develop and sustain WHO as a flexible, learning Organization, enabling it to carry out its mandate more efficiently and effectively.

13 24

SO 4

SO 5 SO 6

40 47

SO 7

SO 8

SO 9 SO 10 SO 11 SO 12

69 77 89 95

SO 13

100

Budget Tables Table 1 Financing sources summary: 2008-2009 and 2010-2011 107

Table 2

Regional allocation of assessed and voluntary contributions for 2008-2009 and 2010-2011 by organizational level

107

iii

Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region

DRAFT PROPOSED PROGRAMME BUDGET 2010-2011 OF THE WESTERN PACIFIC REGION In May 2006, the Fifty-ninth World Health Assembly approved the Eleventh General Programme of Work covering the 10-year period 2006-2015, coinciding with the time frame for achieving the Millennium Development Goals. The Eleventh General Programme of Work outlines a strategic framework and direction for the work of WHO, both Member States and the Secretariat, and a platform for dialogue with WHO partners in global health. The Fifty-ninth World Health Assembly directed that the Eleventh General Programme of Work be implemented through the development of a six-year Medium-term Strategic Plan 2008-2013, with biennial programme budgets agreed with the governing bodies. The Medium-term Strategic Plan 2008-2013 of the Western Pacific Region provides the regional strategic direction for the Organization for the six-year period within the context of the Eleventh General Programme of Work, the 13 global strategic objectives and the Organization-wide expected results of WHO. The Medium-term Strategic Plan 2008-2013 of the Western Pacific Region identifies the regional expected results that will directly contribute to achievement of the Organization-wide expected results. It establishes a flexible, multibiennial programme structure to guide preparation of the programme budget and operational plans across the three bienniums. The Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region provides the operational direction for WHO in the Region for the two-year period beginning in 2010, the second biennial programme budget under the Medium-term Strategic Plan 2008-2013 of the Western Pacific Region. The Proposed Programme Budget 2010-2011 of the Western Pacific Region will be presented to the sixtieth session of the WHO Regional Committee for the Western Pacific in 2009. The content and format of the Proposed Programme Budget 2010-2011 of the Western Pacific Region will be similar to the Programme Budget 2008-2009 of the Western Pacific Region, ensuring continuity and comparability across biennia. It will be developed in close collaboration with WHO country offices, the Regional Office and WHO Headquarters and will be closely aligned with the proposed Organization-wide Programme Budget 2010-2011. Actual performance in achieving regional strategic objectives will be measured by indicators and targets. WHO is committed to a results-based management approach in achieving the strategic objectives through the Organization's collaborative programmes with the countries and areas of the Western Pacific Region. The focus in the preparation of the Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region has been on fine-tuning the indicators and preparing realistic targets for 2011. The regional orientation was provided by WHO in the Western Pacific Region: a Framework for Action. This framework was endorsed as a set of guiding principles for WHO's work in the Region in the early 2 1

1 2

Document WHA A59/25 Document WPR/RC50/2

Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region

years of the 21st century by the fiftieth session of the Regional Committee.3 The Regional Director was requested by the Regional Committee to work closely with Member States to implement the approaches outlined in the Framework for Action, with particular attention to least developed countries. The relationship between health and development is clearly recognized and is well reflected by the central role for health in the United Nations Millennium Development Goals. These goals have focused efforts on achieving significant, measurable improvements in people's lives, with the elimination of poverty as the overarching priority. Through the Medium-term Strategic Plan 2008-2013 and the Programme Budget

2010-2011, WHO will support Member States in creating an environment for poverty alleviation and in strengthening health systems as prerequisites for ensuring equitable access to efficient and high-quality health services.

Resolution WPR/RC50.R3

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

STRATEGIC OBJECTIVE 1

To reduce the health, social and economic burden of communicable diseases.

Scope

The work under this strategic objective focuses on prevention, early detection, diagnosis, treatment, control, elimination and eradication measures to combat communicable diseases that disproportionately affect poor and marginalized populations. The targeted diseases include but are not limited to: vaccine-preventable, tropical, zoonotic and epidemic-prone diseases, excluding HIV/AIDS, tuberculosis and malaria.

Regional indicators and targets

• Measles elimination and hepatitis B control by 2012 and vaccine-preventable disease mortality reduction by two thirds by 2013 (resolutions WPR/RC54.R3 and WHA58.15). • Percentage of countries and areas maintaining certification of polio eradication: 100% by 2010 (resolution WHA41.28). • Coverage of school-age children at risk with regular treatment against schistosomiasis and soil-transmitted helminth infections: 75% by 2010 (resolution WHA54.19). • Percentage of countries and areas achieving elimination of lymphatic filariasis: 100% by 2020 (resolution WHA50.29). • Percentage of countries and areas with dengue national plans developed under the framework of IHR and an available focal point: 100% by 2013. • Percentage of countries and areas complying with the International Health Regulations (2005) core requirements for surveillance, reporting, notification, verification and response: 100% by 2013 (resolution WHA58.3). • Proportion of countries and areas that have achieved leprosy elimination and are implementing the leprosy post-elimination strategy: 100% by 2013.

Links with other strategic objectives

• Strategic objectives 2, 3, 4, 6 and 9: in relation to integrated disease control, surveillance and harmonized research initiatives. • Strategic objective 5: in relation to mutual support in field operations and health security. • Strategic objective 7: in relation to the work on promoting the rights of leprosy patients to be free from stigma and discrimination. • Strategic objective 8: in relation to the adoption of adequate solutions for management of health care waste. • Strategic objective 9: in relation to water and sanitation aspects of zoonotic diseases. • Strategic objective 10: in relation to the implementation of programmes through financially sustainable health system approaches. • Strategic objective 11: in relation to access to safe and effective vaccines, medicines and interventions, as well as quality assurance of diagnostics and laboratory services.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

Issues and challenges

Communicable diseases (excluding HIV/AIDS, tuberculosis and malaria) account for a significant portion of childhood mortality. Without a reduction of this disease burden, the achievement of the health-related Millennium Development Goals and those in education, gender equality, poverty reduction and economic growth will be in jeopardy. Experience shows that the prevention of communicable diseases is not only one of the most cost-effective public health interventions, but it also yields positive economic returns. Activities for the prevention, early detection, diagnosis, treatment, control, elimination and eradication of communicable diseases are among the most effective components of the public health system, especially in reaching marginalized, poor and young populations, as well as women. Challenges exist in those countries and areas of the Region that have weak health system structures. A move towards decentralization of public health programmes have proven to be counterproductive to strengthening the health systems of some countries and areas. A shortage of appropriately qualified health care practitioners has further weakened health systems. Serving hard-to-reach populations in remote areas and among minority groups remains a significant challenge. Through the International Health Regulations (2005) (IHR {2005}), which came into effect in 2007, WHO has a binding and legal obligation to strengthen its internal capacity on epidemic/public health emergency alert and response and to support Member States in the development and maintenance of minimum core capacities for detection, assessment, and response to public health risks and emergencies, the majority of which are due to communicable diseases. It will be critical to move beyond a vertical programme approach and create strategies for communicable disease control, including the neglected tropical diseases, within integrated health systems, if strategic objective 1 is to be achieved.

Strategic approaches

Strategic approaches for Member States: • Invest in human resources and commit the political and financial resources necessary to ensure and expand equitable access to high-quality and safe interventions for the prevention, early detection, diagnosis, treatment and control of communicable diseases among all populations. • Establish and maintain effective coordination mechanisms with all partners and across all relevant sectors involved in communicable disease prevention and control, including neglected tropical diseases at the country level. • Adopt the necessary legal, administrative, financial, technical and political provisions for the development, strengthening and maintenance of integrated surveillance systems at all levels with the ability to detect, report and respond to public health risks and potential public health emergencies. • Implement effectively the Asia Pacific Strategy for Emerging Diseases (APSED) to build and strengthen country core capacities necessary for effective preparedness, early detection of and rapid response to emerging diseases which threaten national, regional and global health security.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

• To generate information for evidence-based policy decisions regarding public health interventions. Strategic approaches for the WHO Secretariat: • Strengthen WHO collaboration with health partners, partnerships and civil society in joint work to articulate ethical and evidence-based policies for communicable diseases. Also, help expand community access to tools and strategies that meet acceptable standards of quality, safety, efficacy and cost-effectiveness, as well as expand access to such tools and strategies. • Strengthen capacity to provide technical assistance, capacity-building and responsiveness to Member States for communicable diseases and neglected tropical diseases, including the facilitation of resource mobilization and advocacy efforts. • Facilitate partnership with other United Nations agencies and partners, public health preparedness through the development, maintenance and administration of stockpiles of vaccines, medicines and drugs for response to public health emergencies. • Provide Member States with tools, strategies and technical assistance for the evaluation, assessment and strengthening of monitoring and surveillance systems. • Coordinate surveillance activities, including the collation, synthesis and dissemination of data to inform policy decisions and public health responses. • Shape the research agenda on communicable diseases, stimulating and supporting the generation, translation and dissemination of knowledge. • Maintain and strengthen an effective regional system for alert and response to outbreaks and other public health emergencies with immediate technical support to affected state(s) for verification, assessment, containment and control. • Assist Member States in strengthening their surveillance and response capacities by effectively implementing APSED, as an important stepping stone to meet the core capacity requirements under the IHR (2005).

ORGANIZATIONWIDE EXPECTED RESULT 01.001

Policy and technical support provided to Member States in order to maximize equitable access of all people to vaccines of assured quality, including new immunization products and technologies, and to integrate other essential child-health interventions with immunization.

REGIONAL EXPECTED RESULT

Policy and technical support provided to Member States to maximize equitable access of all people to vaccines of assured quality, including new immunization products and technologies, and to integrate other essential child-health interventions with immunization.

01.001.WP01

REGIONAL INDICATORS

01.001.WP01.01 Number of countries and areas that have reached at least 90% coverage in national vaccination coverage and at least 80% in vaccination coverage in each district unit.

01.001.WP01.02 Number of countries and areas that streamlined the delivery of immunization services by integrating with other health services (e.g. prevention and

01.001.WP01.03 Number of countries and areas that have a specified national budget line to ensure sustainable financing of immunization.

01.001.WP01.04 Number of countries and areas assisted with different activities (e.g. surveillance, cost-effectiveness analysis) to facilitate decisions about appropriate changes

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

treatment of Vitamin A deficiency, bednet distribution, deworming).

and additions to the immunization schedule, including introduction of new vaccines and/or technologies.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

In accordance with the global immunization vision and strategy, WHO will provide policy and technical support to Member States in order to increase protection against more diseases by making immunization available to all eligible people, introducing new vaccines and technologies, and linking immunization to the delivery of other health interventions.

ORGANIZATIONWIDE EXPECTED RESULT 01.002

Effective coordination and support provided in order to achieve certification of poliomyelitis eradication, and destruction, or appropriate containment, of polioviruses, leading to a simultaneous cessation of oral poliomyelitis vaccination globally.

REGIONAL EXPECTED RESULT

Effective coordination and provision of support to Member States to retain certification of poliomyelitis elimination and to achieve destruction, or appropriate containment, of polioviruses, leading to a simultaneous cessation of oral polio vaccination.

01.002.WP01

REGIONAL INDICATORS

01.002.WP01.01 Number of countries and areas that report zero cases of poliomyelitis.

01.002.WP01.02 Percentage of countries and areas using oral polio vaccine (OPV) concurring with an internationally agreed time line and process for cessation of routine OPV use.

01.002.WP01.03 Percentage of countries and areas submitting annual progress reports on maintenance of polio free status to the Regional Certification Commission.

01.002.WP01.04 Number of countries and areas maintaining up-to-date national inventory of wild poliovirus infectious and potentially infectious materials.

BASELINE

100%

TARGETS TO BE ACHIEVED BY

100%

2009

TARGETS TO BE ACHIEVED BY

100%

2011

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

TARGETS TO BE ACHIEVED BY

100%

2013

JUSTIFICATION

Recent outbreaks of polio outside of the Region have delayed the global polio eradication initiative. It is, therefore, required that Western Pacific Region countries and areas continue to maintain high polio immunization coverage rates and maintain strong acute flaccid paralysis (AFP) surveillance and laboratory systems. It is expected that limited preventive polio supplementary immunization activities in some countries and areas may be conducted and capacity to respond to importation of wild poliovirus and emergence of circulating vaccine-derived poliovirus must be maintained. Once global poliovirus transmission has been interrupted, the OPV using countries need to conduct activities related to OPV cessation (laboratory containment and AFP surveillance will continue through to 2013).

ORGANIZATIONWIDE EXPECTED RESULT 01.003

Effective coordination and support provided to Member States in order to provide access for all populations to interventions for the prevention, control, elimination and eradication of neglected tropical diseases, including zoonotic diseases.

REGIONAL EXPECTED RESULT

Effective coordination and support provided to Member States to provide access for all populations to interventions for the prevention, control, elimination and eradication of neglected tropical diseases, including dengue and zoonotic diseases.

01.003.WP01

REGIONAL INDICATORS

01.003.WP01.01 Number of countries and areas that have achieved elimination of leprosy at national and subnational levels.

01.003.WP01.02 Number of countries and areas receiving technical support for the development and implementation of national dengue prevention and control plans and assistance as needed in resource mobilization.

01.003.WP01.03 Number of countries and areas that have achieved 80% coverage over five consecutive rounds of MDA.

01.003.WP01.04 Number of countries and areas supported to complete the mapping of foodborne trematodes infections in high-risk areas.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Neglected tropical diseases (NTDs) disproportionately affect the poor. Dengue is a public health problem that is often overlooked and underestimated. Lymphatic filariasis is the second leading cause of disability. NTDs are often characterized by a high cumulative disease burden, as a result

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

of co-infections with more than one agent. While the Region has made substantial progress in the elimination of leprosy, several countries still have pockets of endemicity and many people with leprosy are still experiencing stigma and discrimination. While WHO needs to target NTDs that can be effectively controlled or even eliminated through low-cost treatment and health-promotional activities, major efforts need to be made as well to address dengue infection in the Region.

ORGANIZATIONWIDE EXPECTED RESULT 01.004

Policy and technical support provided to Member States in order to enhance their capacity to carry out surveillance and monitoring of all communicable diseases of public health importance.

REGIONAL EXPECTED RESULT

Provision of policy and technical support to Member States to enhance their capacity to carry out surveillance and monitoring of all communicable diseases of public health importance.

01.004.WP01

REGIONAL INDICATORS

01.004.WP01.01 Number of countries and areas receiving enhanced technical assistance from WHO in strengthening communicable disease surveillance and monitoring systems.

01.004.WP01.02 Number of countries and areas that have strengthened surveillance and monitoring of communicable diseases, and of other neglected tropical diseases.

01.004.WP01.03 Number of countries and areas that have established a surveillance and information system and are regularly reporting to Dengue Net.

01.004.WP01.04 Number of countries and areas that have established a surveillance and information system for helminth infections.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Communicable disease surveillance is essential for early warning of potential threats to public health and for programme monitoring function. Effective surveillance systems provide useful information which acts as a basis for decision-making in identifying priority activities and allocating limited resources more efficiently.

ORGANIZATIONWIDE EXPECTED RESULT 01.005

New knowledge, intervention tools and strategies that meet priority needs for the prevention and control of communicable diseases developed and validated, with scientists from developing countries increasingly taking the lead in this research.

REGIONAL EXPECTED RESULT

01.005.WP01

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

REGIONAL INDICATORS

01.005.WP01.01 Number of studies/surveys being conducted that focus on intervention tools and strategies for control of communicable diseases in developing countries and areas.

01.005.WP01.02 Percentage of total research funds in the Region used by developing-country research institutes or with developingcountry researchers.

01.005.WP01.03 Number of research projects supported, directly addressing programmatic gaps.

01.005.WP01.04 Regional research strategic plan in neglected tropical diseases developed.

BASELINE

10%

TARGETS TO BE ACHIEVED BY

20%

2009

TARGETS TO BE ACHIEVED BY

30%

2011

TARGETS TO BE ACHIEVED BY

40%

2013

JUSTIFICATION

Even though 95% of the burden of disability and premature mortality affects the developing world, a very small percentage of research funding is actually devoted to communicable diseases that constitute a major burden of disease in developing countries and areas. These diseases primarily affect the poor, who are not considered as a profitable market segment of society for the private sector. There are big gaps in the availability of tools to prevent, control or eliminate many communicable diseases. WHO plays a significant role in helping countries and areas address research gaps through a comprehensive plan and by supporting Member States to engage in policies that are evidence-based.

ORGANIZATIONWIDE EXPECTED RESULT 01.006

Support provided to Member States in order to achieve the minimum core capacities required by the International Health Regulations (2005) for the establishment and strengthening of alert and response systems for use in epidemics and other public health emergencies of international concern.

REGIONAL EXPECTED RESULT

Support provided to Member States in achieving the minimum capacities and functions required by the International Health Regulations (2005), specifically those related to advocacy, national International Health Regulations focal points and the core capacities for designated points of entry.

01.006.WP01

REGIONAL INDICATORS

01.006.WP01.01 Number of Member States that have functional national International Health Regulations focal point.

01.006.WP01.02 Number of countries and areas supported by WHO in complying with the IHR (2005).

BASELINE

TARGETS TO BE

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The IHR (2005) request each Member State to designate or establish a national IHR focal point and perform the functions required, including urgent communications with WHO and with other ministries/sections within the country. Member States are expected to review and adjust (when necessary) their domestic legislations in line with the IHR (2005). In addition to the core capacity requirements for surveillance and response, each Member State is also expected to assess and develop the core capacities for designated points of entry by June 2012.

ORGANIZATIONWIDE EXPECTED RESULT 01.007

Member States and the international community equipped to detect, assess, respond to and cope with major epidemic and pandemic-prone diseases (e.g. influenza, meningitis, yellow fever, haemorrhagic fevers, plague and smallpox) through the development and implementation of tools, methodologies, practices, networks and partnerships for prevention, detection, preparedness and intervention.

REGIONAL EXPECTED RESULT

Support provided to Member States to achieve the minimum capacities required for the preparedness, detection, assessment of and response to emerging diseases, including major epidemic and pandemic-prone diseases such as influenza, by effectively implementing the Asia Pacific Strategy for Emerging Diseases (APSED).

01.007.WP01

REGIONAL INDICATORS

01.007.WP01.01 Number of countries and areas implementing a country APSED workplan, including plans of action to meet the core capacity requirements for surveillance and response under the IHR (2005).

01.007.WP01.02 Number of countries and areas that have the minimum core capacities for detecting, assessing and responding to emerging infectious diseases, including epidemic-prone diseases.

01.007.WP01.03 Number of countries and areas that have established laboratory networking between national reference and local laboratories.

01.007.WP01.04 Number of countries and areas that have national pandemic preparedness plans in place and validated.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

ACHIEVED BY

2013

JUSTIFICATION

The Western Pacific Region continues to face threats from emerging infectious diseases and other public health emergencies, such as avian influenza A (H5N1) and pandemic influenza. The Asia Pacific Strategy for Emerging Diseases (APSED) was endorsed by the Regional Committee in September 2005 as a strategic framework and guide for countries and areas in strengthening core capacities for effective preparedness, early detection of and rapid response to emerging diseases. Implementation of the APSED will help countries and areas in meeting the core capacity requirements for surveillance and response under the IHR (2005).

ORGANIZATIONWIDE EXPECTED RESULT 01.008

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

REGIONAL EXPECTED RESULT

Coordinated regional capacity rapidly available to Member States for detection, verification, risk assessment of and response to epidemics and other public health emergencies of regional and international concern.

01.008.WP01

REGIONAL INDICATORS

01.008.WP01.01 Regional event management system (EMS) in place.

01.008.WP01.02 Number of partner institutions in the Region participating in the Global Outbreak Alert and Response (GOARN).

01.008.WP01.03 Regional rapid response mechanism and standard operating procedures established and strengthened.

01.008.WP01.04 Percentage of requests for assistance from countries and areas for which WHO mobilizes coordinated regional and international response support within three days.

BASELINE

40%

TARGETS TO BE ACHIEVED BY

70%

2009

TARGETS TO BE ACHIEVED BY

80%

2011

TARGETS TO BE ACHIEVED BY

90%

2013

REGIONAL STRATEGIC OBJECTIVE STATEMENT 1

JUSTIFICATION

Communicable diseases do not respect international borders and can spread to other countries and areas rapidly. Experience with recent emerging diseases such as severe acute respiratory syndrome (SARS) and avian influenza clearly demonstrate that a coordinated international and regional response to epidemics and other public health emergencies of international concern are critical. WHO is mandated and obligated under the International Health Regulations (2005) to rapidly mobilize and coordinate international support and response to disease outbreaks, epidemics and other public health emergencies of international concern.

ORGANIZATIONWIDE EXPECTED RESULT 01.09

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

REGIONAL EXPECTED RESULT

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

01.009.WP01

REGIONAL INDICATORS

01.009.WP01 Proportion of declared emergency situations due to epidemic and pandemic prone diseases where operations have been implemented in a timely fashion.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

STRATEGIC OBJECTIVE 2

To combat HIV/AIDS, tuberculosis and malaria.

Scope

Work under this strategic objective will focus on: scaling up and improving prevention, treatment, care and support interventions for HIV/AIDS, tuberculosis and malaria so as to achieve universal access, in particular for seriously affected populations and vulnerable groups; advancing related research; removing obstacles that block access to interventions and impediments to their use and quality; and contributing to the broader strengthening of health systems.

Regional indicators and targets

HIV/AIDS: • HIV-related deaths averted in low- and middle-income countries and areas due to antiretroviral therapy by 2013. • HIV prevalence reduction among vulnerable populations: all countries and areas with low prevalence and concentrated HIV epidemics have halted or reversed HIV prevalence among most at-risk populations (injecting drug users, sex workers, men who have sex with men, mobile populations) by 2013. • Mother-to-child HIV transmission reduction: 60% reduction in the percentage of HIV-infected infants born to HIV-infected mothers, down to a level of 10% by 2013 (baseline of 25% in 2005). Tuberculosis: • TB mortality reduction: 50% reduction by 2010 (resolution WPR/RC51.R4). • TB prevalence reduction: 50% reduction in TB prevalence rate by 2010 (resolution WPR/RC51.R4). Malaria: • Malaria mortality reduction in endemic countries and areas: 50% reduction by 2013. • Malaria morbidity reduction in endemic countries and areas: 50% reduction of confirmed malaria cases by 2013. • Elimination of malaria in countries where that objective is considered feasible by 2013: five countries have a feasible and technically sound national malaria elimination plan.

Links with other strategic objectives

• Strategic objective 1: particularly work related to delivery of interventions; strengthening research capacity and expanding access to new strategies and tools, such as vaccines; and strengthening systems for monitoring and surveillance of communicable diseases. • Strategic objective 3: particularly work relating to HIV and mental health. • Strategic objective 4: particularly efforts related to supporting research and development of new tools and interventions; meeting specific needs of children, adolescents and women of child-bearing age; formulating and implementing gender-sensitive interventions; and tackling sexually transmitted infections.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

• Strategic objective 6: specifically relating to prevention of tobacco use and its relationship with tuberculosis; and prevention of unsafe sex. • Strategic objective 7: specifically work relating to approaches that enhance equity and are pro-poor, genderresponsive, ethical and human rights based. • Strategic objective 8: particularly relating to environmental health and its relationship with malaria. • Strategic objective 9: particularly work in the area of nutrition and its relationship to HIV/AIDS. • Strategic objective 10: particularly efforts related to organization, management and delivery of health services; areas of human resources capacity strengthening, integrated training and widening of service provider networks; and work related to minimizing the potential of financial catastrophe and impoverishment due to outof-pocket health expenses. • Strategic objective 11: specifically work related to essential medicines, medical products and technologies for the prevention and treatment of HIV/AIDS, tuberculosis and malaria. • Strategic objective 12: specifically work related to health knowledge and advocacy materials made accessible to Member States.

Issues and challenges

STI and HIV/AIDS, tuberculosis and malaria impose a heavy disease burden on the Western Pacific Region despite significant progress in control of these diseases. Reducing the prevalence of HIV, STI, TB and malaria is crucial to achieve the Millennium Development Goals, and will contribute to reducing poverty and alleviate the burden on individuals, communities, nations and their health systems. The HIV situation in the Region is diverse: Cambodia and Papua New Guinea have generalized epidemics. In China, Viet Nam and Malaysia, the HIV epidemic is concentrated among injecting drug users. Transmission of HIV is primarily linked to persons who engage in high-risk behaviours, such as injecting drug users, men who have sex with men, and sex workers who are often socially marginalized or persecuted. Substantial progress has been achieved in HIV prevention among vulnerable groups, using strategies such as the 100% condom use programme (CUP) coupled with outreach services among sex workers and their clients, and harm reduction among injecting drug users. The effectiveness of 100% CUP has been demonstrated in Cambodia, with a decrease in HIV prevalence in the general population, in line with increased 100% condom use among sex workers and their clients. Through the "3 by 5" Initiative, by December 2005 some 40 000 people in the Region, about 25% of those in need, were receiving antiretroviral therapy, compared to 15 000 in 2004. This progress was particularly notable in Cambodia, where half of those in need are now receiving antiretroviral drugs. Great challenges lie ahead in ending the stigma associated with the disease, reaching marginalized groups, and increasing political commitment to achieve universal access to prevention, treatment and care. For TB control, strong leadership and political commitment contributed to the Region being the first to have met the intermediate targets of detecting 70% of estimated TB cases and successfully treating 85% of these cases, as well as region-wide population coverage of directly observed treatment, short-course (DOTS) in 2005. Further progress towards achieving the regional goal of halving TB prevalence and mortality by one half from the 2000 level, thus contributing to the achievement of the TB-related MDG, requires improvement in several areas: the

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

quality of DOTS implementation, further increases in case detection, addressing weaknesses in health systems, addressing multidrug-resistant TB and TB-HIV co-infection, equitable access to TB services and involvement of a wider range of health providers, including the private sector. Malaria is endemic in 10 countries and areas of the Region. In the Mekong region, transmission occurs in remote forest fringe areas where ethnic minority groups and mobile populations are at major risk. The incidence is high in Papua New Guinea, Solomon Islands and Vanuatu. Falciparum malaria is predominant, but vivax malaria is also widespread, with re-emergence in central China and the Korean peninsula. Between 1992 and 2000, in most endemic countries and areas of the Region, malaria morbidity and mortality were reduced by over 50%. Challenges are high levels of antimalarial drug resistance and consequentially the shift to highly effective but more expensive artemisinin-based combination therapies based on laboratory diagnosis including rapid diagnostic tests, significant availability of counterfeit antimalarials, the threat of epidemics, achieving equitable access to interventions for those at greatest risk including through community-based interventions and sustaining the gains achieved. In a number of countries, notably Malaysia and the Republic of Korea, malaria incidence rates have now dropped so low that they have embarked on malaria elimination. Other countries have changed their national goals from control to a gradual up-scaling towards elimination by successively increasing the number of malaria-free provinces, for example the Philippines and China. The substantial progress achieved by most countries must be maintained by the Asia Pacific Region to make a lasting contribution to global malaria control and eventually elimination. Cross-cutting issues that must be addressed include poor and vulnerable populations that are disproportionately affected and requiring public health policies to recognize their special needs and develop appropriate interventions with the involvement of other relevant sectors. Serious drug resistance occurs among all three diseases, requiring regular, good-quality monitoring, as well as timely and appropriate changes in treatment policies. This must be linked with drug quality and drug use issues, quality assurance of diagnostic tests and microscopy, the development of approaches for cooperating with the wider range of health providers including private providers, sectors, programmes and communities to improve the availability of good quality drugs and their rational use. epidemics. Effective surveillance and response systems are crucial for monitoring and dealing with

Improvements in programme monitoring and evaluation, including enhancement of information

systems will be important. Operational and social research is needed to further develop and tailor interventions. Proven effective prevention and treatment interventions need to be scaled up to achieve universal access. This will depend on improving the management of programmes, building synergies with other programmes and integrating service delivery. It also will depend on strengthening health systems and political commitment and mobilizing necessary human and sustainable financial resources by engaging individuals, communities and national and international partners into effective cooperation.

Strategic approaches

Strategic approaches for Member States: • Combating HIV, STI and TB and controlling and ultimately eliminating malaria will require ensuring and expanding equitable access to high-quality and safe interventions for the prevention, early detection,

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

diagnosis, treatment and control of the three diseases.

• Major impetus will be given to promoting the delivery and universal access of essential interventions for prevention, treatment, care and support to halt the spread and reduce morbidity and mortality from the three diseases. Harmonization between interventions and programmes will be encouraged to maximize the Special emphasis will be placed on

effectiveness of a given patient encounter with the health system.

ensuring that the services are also gender-sensitive and tailored and delivered to the poor, vulnerable groups and hard-to-reach populations and on ensuring relevance to sociocultural contexts. The use of evidence, norms and standards in policy and programme formulation will be encouraged. • Strengthening and supporting human resources and provider networks and enhancing the public-private mix of services will be vital. This includes training and upgrading the skills of health professionals and community workers; widening the service provision networks and pool of providers; strengthening human resources management capacity; better engagement of and coordination with nongovernmental and private sector institutions; strengthening referral systems; tapping the potential of community health workers, persons living with the diseases and family members; and promoting strategies to retain health human resources. • Facilitating the availability and promoting proper use of safe and affordable good-quality medicines, diagnostics, insecticides and other health commodities, expanding quality-assured laboratory services, and ensuring well-functioning public and private supply chains. • Monitoring, evaluation and surveillance systems for decision-making, progress monitoring and accountability towards STI and HIV/AIDS, TB and malaria targets will be enhanced and effectiveness and efficiency of information systems improved. This includes generation and use of age- and sex-disaggregated data;

strengthening epidemiological and behavioural surveillance (including the use of Geographical Information Systems) and monitoring of drug and insecticide resistance; strengthening data collection and analysis capacity (including financial tracking); assessing the impact of interventions and trends of the three diseases in special population groups, including poor and vulnerable populations; refining regional indicators for key new interventions; integrating monitoring and evaluation of STI and HIV/AIDS, TB and malaria programmes into existing national health information systems; and standardization to allow in-country and cross-country comparisons. • Efforts to ensure sustained political commitment, better engagement of communities and affected persons and more effective partnerships will also be critical, as well as strengthening mechanisms for resource mobilization and utilization and action to increase absorption of available resources. Nurturing of STI and HIV/AIDS, TB and malaria partnerships and the involvement of stakeholders at country, regional and global levels will be required as well as engagement of communities and affected persons. Advocacy and concerted efforts to combat the three diseases will be a major factor for success. • Enabling and promoting research to advance prevention, treatment and care will also be essential, particularly in areas of safe and effective prevention technologies, medicines (including simplified regimens) and diagnostic tools, as well as operations including social research to determine the effectiveness of service delivery approaches within different contexts.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

Strategic approaches for the WHO Secretariat: • Adapting global STI and HIV/AIDS, TB and malaria policies including for malaria elimination, strategies and standards to the Western Pacific Region, and developing regional policies, standards including for the containment of drug resistance and implementation guidelines where appropriate. • Providing technical cooperation and coordination support to Member States for the implementation of locally appropriate policies, strategies and standards, and for scaling up STI and HIV/AIDS, TB and malaria programmes, particularly to reach populations most in need, including human resources capacity strengthening. • Facilitating availability, access and proper use of high-quality related medicines and commodities. • Measuring progress towards global and regional targets, especially for vulnerable and poor groups; assessing national programme and system performance, financing and impact initiatives; and providing Member States with tools, strategies and technical assistance for strengthening surveillance data monitoring and evaluation, including the monitoring of drug resistance. • Facilitating and strengthening partnerships, advocacy and communications. • Supporting global, regional, subregional and intercountry initiatives aimed at prevention and control of STI and HIV/AIDS, TB and malaria and malaria elimination. • Assisting Member States to strengthen their mechanisms for resource mobilization and utilization. • Fostering and supporting research and building research capacity in target countries and areas.

ORGANIZATIONWIDE EXPECTED RESULT 02.001

Guidelines, policy, strategy and other tools developed for prevention of, and treatment and care for patients with, HIV/AIDS, tuberculosis and malaria, including innovative approaches for increasing coverage of the interventions among poor people, and hard-to-reach and vulnerable populations.

REGIONAL EXPECTED RESULT

Regional guidelines, policies, strategies and other tools developed (adapting global ones, as appropriate) for prevention, treatment and care for STI and HIV/AIDS, malaria and TB (including innovative approaches for increasing coverage of the interventions among the poor, hard to reach and vulnerable populations).

02.001.WP01

REGIONAL INDICATORS

02.001.WP01.01 Number of targeted countries and areas with costed medium-term strategic plans in response to HIV/AIDS, TB and malaria.

02.001.WP01.02 Number of WHO regional policies, strategies or guidelines for STI and HIV/AIDS, malaria and TB control developed, updated or adapted.

BASELINE

STI and HIV/AIDSI: 2 Malaria 4 TB: 3

STI and HIV/AIDS: 0 Malaria: 2 TB: 1

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 3 Malaria: 8 TB: at least 5

STI and HIV/AIDS: 6 Malaria: 5 TB: at least 2

2009

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 5 Malaria: 10 TB: 7

STI and HIV/AIDS: at least 2 Malaria: 7 TB: at least 4

2011

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 8 Malaria: 10 TB: 7

STI and HIV/AIDS: at least 3 Malaria: 9 TB: at least 4

2013

JUSTIFICATION

WHO's normative function includes the development and coordination of relevant policies, strategies and guidelines to guide actions at global, regional and country levels. WHO's leadership is crucial in bringing together expertise and experiences to formulate policies, strategies and guidelines for prevention, treatment and care for STI and HIV/AIDS, malaria and TB, which are specific to the context of the Western Pacific Region and which ensure that interests of poor and vulnerable populations are served.

ORGANIZATIONWIDE EXPECTED RESULT 02.002

Policy and technical support provided to countries towards expanded gender-sensitive delivery of prevention, treatment and care interventions for HIV/AIDS, tuberculosis and malaria, including integrated training and service delivery; wider service-provider networks; and strengthened laboratory capacities and better linkages with other health services, such as those for sexual and reproductive health, maternal, newborn and child health, sexually transmitted infections, nutrition, drug-dependence treatment services, respiratory care, neglected diseases and environmental health.

REGIONAL EXPECTED RESULT

Policy, technical and coordination support provided to countries and areas for the implementation of prevention, treatment and care interventions for STI and HIV/AIDS, malaria and TB and their scaling-up to reach the populations most in need (including integrated training and service delivery; wider service provider networks; strengthened laboratory capacities and better linkages with other health services).

02.002.WP01

REGIONAL INDICATORS

02.002.WP01.01 Number of targeted countries and areas that have developed and are implementing integrated/coordinated policies on STI and HIV/AIDS and/or malaria and/or tuberculosis.

02.002.WP01.02 Number of supported countries and areas that have achieved all priority targets for key interventions as indicated in their national STI and HIV/AIDS, malaria and TB control plans.

BASELINE

STI and HIV/AIDS: 2 (antiretroviral treatment or ART target) Malaria: 2 (insecticide treated nets or ITN coverage) TB: 5 (case detection rate or CDR and treatment success rate or TSR targets)

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 3 Malaria: 7 TB: 6 (CDR and TSR targets)

2009

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 5 Malaria: 9 TB: at least 3 (new core targets)

2011

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 8 Malaria: 9 TB: 6 (new core targets)

2013

JUSTIFICATION

WHO has a firm commitment to maximize access to STI and HIV/AIDS, malaria and TB interventions, as outlined in the various World Health Assembly resolutions, the Global Health Sector for HIV/AIDS, the Global Plan and the Regional Strategic Plan to Stop TB; the Global Plan to Roll Back Malaria; articulation of WHO's Contribution to Universal Access to HIV/AIDS Prevention, Treatment; Care and Support and implementation of the Millennium Development Goals, and others.

ORGANIZATIONWIDE EXPECTED RESULT 02.003

Global guidance and technical support provided on policies and programmes in order to promote equitable access to essential medicines, diagnostic tools and health technologies of assured quality for the prevention and treatment of HIV/AIDS, tuberculosis and malaria, and their rational use by prescribers and consumers, and, in order to ensure uninterrupted supplies of diagnostics, safe blood and blood products, injections and other essential health technologies and commodities.

REGIONAL EXPECTED RESULT

Guidance and technical support provided on policies and programmes to promote equitable access to essential medicines of assured quality for the prevention and treatment of STI and HIV/AIDS, malaria and TB, and their rational use by prescribers and consumers; and on uninterrupted supply of quality diagnostics, safe blood and other essential commodities.

02.003.WP01

REGIONAL INDICATORS

02.003.WP01.01 Number of countries and areas supported to improve forecasting, procurement and supply management systems for HIV, STI, malaria and TB medicines and other essential commodities.

02.003.WP01.02 Number of countries and areas supported in the monitoring of the quality of drugs and other commodities for STI and HIV/AIDS, malaria and TB prevention and control, and in the screening of blood.

BASELINE

STI and HIV/AIDS: 4 Malaria: 8 TB: 17

STI and HIV/AIDS: 4 Malaria: 5 TB: 17

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 6 Malaria: 9 TB: 27

STI and HIV/AIDS: 7 Malaria: 9 TB: 27

2009

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 7 Malaria: 9 TB: 27

STI and HIV/AIDS: 8 Malaria: 9 TB: 27

2011

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 9 TB: 27

2013

JUSTIFICATION

Achieving target times for STI and HIV/AIDS, tuberculosis and malaria prevention and control depends significantly on availability of and access to high-quality medicines, diagnostics and other essential health technologies. Expanding access and ensuring the quality of these is a major priority for WHO, as evidenced by various World Health Assembly and Regional Committee resolutions. This is an increasing priority area for Member States and there is enormous demand for WHO's support in this area at all levels of the Organization.

ORGANIZATIONWIDE EXPECTED RESULT 02.004

Global, regional and national systems for surveillance, evaluation and monitoring strengthened and expanded to keep track of progress towards targets and allocation of resources for HIV/AIDS, tuberculosis and malaria control and to determine the impact of control efforts and the evolution of drug resistance.

REGIONAL EXPECTED RESULT

Regional and national surveillance, evaluation and monitoring systems strengthened and expanded to monitor progress towards targets and resource allocations for STI and HIV/AIDS, malaria and TB control, including monitoring of drug and insecticide resistance and the impact of control efforts.

02.004.WP01

REGIONAL INDICATORS

02.004.WP01.01 Number of countries and areas that regularly collect, analyse and report STI and HIV/AIDS, malaria and TB surveillance data and coverage, using WHO's standardized methodologies, including appropriate age and sex disaggregation.

02.004.WP01.02 Number of countries and areas that regularly collect and report STI and HIV/AIDS, malaria and TB programme monitoring and evaluation data (including financial data) and core indicators and targets.

02.004.WP01.03 Number of countries and areas reporting on surveillance and monitoring of STI and HIV/AIDS, malaria and TB drug resistance.

BASELINE

STI and HIV/AIDS: 8 Malaria: 6 TB: 36

STI and HIV/AIDS: 5 Malaria: 4 TB: 36

STI and HIV/AIDS: 3 (HIV); 10 (STI) Malaria: 7 TB: 16

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 10 TB: 36

STI and HIV/AIDS: 7 Malaria: 10 TB: 36

STI and HIV/AIDS: 4 (HIV); 10 (STI) Malaria: 10

2009

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

TB: 18

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 10 TB: 36

STI and HIV/AIDS: 4 (HIV); 10 (STI) Malaria: 10 TB: 21

2011

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 10 TB: 36

STI and HIV/AIDS: 5 (HIV); 10 (STI) Malaria: 10 TB: 23

2013

JUSTIFICATION

WHO has a critical role in supporting and coordinating STI and HIV/AIDS, tuberculosis and malaria surveillance activities at the global, regional and country levels which includes supporting synthesis and dissemination of data for informing policy decisions and public health responses on these diseases; shaping the research agenda; stimulating and supporting the generation, translation and dissemination of knowledge, evidence and lessons learnt. Regional and in country support for strengthening surveillance and programme monitoring and evaluation activities is crucial to providing timely information for strategic and policy development, effective programme management and timely response to issues.

ORGANIZATIONWIDE EXPECTED RESULT 02.005

Political commitment sustained and mobilization of resources ensured through advocacy and nurturing of partnerships on HIV/AIDS, tuberculosis and malaria at country, regional and global levels; support provided to countries as appropriate to develop or strengthen and implement mechanisms for resource mobilization and utilization and increase the absorption capacity of available resources; and engagement of communities and affected persons increased to maximize the reach and performance of HIV/AIDS, tuberculosis and malaria control programmes.

REGIONAL EXPECTED RESULT

Political commitment sustained and mobilization of resources ensured through advocacy and nurturing of STI and HIV/AIDS, malaria and tuberculosis partnerships at country, regional and global levels; support provided to countries and areas as appropriate to develop/strengthen and implement mechanisms for resource mobilization and utilization; and engagement of communities and affected persons increased to maximize the reach and performance of STI and HIV/AIDS, malaria and tuberculosis control.

02.005.WP01

REGIONAL INDICATORS

02.005.WP01.01 Number of targeted countries and areas that receive WHO support in accessing financial resources or increasing absorption of funds for STI and HIV/ AIDS, malaria and TB control.

02.005.WP01.02 Number of targeted countries and areas with

verifiable active involvement of communities, people living with HIV/AIDS, most at risk populations, civil society organizations, private sector in planning, design, implementation and evaluation of STI and HIV/AIDS, malaria

and TB programmes.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

BASELINE

STI and HIV/AIDS: 9 Malaria: 6 TB: 17

STI and HIV/AIDS: 5 Malaria: 5 TB: 17

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 8 TB: 20

STI and HIV/AIDS: 7 Malaria: 10 TB: 20

2009

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 8 TB: 20

STI and HIV/AIDS: 7 Malaria: 10 TB: 20

2011

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: 9 Malaria: 8 TB: 20

STI and HIV/AIDS: 9 Malaria: 10 TB: 20

2013

JUSTIFICATION

Partnerships to broaden technical and financial resources are critical to scaling up and reaching the intervention goals of the STI and HIV/AIDS, malaria and TB programmes. The Region, countries and areas actively participate and substantially contribute to the work of partnerships (such as UNAIDS; Stop TB and Rollback Malaria Partnerships; Global Fund to Fight AIDS, Tuberculosis and Malaria; U.S. President's Emergency Plan for AIDS Relief; the Global TB Drug Facility; Malaria Medicines and Supply Service; and AIDS Medicines and Diagnostics Service). Partnerships that exist in the Region and countries and areas need to be enhanced or expanded in order to further strengthen political commitment and to increase the level of resources, and accelerate actions towards achieving the relevant MDG.

ORGANIZATIONWIDE EXPECTED RESULT 02.006

New knowledge, intervention tools and strategies developed and validated to meet priority needs for the prevention and control of HIV/AIDS, tuberculosis and malaria, with scientists from developing countries increasingly taking the lead in this research.

REGIONAL EXPECTED RESULT

Operational research for the prevention and control of STI and HIV/AIDS, malaria and TB supported and research capacity strengthened in target countries and areas.

02.006.WP01

REGIONAL INDICATORS

02.006.WP01.01 Number of new operational research projects in the field of STI and HIV/AIDS, malaria or TB prevention and control supported by WHO in the Region.

02.006.WP01.02 Number of countries and areas actively pursuing operational research in the field of STI and HIV/AIDS, malaria or TB with verifiable involvement of local institutions.

BASELINE

STI and HIV/AIDS: 2 Malaria: 14 TB: 0

STI and HIV/AIDS: 2 Malaria: 10 TB: 0

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: at least 3 Malaria : at least 10 (1/country)

STI and HIV/AIDS: at least 3 Malaria: 10

2009

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

TB: at least 4

REGIONAL STRATEGIC OBJECTIVE STATEMENT 2

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: at least 3 Malaria: at least 10 (1/country) TB: at least 5

STI and HIV/AIDS: at least 3 Malaria: 10 TB: at least 5

2011

TARGETS TO BE ACHIEVED BY

STI and HIV/AIDS: at least 3 Malaria: at least 10 (1/country) TB: at least 7

STI and HIV/AIDS: at least 3 Malaria: 10 TB: at least 7

2013

JUSTIFICATION

Appropriately directed operational research can have a significant impact on STI and HIV/AIDS, malaria and TB control through the improvement, development and evaluation of new tools, interventions and strategies. WHO's facilitating role in this area is critical to finding the most effective and context-appropriate measures for combating these diseases and building a sustainable groundwork for developing countries and areas to undertake research of national and local relevance, and to the utilization of results for effective and efficient programme management.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

STRATEGIC OBJECTIVE 3

To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment.

Scope

The work under this strategic objective focuses on the following activities: advocacy, research, policy development and strengthening; programme implementation, including partnerships; monitoring and evaluation of country/regional progress, health burden and determinants; strengthening of health and rehabilitation systems and services for a comprehensive approach, implementation of prevention programmes and capacity-building in the area of chronic noncommunicable conditions (including cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, hearing and visual impairment – including blindness and genetic disorders, mental, behavioural and neurological disorders, and those provoked by psychoactive substance use; injuries due to road traffic crashes, drowning, burns, poisoning, falls, violence in the family, the community or between organized groups; and disabilities from all causes).

Regional indicators and targets

• A 2% annual reduction in global burden of disease (disability adjusted life years) from the major chronic, noncommunicable conditions over and above current trends. • To halt and begin to reverse current increasing trends of mental, behavioural, neurological and psychoactive substance use disorders. • To halt and begin to reverse current increasing trends in mortality from injuries.

Links with other strategic objectives

• Strategic objective 6: in relation to population-wide approaches to combating tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity as risk factors; and in relation to approaches directed at individuals at high risk from these risk factors, as well as approaches directed at the prevention of other risk factors.

Issues and challenges

In the Western Pacific Region, there is evidence of strong political commitment in many of these areas, but in most countries and areas, this commitment still needs to translate into effective policies and legislation, into operational plans and programmes, and into defined budget lines and investment. Many programmes in the Region are dependent on external funding and are not sustainable. While the

components of this strategic objective represent some of the greatest public health burdens in the world and disproportionately affect developing countries and areas, international and national investment is limited. There is a growing body of data in the Region (e.g. WHO STEPwise approach to surveillance of noncommunicable disease (NCD) risk factors (STEPS), Global Youth Tobacco Survey) in many of the areas covered by this strategic objective, but there are still challenges in data quality, systems of data collection, capacity for local work, and dissemination of data and findings.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

Health systems and capacities are still geared, in most developing countries and areas, around more traditional public health challenges and there is a need to reorient capacity-building. In developing countries in the Western Pacific Region, a person with diabetes, hypertension, or physical disability is usually unable to access effective services in their community. Health workers are often ill-equipped to deal with chronic disease and the

prevention of unintentional injury, physical and mental abuse, disability and mental illness. The scope of the work of WHO or of the health sector alone is limited due to the inherent multisectoral nature of the burden. WHO is therefore challenged to create and sustain networks and partnerships that span countries and areas and sectors and lead to effective action. Many countries and areas in the Western Pacific Region have developed NCD task forces and similar committees. These health-oriented taskforces must adopt ways of A number of Regional Committee

working that will involve wider multisectoral partnerships and action.

resolutions and enabling documents have mandated and developed the strategic approaches outlined below: • WPR/RC51.R5: Prevention and Control of Noncommunicable Diseases • The Tonga Commitment to Promote Healthy Lifestyles and Supportive Environment (March 2003, Nuku’alofa, Tonga) • WPR/RC55.R7: Tobacco Control • WPR/RC52.R5: Regional Strategy for Mental Health

Strategic approaches

Strategic approaches for Member States: • Translate commitment into effective policies, legislation, operational plans and programmes. This includes the investment of national resources and the development of health financing systems that provide access to effective prevention and control in all themes under strategic objective 3. • Improve capacity for surveillance through establishing systems for tracking of risk factors, registers of key events and diseases, and mortality records of sufficient quality to permit evidence-based policy-making. • Strengthen and sustain health promotion programmes including national and local efforts to raise awareness of healthy lifestyles and develop supportive environments. • Strengthen and sustain clinical prevention by developing evidence-based clinical guidelines, training staff, delivering efficient services and assuring quality. • Strengthen and sustain national networks that can extend the reach of health services into other sectors and into local communities. Strategic approaches for the WHO Secretariat: • Provide advocacy and guidance in the development, implementation and monitoring of national policies, programmes and plans in these areas of work. • Provide standard instruments for surveillance and supporting the development of surveillance systems. • Assess and strengthen the systems (health and other sectors) to prevent, manage and provide services, including rehabilitation.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

• Support training and capacity-building in countries and areas through guidance and direct technical assistance to develop a health workforce better equipped to deal with these conditions. • Build and support networks and partnerships with international, governmental, nongovernmental, and private organizations, and with the media.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

ORGANIZATIONWIDE EXPECTED RESULT 03.001

Advocacy and support provided to increase political, financial and technical commitment in Member States in order to tackle chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities together with visual impairment, including blindness.

REGIONAL EXPECTED RESULT

Advocacy and support provided to increase political, financial and technical commitment in countries and areas in order to address chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities.

03.001.WP01

REGIONAL INDICATORS

03.001.WP01.01 Number of targeted countries and areas that have a focal point or unit for injuries and violence prevention with its own budget in the health ministry.

03.001.WP01.02 Number of countries and areas that participate in the development and implementation of The World Report on Disability and Rehabilitation.

03.001.WP01.03 Number of low- and middle-income countries with mental health budgets of more than 1% of the total health budget.

03.001.WP01.04 Number of low- and middle-income countries and areas that have a unit or department for chronic noncommunicable conditions in the health ministry or equivalent health authority.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Resources will be used to raise the profile of and strengthen commitment for action on chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities at global, regional and national levels. Resources will also be used to support the activities of units in national health authorities with limited capacity to address chronic noncommunicable conditions, mental and behavioural disorders, violence and injuries and disabilities. Finally, resources will be used for the development of tools, reports and campaigns that describe the situation and make recommendations for action.

ORGANIZATIONWIDE EXPECTED RESULT 03.002

Guidance and support provided to Member States for the development and implementation of policies, strategies and regulations in respect of chronic noncommunicable conditions, mental and neurological disorders, violence, injuries and disabilities together with visual impairment, including blindness.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

REGIONAL EXPECTED RESULT

Guidance and support provided to countries and areas for the development and implementation of policies, strategies and regulations for chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities.

03.002.WP01

REGIONAL INDICATORS

03.002.WP01.01 Number of targeted countries and areas that have and are implementing national plans to prevent unintentional injuries and violence.

03.002.WP01.02 Number of targeted countries and areas that have and are implementing national plans for disability and rehabilitation.

03.002.WP01.03 Number of policies, plans or laws formally initiated by countries with WHO support.

03.002.WP01.04 Number of countries and areas that have and are implementing a multisectoral national policy for the prevention and control of chronic noncommunicable conditions.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

National plans and policies are key to coordinated multisectoral responses to chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities. A few low- and middle-income countries and areas have developed such plans for noncommunicable diseases; however, several more are actively engaged in developing or completing plans. Resources will be used to support regional and country processes to advance development and initial implementation of policies and plans.

ORGANIZATIONWIDE EXPECTED RESULT 03.003

Improvements made in Member States’ capacity to collect, analyse, disseminate and use data on the magnitude, causes and consequences of chronic noncommunicable conditions, mental and neurological disorders, violence, injuries and disabilities together with visual impairment, including blindness.

REGIONAL EXPECTED RESULT

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

03.003.WP01

REGIONAL INDICATORS

03.003.WP01.01 Number of targeted countries and areas that have published a

03.003.WP01.02 Number of targeted countries and areas that have published a

03.003.WP01.03 Number of targeted countries and areas establishing or

03.003.WP.01.04 Number of countries and areas with a national health

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

national compilation of data on the magnitude, causes and consequences of injuries and violence.

national compilation of data on the prevalence and incidence of disabilities.

substantially strengthening national or regional information systems on the magnitude, causes and consequences of mental, behavioural, neurological and psychoactive substance use disorders.

reporting system and annual reports that include indicators for chronic noncommunicable conditions.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY 2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Resources will be used to support countries and areas to better document the public health impact and costs of chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities. More specifically, resources will be used to set up data collection systems and support data analysis and dissemination. Resources will also be used to monitor and provide feedback on regional trends.

ORGANIZATIONWIDE EXPECTED RESULT 03.004

Improved evidence compiled by WHO on the cost-effectiveness of interventions to tackle chronic noncommunicable conditions, mental and neurological and substance-use disorders, violence, injuries and disabilities together with visual impairment, including blindness.

REGIONAL EXPECTED RESULT

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

03.004.WP01

REGIONAL INDICATORS

03.004.WP01.01 Evidence on the cost-effectiveness of a core package of interventions for chronic noncommunicable conditions summarized and the regional cost of implementation estimated.

BASELINE

Evidence gathered.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

TARGETS TO BE ACHIEVED BY

Core package completed.

2009

TARGETS TO BE ACHIEVED BY

Core package disseminated.

2011

TARGETS TO BE ACHIEVED BY

Expanded and desirable packages are completed, and overall approach is contextualized for country implementation.

2013

JUSTIFICATION

Resources will be used to support further research in low- and middle-income countries and areas on cost-effectiveness of interventions. This will include training and workshops to refine methodology, studies and compilation of results at national and regional levels, building on existing tools, methods and best practice documents and focused dissemination strategies. Resources will also be used to inform policy-makers at country level and to assist them with using this information for priority setting.

ORGANIZATIONWIDE EXPECTED RESULT 03.005

Guidance and support provided to Member States for the preparation and implementation of multisectoral, population-wide programmes to promote mental health and to prevent mental and behavioural disorders, violence and injuries, together with hearing and visual impairment, including blindness.

REGIONAL EXPECTED RESULT

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

03.005.WP01

REGIONAL INDICATORS

03.005.WP01.01 Number of countries and areas that use guidelines on multisectoral interventions to prevent violence and unintentional injuries in their contexts with WHO support.

03.005.WP01.02 Number of countries that have initiated, with WHO assistance, a community-based project to decrease suicides.

03.005.WP.01.03 Number of countries implementing strategies recommended by WHO for population-wide prevention of hearing and visual impairment, including blindness.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Resources will be used to support the implementation of prevention programmes at local, national and regional level, including the necessary training and workshops. They will also be used for global and regional guidelines and best practice documents, and for global coordination and monitoring of country experiences and lessons learnt.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

ORGANIZATIONWIDE EXPECTED RESULT 03.006

Guidance and support provided to Member States to improve the ability of their health and social systems to prevent and manage chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities together with visual impairment, including blindness.

REGIONAL EXPECTED RESULT

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

03.006.WP01

REGIONAL INDICATORS

03.006.WP01.01 Number of targeted countries and areas that have strengthened their health care-system response to unintentional injuries and violence using WHO guidelines.

03.006.WP01.02 Number of countries and areas that have strengthened their rehabilitation services using the recommendations in The World Report on Disability and Rehabilitation and related WHO guidelines.

03.006.WP01.03 Number of low- and middle-income countries that have completed a systematic assessment of their mental health systems by means of WHO's assessment instrument for mental health systems (WHO-AIMS).

03.006.WP01.04 Number of low- and middle-income countries and areas implementing integrated primary health care strategies recommended by WHO in the management of chronic noncommunicable conditions.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY 2013

JUSTIFICATION

Resources will be used for documents, training, workshops and direct support for the strengthening of health and rehabilitation services in low- and middle-income countries and areas, to ensure that they improve ways in which they address chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities.

ORGANIZATIONWIDE EXPECTED RESULT 03.006

REGIONAL EXPECTED RESULT

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

03.006.WP02

REGIONAL STRATEGIC OBJECTIVE STATEMENT 3

REGIONAL INDICATORS

03.006.WP02.01 Number of countries and areas with strengthened health-system services for the management and treatment of tobacco dependence as a result of using WHO's policy recommendations.

03.006.WP02.02 Availability of evidence-based guidance/guidelines on the cost-effectiveness of interventions for prevention and management of cardiovascular diseases, diabetes, cancer and respiratory disease.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

STRATEGIC OBJECTIVE 4

To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals.

Scope

Work under this strategic objective will focus on action towards ensuring universal access to, and coverage with, effective public health interventions to improve maternal, newborn, child, adolescent, and sexual and reproductive health, with emphasis on reducing gender inequality and health inequities; development of evidence-based, gender-sensitive, coordinated and coherent approaches to addressing needs at key stages of life and improving sexual and reproductive health, using a life-course approach; fostering synergies between maternal, newborn, child, adolescent, sexual and reproductive health interventions and other public health programmes, and supporting action to strengthen health systems; and formulating and implementing policies and programmes that promote healthy and active ageing for all individuals.

Regional indicators and targets

• Number of countries and areas in which at least 85% of births are attended by skilled birth attendants: 33 by 2013. • Maternal mortality ratio: by 2013, no more than four countries and areas have a maternal mortality ratio above 100 per 100 000 live births. • Under-5 mortality rate: by 2013, 30 countries and areas are on track to meet the Millennium Development Goal (MDG) Target 5 (reduce by two thirds, between 1990 and 2015, the under-5 mortality rate) or have an under-5 mortality rate lower than 20 per 1000 live births. • Number of countries and areas in which contraceptive prevalence rate is 60% or more: 29 by 2013.

Links with other strategic objectives

• Strategic objectives 1 and 2: in relation to ensuring the effective delivery, in an integrated manner, of immunization and other interventions for the control of major infectious diseases through services for maternal, newborn, child and adolescent health, and sexual and reproductive health. • Strategic objectives 6 to 9, especially 6, 7 and 9: sufficient attention needs to be given to: (a) social and economic determinants of ill-health that limit progress towards this strategic objective; (b) major risk factors, such as poor nutrition; and (c) human rights-based and gender-responsive approaches to ensure equitable access to key services. • Strategic objectives 10 and 11: with attention to specific actions required to strengthen health systems so that they can rapidly expand access to effective interventions for maternal, newborn, child, adolescent, and sexual and reproductive health, while ensuring a continuum of care across the life course and across different levels of the health system, including the community.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

Issues and challenges

Significant progress has been made over the years in reducing maternal and childhood mortality in the Western Pacific Region. However, nearly 50 000 mothers die every year from pregnancy- or childbirth-related

complications, 360 000 babies die during the first month of life, and another 406 000 children who survive the first month do not see their fifth birthday. Although cost-effective interventions are available to respond to most of the health problems of mothers and young children, underdeveloped health systems in some countries and areas of the Region fail to ensure the accessibility, affordability and quality of essential services for mothers and children, and prevent unnecessary deaths. A joint WHO/UNICEF Regional Child Survival Strategy (resolution WPR/RC56.R5) provides a unified direction to guide countries and areas in accelerating and sustaining action to scale up an essential package of child survival interventions in an integrated way and in collaboration with all stakeholders, through the health system context. While the strategy is primarily targeted at intensifying action towards reducing child mortality, it outlines a strong link with efforts to reduce maternal mortality and to intensify action towards reaching key health-related MDG, especially MDG 4 and 5, in the Region. Significant morbidity and mortality among adolescents is due to teenage pregnancy, sexually transmitted infections including HIV/AIDS, injuries, suicide and violence. Many of these are preventable through improving access to information, skills and services as well as reducing the vulnerability of adolescents. Action towards universal access to and coverage with effective interventions faces the following challenges: • There is an enormous burden of disease and high mortality in the vulnerable group of women, children and adolescents. • Political will to make a difference is still lacking in many countries and areas as resources are largely insufficient. • Progress towards this strategic objective is dependent on the overall strengthening of health systems and, in particular, action for dealing with the crisis affecting human resources for health. • Competing health priorities, vertical programme approaches and lack of coordination between government and development partners result in programme fragmentation, missed opportunities and inefficient use of resources.

Strategic approaches

Strategic approaches for Member States: • Commit resources and prioritize national action towards universal access to and coverage with reproductive, maternal, newborn, child and adolescent health care, while addressing health inequities that fuel high levels of mortality and morbidity. • Work towards harmonization of programme efforts and the integration of service delivery. • Ensure that the continuum of care runs through the life-course, and spans the home, the community and different levels of the health system.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

• Ensure the strengthening of adequate and equitable financing and delivery of quality health-supportive services. • Promote community-based interventions to increase demand for services and to support appropriate care in the home across the life-course. Strategic approaches for the WHO Secretariat: • Provide technical guidance for the formulation and implementation of effective and evidence-based policies and interventions to improve reproductive, maternal, child and adolescent health. • Develop synergies between programme areas to ensure continuum of care. • Support countries and areas to develop their institutional capacity to deliver effective interventions, with particular attention to the strengthening of human resources for health. • Support countries and areas to monitor their health situation and assess progress towards internationally agreed goals and targets relevant to this objective. • Work with civil society and the private sector through partnerships to harmonize the work of United Nations agencies at the country level and to mobilize political leadership and resources as well as integration of poverty reduction strategies for improving reproductive, maternal, newborn, child and adolescent health.

ORGANIZATIONWIDE EXPECTED RESULT 04.001

Support provided to Member States to formulate a comprehensive policy, plan and strategy for scaling up towards universal access to effective interventions in collaboration with other programmes, paying attention to reducing gender inequality and health inequities, providing a continuum of care throughout the life course, integrating service delivery across different levels of the health system and strengthening coordination with civil society and the private sector.

REGIONAL EXPECTED RESULT

Support provided to Member States to develop a comprehensive policy, plan and strategy for scaling up towards universal access to effective interventions in collaboration with other programmes, paying attention to gender inequality and gaps in health equity, providing a continuum of care throughout the life-course, integrating service delivery across different levels of the health system and strengthening coordination with civil society and the private sector.

04.001.WP01

REGIONAL INDICATORS

04.001.WP01.01 Number of target countries and areas that have an integrated policy on universal access to effective interventions for improving maternal, newborn and child health.

04.001.WP01.02 Number of target countries and areas that have a policy on universal access to sexual and reproductive health.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

2013

JUSTIFICATION

Achievement of targets will require: advocacy and coordination of effective international efforts and the strengthening of collaboration with partners (e.g. through the Maternal Newborn and Child Health Partnership); and promotion of key initiatives and approved actions such as the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health.

ORGANIZATIONWIDE EXPECTED RESULT 04.002

National research capacity strengthened as necessary and new evidence, products, technologies, interventions and delivery approaches of global and/or national relevance available to improve maternal, newborn, child and adolescent health, to promote active and healthy ageing, and to improve sexual and reproductive health.

REGIONAL EXPECTED RESULT

National research capacity strengthened as necessary and new evidence, products, technologies, interventions and delivery approaches of global and/or national relevance available to improve maternal, newborn, child and adolescent health; to promote active and healthy ageing; and to improve sexual and reproductive health.

04.002.WP01

REGIONAL INDICATORS

04.002.WP01.01 Number of target countries and areas that have completed studies on priority issues with WHO support.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Country-led identification of research priorities and opportunities for strengthening national research capacity will have to be given greater attention. The setting of those research priorities, done in close consultation with national research partners and other stakeholders, will have to be improved. Support will be needed for use of research findings in informing policies and programmes.

ORGANIZATIONWIDE EXPECTED RESULT 04.003

Guidelines, approaches and tools for improving maternal care applied at the country level, including technical support provided to Member States for intensified action to ensure skilled care for every pregnant woman and every newborn, through childbirth and the postpartum and postnatal periods, particularly for poor and disadvantaged populations, with progress monitored.

REGIONAL EXPECTED RESULT

Technical and policy support provided to Member States for implementing national plans of action for the reduction of maternal and newborn mortality, thereby achieving universal coverage of skilled attendants on maternal and newborn care.

04.003.WP01

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

REGIONAL INDICATORS

04.003.WP01.01 Number of countries and areas implementing strategies for increasing coverage of skilled care at birth.

04.003.WP01.02 Number of countries and areas that have reviewed and implemented evidence-based guidelines and tools for the reduction of maternal and newborn mortalities.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY 2013

JUSTIFICATION

In the Western Pacific Region, every year there are 40 million to 50 million pregnancies with 50 000 maternal deaths and 300 000 newborn deaths on the first day of birth. As maternal mortality ratio reflects women's basic health status, their access to health care and the quality of care that they receive, technical support to Member States is important, especially for skilled birth attendants.

ORGANIZATIONWIDE EXPECTED RESULT 04.004

Guidelines, approaches and tools for improving neonatal survival and health applied at country level, with technical support provided to Member States for intensified action towards universal coverage, effective interventions and monitoring of progress.

REGIONAL EXPECTED RESULT

Guidelines, approaches and tools for improving neonatal survival and health in use at country level, with technical support provided to Member States for intensified action towards the achievement of universal coverage, effective interventions and progress monitoring.

04.004.WP01

REGIONAL INDICATORS

04.004.WP01.01 Number of target countries and areas implementing strategies for increasing coverage with interventions for neonatal survival and health.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Achievement of this expected result will require a continuum of care between maternal, newborn and child health services and strengthened links between these and other programmes such as immunization, family planning, nutrition, HIV/AIDS, syphilis elimination and malaria control. Furthermore, it will need community involvement and promotion of contact between mothers,

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

their families and health workers; a continuum of care between communities and health facilities; provision of suitable facilities for maternal and newborn care at community and primary-care levels, especially for low-birth-weight infants; and systems for monitoring trends in neonatal survival, disaggregated by sex, that allow the detection of subpopulations at high risk.

ORGANIZATIONWIDE EXPECTED RESULT 04.005

Guidelines, approaches and tools for improving child health and development applied at the country level, with technical support provided to Member States for intensified action towards universal coverage of the population with effective interventions and for monitoring progress, taking into consideration international and human-rights norms and standards, notably those stipulated in the Convention on the Rights of the Child.

REGIONAL EXPECTED RESULT

Policy and technical support provided to Member States for intensified action towards agreed goals ensuring universal access, coverage and quality of key public health interventions for newborn and child survival.

04.005.WP01

REGIONAL INDICATORS

04.005.WP01.01 Number of countries and areas implementing coordinated strategies for newborn and child survival.

04.005.WP01.02 Number of countries and areas that have expanded geographical coverage of IMCI to more than 75% of target districts.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Around 800 000 children under 5 years of age die every year in the Region from common preventable and treatable conditions. The WHO/UNICEF Regional Child Survival Strategy was adopted by the 56th session of the WHO Regional Committee for the Western Pacific as a unified direction and guide towards accelerated and sustained actions towards reducing inequities in child survival and achieving national targets for MDG 4.

ORGANIZATIONWIDE EXPECTED RESULT 04.006

Technical support provided to Member States for the implementation of evidence-based policies and strategies on adolescent health and development, and for the scaling up of a package of prevention, treatment and care interventions in accordance with established standards.

REGIONAL EXPECTED RESULT

Policy and technical support provided to Member States for coordinated implementation of evidence-based strategies, norms and standards for the prevention and care of diseases and health-compromising behaviours in adolescents, as well as conditions that place adolescents at risk.

04.006.WP01

REGIONAL INDICATORS

04.006.WP01.01 Number of target countries and areas that implement evidence-based policies and guidelines that

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

protect and care for the health of adolescents.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Adolescents are at high risk of morbidity and mortality from early pregnancy, sexually transmitted infections including HIV, injuries, suicide and violence. Achievement of MDG 5 and 6 will depend on reduction of HIV transmission and maternal mortality among adolescents.

ORGANIZATIONWIDE EXPECTED RESULT 04.007

Guidelines, approaches and tools made available, with provision of technical support to Member States, for accelerated action towards implementing the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health, with particular emphasis on ensuring equitable access to good-quality sexual and reproductive health services, particularly in areas of unmet need, and with respect for human rights as they relate to sexual and reproductive health.

REGIONAL EXPECTED RESULT

Technical support provided to Member States for accelerated action towards implementing the Global Reproductive Health Strategy and improving family planning and reproductive health care.

04.007.WP01

REGIONAL INDICATORS

04.007.WP01.01 Number of countries and areas implementing the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health.

04.007.WP01.02 Number of countries and areas that have reviewed and implemented the evidence-based guidelines and manuals on family planning and reproductive health developed by WHO.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Unsafe abortion is a leading cause of maternal mortality in the priority countries and areas. Implementing the global reproductive health strategy and improving universal access to and quality of family planning and reproductive health service are basic assumptions for reducing maternal mortality and achieving strategic objective 4.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 4

ORGANIZATIONWIDE EXPECTED RESULT 04.008

Guidelines, approaches, tools, and technical assistance provided to Member States for increased advocacy for consideration of ageing as a public health issue, for the development and implementation of policies and programmes aiming at maintaining maximum functional capacity throughout the life course and for the training of health-care providers in approaches that ensure healthy ageing.

REGIONAL EXPECTED RESULT

Technical support provided to Member States for increased advocacy for implementation of policies and programmes, and for training programmes for health care providers on healthy ageing.

04.008.WP01

REGIONAL INDICATORS

04.008.WP01.01 Number of countries and areas implementing national advocacy strategies for policies and programmes on healthy ageing.

04.008.WP01.02 Number of countries and areas with training programmes on healthy ageing.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

One third of the world's ageing population – people over 60 years – are found in the Western Pacific Region. Healthy older persons are valuable resources for their families and for society. Health throughout the life-course can be achieved by: maintaining maximum functional capacity; promoting health and well-being and creating supportive community, home and health care services and programmes for older persons; and ensuring inter-generational health equity within health care systems are critical to achieving health throughout the life-course.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

STRATEGIC OBJECTIVE 5

To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact.

Scope

The joint efforts of the Member States and the Secretariat regarding this strategic objective involve the following: health-sector emergency preparedness; intersectoral action for reducing risk and vulnerability within the framework of the International Strategy for Disaster Reduction; responding to the health needs experienced during emergencies and crises (including nutrition-related needs as well as those concerning water and sanitation); assessing needs of affected populations; health actions during the transition and recovery phases following conflicts and disasters; fulfilling WHO’s mandate within the framework of the reform process to enhance the United Nations humanitarian response; the global alert and response system for environmental and foodsafety public health emergencies within the framework of the International Health Regulations (2005); risk reduction in respect of specific threats; and preparedness and response programmes for environmental and food safety public health emergencies. In this way, WHO is making an important contribution to health security that also has critical implications for efforts to promote peace.

Regional indicators and targets

• Proportion of countries and areas with health-related disaster preparedness, risk-reduction and mitigation plans: 60%. • Proportion of countries and areas with declared emergencies receiving WHO emergency interventions: 60%. • Proportion of countries and areas affected by crises in which avoidable mortality has been kept below emergency thresholds: 60%.

Links with other strategic objectives

• Strategic objective 1: in relation to the International Health Regulations (2005) and responding to public health emergencies involving epidemics. • Strategic objective 3: in relation to gender violence, responding to psychosocial needs of affected populations; responding to the health needs of the disabled; mass-casualty management; and health care for those suffering from chronic diseases. • Strategic objective 4: in relation to the response to the health needs of vulnerable populations, especially mothers and children in emergency situations. • Strategic objective 8: in relation to intersectoral action for emergency preparedness and risk reduction, and for dealing with environmental, chemical and radiological emergencies. • Strategic objective 9: in relation to nutrition in emergency situations.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

Issues and challenges

Of the six WHO regions, the Western Pacific Region has the highest number of natural hazard events per year. The five main issues in the Region include:

(1) recurring natural hazards and increasing numbers of technological hazards that may cause emergencies and then become disasters in vulnerable and inadequately prepared communities;

(2) insufficient preparedness for emergencies at provincial and community levels, aggravating the impacts of hazards on health and health services;

(3) weak capacity of health authorities for emergency management, leading to ineffective or inappropriate emergency support;

(4) lack of collaboration among partner agencies, leading to the inappropriate use of limited resources and hindering collective efforts; and

(5) shortages of systematic and reliable public health information on emergencies, making it difficult to measure their impact, develop sound policies or monitor activities.

Strategic approaches

Strategic approaches for Member States: • Build national institutional capacity for effective preparedness, response and recovery efforts. • Establish effective national coordination mechanisms including timely information sharing for response to emergencies. • Promote health systems preparedness with a multi-hazard approach, including capacity to anticipate events and the use of early warning mechanisms. Strategic approaches for the WHO Secretariat: • Build capacity in the field of emergency preparedness and response through multisectoral, multidisciplinary and all-hazard approaches. • Support the establishment and maintenance of national operational capacity of Member States for rapid response and for leading coordinated action of multiple stakeholders in public health emergencies, disasters, conflicts and other crises. • Develop technical and operational capacity in support of countries and areas in crises, particularly in conducting health assessments, coordinating health action, filling gaps, providing guidance and monitoring the performance of humanitarian action on the health of affected populations. • Leverage the vast array of skills across WHO in support of response to health emergencies (mental health, nutrition, environmental health, water and sanitation, health promotion, food safety, essential medicines, violence and injury prevention, mass casualty management, noncommunicable diseases, communicable diseases, and maternal and child health).

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

ORGANIZATIONWIDE EXPECTED RESULT 05.001

Norms and standards developed, capacity built and technical support provided to Member States for the development and strengthening of national emergency preparedness plans and programmes.

REGIONAL EXPECTED RESULT

Norms and standards developed, capacity built and technical support provided to Member States for the development and strengthening of national emergency preparedness plans and programmes.

05.001.WP01

REGIONAL INDICATORS

05.001.WP01.01 Number of countries and areas implementing national emergency preparedness activities.

05.001.WP01.02 Number of countries and areas that have national emergency preparedness plans.

05.001.WP01.03 Number of guidelines, standards, protocols or references developed.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

National preparedness for health emergencies should be strengthened through the development of norms and standards, training programmes/activities and other forms of technical support that can be provided by WHO.

ORGANIZATIONWIDE EXPECTED RESULT 05.002

Norms and standards developed and capacity built to enable Member States to provide timely response to disasters associated with natural hazards and conflict-related crises.

REGIONAL EXPECTED RESULT

Norms and standards developed, capacity built and technical support provided to Member States for a timely response to disasters associated with natural and human-generated hazards.

05.002.WP01

REGIONAL INDICATORS

05.002.WP01.01 Number of international emergency events to which WHO provided support.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Effective and efficient response can be measured by the technical support provided and

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

norms/standards developed.

ORGANIZATIONWIDE EXPECTED RESULT 05.003

Norms and standards developed and capacity built to enable Member States to assess needs and for planning interventions during the transition and recovery phases of conflicts and disasters.

REGIONAL EXPECTED RESULT

Norms and standards developed, capacity built and technical support provided to Member States for assessing needs and for planning and implementing transition and recovery actions in postdisaster and post-conflict situations.

05.003.WP01

REGIONAL INDICATORS

05.003.WP01.01 Number of projects where WHO provided support for development of norms and standards, capacity-building and actual planning/implementation of transition and recovery activities.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Improvements in transition and recovery activities can be seen in norms and standards developed and in capacity-building activities provided.

ORGANIZATIONWIDE EXPECTED RESULT 05.004

Coordinated technical support provided to Member States for communicable disease control in natural disaster and conflict situations.

REGIONAL EXPECTED RESULT

Coordinated technical support provided to Member States for communicable disease control in disasters resulting from natural and human-generated hazards.

05.004.WP01

REGIONAL INDICATORS

05.004.WP01.01 Number of joint activities with WHO Communicable Diseases Surveillance and Response Unit (CSR) in emergency preparedness and response.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Response in emergencies will be strengthened with joint activities with CSR in the control and prevention of outbreaks and communicable diseases.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

ORGANIZATIONWIDE EXPECTED RESULT 05.005

Support provided to Member States for strengthening national preparedness and for establishing alert and response mechanisms for food-safety and environmental health emergencies.

REGIONAL EXPECTED RESULT

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

05.005.WP01

REGIONAL INDICATORS

05.005.WP01.01 Number of joint WHO divisional activities on food safety, environmental health and water/sanitation in emergency preparedness and response.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

WHO has an essential role in strengthening global capacity for emergency and humanitarian action.

ORGANIZATIONWIDE EXPECTED RESULT 05.005

Support provided to Member States for strengthening national preparedness and for establishing alert and response mechanisms for food-safety and environmental health emergencies.

REGIONAL EXPECTED RESULT

Support provided to Member States for strengthening national preparedness, alert and response to food-safety and environmental health emergencies.

05.005.WP02

REGIONAL INDICATORS

05.005.WP02.01 Number of activities supported in the area of preparedness, alert and response to environmental emergencies.

05.005.WP02.02 Number of countries and areas in which protocols for food-safety emergencies have been developed and/or adapted and training conducted.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

WHO has an essential technical support role in strengthening global preparedness for food-safety and environmental health emergencies.

ORGANIZATION-

Effective communications issued, partnerships formed and coordination developed with other

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

WIDE EXPECTED RESULT 05.006

organizations in the United Nations system, governments, local and international nongovernmental organizations, academic institutions and professional associations at the country, regional and global levels.

REGIONAL EXPECTED RESULT

Effective communications issued, partnerships formed and coordination developed with other organizations in the United Nations system, governments, local and international nongovernmental organizations, academic institutions and professional associations at the country, regional and global levels.

05.006.WP01

REGIONAL INDICATORS

05.006.WP01.01 Number of collaborative activities in which WHO has been actively involved.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Lack of collaboration among partner agencies can lead to inappropriate use of limited resources and can hinder collective efforts towards health security.

ORGANIZATIONWIDE EXPECTED RESULT 05.006

REGIONAL EXPECTED RESULT

Effective communications in emergency and outbreak situations.

05.006.WP02

REGIONAL INDICATORS

05.006.WP02.01 Number of communications (press conferences, press releases, fact sheets) in emergency and outbreak situations.

BASELINE

TARGETS TO BE ACHIEVED BY

10% above baseline

2009

TARGETS TO BE ACHIEVED BY

15% above baseline

2011

TARGETS TO BE ACHIEVED BY

20% above baseline

2013

REGIONAL STRATEGIC OBJECTIVE STATEMENT 5

JUSTIFICATION

WHO has been recognized and valued as an authoritative source of accurate and timely health information during emergency and outbreak situations.

ORGANIZATIONWIDE EXPECTED RESULT 05.007

Acute, ongoing and recovery operations implemented in a timely and effective manner.

REGIONAL EXPECTED RESULT

Acute, ongoing and recovery operations implemented in a timely and effective manner.

05.007.WP01

REGIONAL INDICATORS

Percentage of acute-onset emergencies for which WHO mobilizes coordinated national and international actions

BASELINE

50% of acute onset emergencies

TARGETS TO BE ACHIEVED BY

10% above baseline

2009

TARGETS TO BE ACHIEVED BY

20% above baseline

2011

TARGETS TO BE ACHIEVED BY

25% above baseline

2013

JUSTIFICATION

WHO is a key player and partner in the coordination of international responses to health emergencies at national and international levels.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

STRATEGIC OBJECTIVE 6

To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex.

Scope

The work under this strategic objective focuses on integrated, comprehensive, multisectoral and multidisciplinary health-promotion and prevention processes and approaches across all WHO’s relevant programmes; and on the prevention or reduction of the occurrence of six major risk factors: use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diet, physical inactivity and unsafe sex. The main activities involve capacity-building for health promotion across all relevant programmes, risk-factor surveillance, the development of ethical and evidence-based policies, strategies, interventions,

recommendations, standards and guidelines for health promotion, prevention and reduction of the occurrence of the major risk factors.

Regional indicators and targets

• Health promotion capacity score: increase in capacity in 30% of Western Pacific Region Member States that have completed the capacity mapping by 2013. • Tobacco use prevalence: half of Western Pacific Region Member States reduce national tobacco use prevalence by 10% by 2013. • Childhood obesity prevalence: 10% of Member States in the Western Pacific Region with a high burden of childhood obesity halt the rise in childhood obesity by 2013. • Level of harmful use of alcohol: 10% increase in the number of Western Pacific Region Member States that have stabilized or reduced harmful use of alcohol by 2013. • Unsafe sex prevalence: Reduce by two thirds the percentage of men and women in Western Pacific Region Member States not wanting a child and not using a contraceptive method and increase to 70% correct and consistent condom use during the last sexual intercourse with a non-regular partner by 2013.

Links with other strategic objectives

• Strategic objectives 2, 3, 4, 7, 8 and 9: Although these seek to deal with the determinants of poor health and strengthen service provision, this strategic objective seeks, in particular, to create healthy environments in order to enable individuals to make healthy choices.

Issues and challenges

Strategic objective 6 includes the major risk factors that contribute to more than 60% of the mortality and more than 50% of the morbidity burden worldwide, affecting predominantly populations in low- and middle-income countries and areas. While much emphasis has been placed on the treatment of the effects of these risk factors, much less attention has been devoted to primary prevention and gender–responsive ways of dealing effectively

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

with these health determinants, and to reach low socioeconomic groups in the population. Tobacco use is a risk factor for six of the eight leading causes of deaths globally. Tobacco use is the leading cause of preventable deaths worldwide, killing 4.9 million people every year. Some 1 million of those deaths are in the Western Pacific Region, with at least 50% of tobacco-attributable deaths occurring in developing countries and areas. It is estimated that at least two people die each minute from a tobacco-related disease. The WHO Framework Convention on Tobacco Control (FCTC), now ratified by all Member States of the Western Pacific Region, is an evidence-based treaty designed to help reduce the burden of disease and death caused by tobacco use. Regional Committee resolution WPR/RC55.R7 called upon Members States to implement tobacco control measures beyond those required by the FCTC. In 2000, alcohol consumption was linked to 2.3 million death years globally and 60 million years of life lost. It also accounts for 5.5% of the overall disease burden in the Western Pacific Region. More than 15 million people worldwide suffer from drug use disorders. In a growing number of countries and areas, injecting drug use is the driving force behind the rapid spread of HIV infection, and up to 90% of HIV infections in many countries and areas are due to injecting drug use. Globally, 17% of the population is estimated to be physically inactive and an additional 41% is estimated to be insufficiently active. Physical inactivity is estimated to cause 1.9 million deaths per year, making it one of the leading risk factors for health. World Health Assembly resolution WHA57.17 endorsed the Global Strategy on Diet, Physical Activity and Health and urged Member States to take actions that promote individual and community health through healthy diet and physical activity and to reduce the risks and incidence of noncommunicable diseases. Unsafe sexual behaviour leads to a major burden of disease associated with unintended pregnancy, sexually transmitted infections, including HIV/AIDS, and other social, emotional and physical consequences that are currently underestimated in present disease estimates. In the Western Pacific Region, Cambodia and Papua New Guinea are facing generalized HIV/AIDS epidemics. Other countries and areas in the Region have a low HIV prevalence. Concentrated epidemics in specific groups in China, Malaysia and Viet Nam have the potential to bridge transmission to the general population. Resolution WPR/RC54.R5 called for the implementation of

approaches that promote lifestyle choices that lead to reductions in transmission of sexually transmitted infections and HIV/AIDS, strengthened health promotion targeted at vulnerable groups, and continued reinforcement of the primary prevention of HIV transmission. Risky behaviour does not often occur in isolation but as part of a cluster; for example, hazardous use of alcohol and other drugs and unsafe sex frequently go together. It is important to understand the underlying social and environmental determinants, including gender, low education, poverty and other inequities. For that reason WHO recognizes the need for a comprehensive, integrated approach to health promotion, together with effective preventive and protective strategies that build the resilience of individuals and strengthen community capacity for improving health. In addition, global estimates show that three billion people, or half of humanity, now live in urban areas. As a determinant of major risk factors, urbanization has both positive and negative implications for health. With an increasing number of people living in towns and cities, where the impact of social, economic, environmental and technological change is greatest, new public health issues and problems are emerging. Of critical concern is the growing number of people who live in deprived environments, slums and informal settlements. In some countries,

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

these constitute 25%-40% of the urban population.

Strategic approaches

Strategic approaches for Member States: • Give priority to sustained health promotion to improve health, reduce health inequalities, control major risk factors and ensure sustainable development at regional and country levels. • Support initiatives to secure new and sustainable funds (tobacco and alcohol taxes, national budgets, local government budgets, donor support, corporate contributions, social health insurance) for the promotion of health. • Establish and strengthen appropriate infrastructure for the promotion of health that enables intersectoral action, community empowerment and good corporate practice. • Strengthen leadership and build capacity to advocate and mobilize multisectors to take forward the recommendations of the Bangkok Charter on Health Promotion in a Globalized World and address broad determinants such as globalization and urbanization. • Establish national systems of surveillance, monitoring and evaluation that can adequately identify at-risk populations through appropriately disaggregated data, and develop responses for the prevention and control of common risk factors and associated health outcomes, giving priority to countries and areas with the highest or increasing burdens. • Build multisectoral national capacities, partnerships and alliances to mainstream gender and equity perspectives and strengthen institutional knowledge and competence in surveillance, policy development, strategic and operational planning, programme management, monitoring and evaluation related to the major risk factors, and disseminate research findings to inform policy and service developments. • Address policy and structural barriers, strengthen household and community capacity, and ensure access to education and information to promote safe sexual behaviours and manage individual and social consequences of unsafe sexual behaviours and practices. • Strengthen regulations, legislation and economic interventions for the promotion of health, e.g. taxation of harmful products. • Implement the WHO Framework Convention on Tobacco Control in collaboration with the Permanent Secretariat for the WHO FCTC and strengthen action and advocacy for tobacco control policies as outlined in the WHO report on the Global Tobacco Epidemic 2008: the MPOWER package. Strategic approaches for the WHO Secretariat: • Provide leadership, technical assistance, coordination, communication, collaboration and advocacy. • Encourage increased investment at all levels and build internal WHO capacity, especially in country offices. • Strengthen the evidence base for health promotion interventions. • Seek to significantly expand health promotion capacity to meet increased needs and activities across all relevant health programmes, including the recommendations of the 6th Global Conference on Health Promotion.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

• Follow up actions recommended at the 7th Global Conference on Health Promotion and sustain action on the WHO Commission on Social Determinants of Health. • Contribute to the Global Forum on Healthy Urbanization 2010 and scale up efforts to advocate for local government action for health.

ORGANIZATIONWIDE EXPECTED RESULT 06.001

Advice and support provided to Member States to build their capacity for health promotion across all relevant programmes, and to establish effective multisectoral and multidisciplinary collaborations for promoting health and preventing or reducing major risk factors.

REGIONAL EXPECTED RESULT

Advice and support provided to countries and areas to strengthen their health promotion capacity across all relevant programmes, and to establish effective multisectoral and multidisciplinary mechanisms and collaborations to promote health and prevent and reduce the occurrence of major behavioural and structural risk factors.

06.001.WP01

REGIONAL INDICATORS

06.001.WP01.01 Number of countries and areas supported to develop national outcome-oriented health promotion strategies and/or activities.

06.001.WP01.02 Number of countries and areas supported to develop and/or expand methods/ mechanisms to sustain financing of health promotion.

06.001.WP01.03 Number of networks strengthened at (a) country level and (b) regional level for promotion of health and prevention of major riskfactors.

BASELINE

(a) 6 (b) 1

TARGETS TO BE ACHIEVED BY

(a) 8 (b) 2

2009

TARGETS TO BE ACHIEVED BY

(a) 10 (b) 3

2011

TARGETS TO BE ACHIEVED BY

(a) 12 (b) 4

2013

JUSTIFICATION

The Regional Health Promotion Framework 2008–2013 provides guidance for the regional focus on building capacity for the promotion of health. Health Promotion Leadership Training for sustainable financing and infrastructure will continue to be a key strategy for achieving the expected results. Implementation at the regional level will be supported by new regional networks in partnership with stakeholders, e.g. Healthy Cities and Health Promoting Schools. At the country level, technical support will be provided to develop boards, councils, multisectoral committees and foundations, which will improve governance and impact on healthy public policy.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

ORGANIZATIONWIDE EXPECTED RESULT 06.002

Guidance and support provided in order to strengthen national systems for surveillance of major risk factors through development and validation of frameworks, tools and operating procedures and their dissemination to Member States where a high or increasing burden of death and disability is attributable to these risk factors.

REGIONAL EXPECTED RESULT

Guidance and support provided to strengthen national systems for major risk factor surveillance by developing, validating and disseminating programme and evaluation frameworks, tools and operating procedures to countries and areas with a high or increasing burden of premature death and disability attributable to major behavioural risk factors.

06.002.WP01

REGIONAL INDICATORS

06.002.WP01.01 Number of target countries and areas supported that have developed a functioning national surveillance system for, and regularly reports on, major health risk factors in adults.

06.002.WP01.02 Percentage of target countries and areas supported that have developed a functioning national surveillance system for, or regularly reports on, major health risk factors in youth.

BASELINE

10%

TARGETS TO BE ACHIEVED BY

35%

2009

TARGETS TO BE ACHIEVED BY

50%

2011

TARGETS TO BE ACHIEVED BY

85%

2013

JUSTIFICATION

Much of the work has already begun, but a substantial number of Member States will embark upon the development and implementation of reliable risk-factor and response surveillance systems during this planning and reporting period. Many Member States will continue to require assistance from WHO to sustain and perfect existing systems, and others will require assistance from WHO to initiate these systems. It is anticipated that the level of effort and material and human resources required for development, modification, validation and dissemination of standards and operating procedures will increase significantly in 2008–2009 and remain at that level during subsequent years.

ORGANIZATIONWIDE EXPECTED RESULT 06.003

Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed, and technical support provided to Member States with a high or increasing burden of disease and death associated with tobacco use, enabling them to strengthen institutions in order to tackle or prevent the public health problems concerned; support also provided to the Conference of the Parties to the WHO Framework Convention on Tobacco Control for implementation of the provisions of the Convention and development and implementation of protocols and guidelines.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

REGIONAL EXPECTED RESULT

Technical assistance, training and advocacy support provided to countries and areas with a high and increasing burden to strengthen institutions in order to address and/or prevent public health problems associated with tobacco use. Support provided to the Conference of the Parties to the WHO Framework Convention on Tobacco Control for implementation of the provisions of the Convention.

06.003.WP01

REGIONAL INDICATORS

06.003.WP01.01 Number of countries and areas that have adopted legislation or equivalent for all or any of the following: ban smoking in health care and educational facilities; ban direct and indirect advertising in national media; and require health warnings on tobacco products, consistent with the WHO Framework Convention on Tobacco Control.

06.003.WP01.02 Number of countries and areas with comparable national youth tobacco use prevalence data disaggregated by age and sex.

06.003.WP01.03 Number of countries and areas that have established or reinforced a national coordinating mechanism for comprehensive tobacco control.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Significant additional investment will be required to adequately address the broad implementation needs in accordance with the decisions taken by the Conference of the Parties in its capacity as an independent governing body. WHO will be working closely with the Conference of Parties and the permanent secretariat of the WHO Framework Convention on Tobacco Control (FCTC) to provide the necessary support to Parties as they develop comprehensive tobacco control policies and programmes and surveillance systems that will allow them to fulfil their obligations under the FCTC. The increased work programme and the commensurate need for more resources was noted in decision FCTC/COP1(12). Countries will need to focus on a strategy to scale up comprehensive tobacco control through institutionalization of surveillance, increasing human resource expertise and capacity, developing multisectoral mechanisms at national and local levels and using evidence for policy to sustain the gains from the FCTC and address the growing demand for simultaneous action at multiple levels.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

ORGANIZATIONWIDE EXPECTED RESULT 06.004

Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed, and technical support provided to Member States with a high or increasing burden of disease or death associated with alcohol, drugs and other psychoactive substance use, enabling them to strengthen institutions in order to combat or prevent the public health problems concerned.

REGIONAL EXPECTED RESULT

Technical support provided to countries and areas with a high and increasing burden of major risk factors and disease in order to strengthen institutions for preventing public health problems associated with alcohol, drugs and other psychoactive substance use.

06.004.WP01

REGIONAL INDICATORS

06.004.WP01.01 Number of countries and areas supported by WHO that have developed policies, plans and programmes for preventing public health problems caused by alcohol, drugs and other psychoactive substance use.

06.004.WP01.02 Number of countries and areas supported by WHO that have developed a surveillance system involving population-based surveys, hospital admissions and other available surveillance data, to provide information on alcohol use, drinking patterns and alcoholrelated harm.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY 2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Significant additional investment is urgently needed to ensure a credible global response commensurate with the burden of premature illness, disability and death attributable to alcohol, drug and other psychoactive substance use. This includes capacity-building and institutional strengthening at all levels of WHO, including collaborating centres, and especially in regional and country offices, to enable the Organization to respond effectively to Member States' needs and to support the implementation of relevant WHO resolutions. A comprehensive and integrated approach to the prevention and reduction of this group of risk factors will be encouraged, but a substantial increase in resource levels is required.

ORGANIZATIONWIDE EXPECTED RESULT 06.005

Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed and technical support provided to Member States with a high or increasing burden of disease or death associated with unhealthy diets and physical inactivity, enabling them to strengthen institutions in order to combat or prevent the public health problems concerned.

REGIONAL EXPECTED RESULT

Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed and technical support provided to countries and areas with a high and increasing burden to strengthen institutions in order to address and/or prevent public health problems

06.005.WP01

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

associated with unhealthy diets and physical inactivity.

REGIONAL INDICATORS

06.005.WP01.01 Number of countries and areas supported by WHO that have developed and implemented policies, plans and programmes for improving diets and physical activity, including adoption of the Global Strategy on Diet, Physical Activity and Health.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

WHO guidelines on interactions with external stakeholders will be revised and updated to better reflect the current environment, especially in relation to the food, alcoholic and non-alcoholic beverage industries, to ensure that public health objectives are highlighted. The increase in resources expected in 2008–2009 is likely to remain at a similar level thereafter. WHO needs to strengthen its normative work on physical activity. Most of the work related to the revision of guidelines will involve consultations with Member States. Interactions also need to include international and national nongovernmental organizations and community groups.

ORGANIZATIONWIDE EXPECTED RESULT 06.006

Evidence-based and ethical policies, strategies, interventions, recommendations, standards and guidelines developed and technical support provided to Member States to promote safer sex and strengthen institutions in order to tackle and manage the social and individual consequences of unsafe sex.

REGIONAL EXPECTED RESULT

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

06.006.WP01

REGIONAL INDICATORS

06.006.WP01.01 Number of countries and areas supported by WHO that have initiated or implemented new or improved interventions at individual, family and community levels to promote safe sexual behaviours to prevent unintended pregnancy and to prevent infectious diseases.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY 2011

REGIONAL STRATEGIC OBJECTIVE STATEMENT 6

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The 1994 International Conference on Population and Development (ICPD) Programme of Action and subsequent reviews have clearly established the critical importance of integrating Reproductive Health and HIV, offering practical and effective models for linking services, systems and programmes to achieve increases in contraceptive prevalence, reduce unmet need for family planning, reduce sexually transmitted infections, prevent HIV infection and transmission to women and prevent mother-to-child transmission of HIV. Reproductive health and women’s health is severely under-resourced given the high levels of maternal and infant morbidity and mortality in many countries and areas in the Region.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

STRATEGIC OBJECTIVE 7

To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rightsbased approaches.

Scope

The work under this strategic objective focuses on leadership in intersectoral action on the broad social and economic determinants of health; improvement of population health and health equity by better meeting the health needs of poor, vulnerable and excluded social groups; connections between health and various social and economic factors (labour, housing and educational circumstances; trade and macroeconomic factors; and the social status of various groups such as women, children, elderly people, and ethnic minorities); and formulation of policies and programmes that are ethically sound, responsive to gender inequalities, effective in meeting the needs of poor people and other vulnerable groups, and consistent with human-rights norms.

Regional indicators and targets

• Number of countries and areas supported to: (1) collect, analyse and use information on social determinants of health that is disaggregated by various relevant indicators of social exclusion, such as sex, age, ethnicity, income; and (2) adopt effective tools, methods and strategies for action: 2 countries and areas per year. • Processes and mechanisms for action established across sectors; and international, regional and national collaboration facilitated to reduce health inequities by addressing social determinants of health, including gender: this is a qualitative indicator related to processes and thus will not have a quantitative target. • Number of countries and areas supported to promote more equitable, pro-poor, gender-responsive and ethical human rights-based health policies, programmes and intervention, with participation by and accountability to all stakeholders: 2 countries and areas per year.

Links with other strategic objectives

Issues of health equity, ethical standards, gender, pro-poor approaches and human rights are relevant to all other strategic objectives. • Strategic objectives 1 to 5: Notwithstanding the technical complexities, it is firmly established that health outcomes are powerfully influenced by social and economic determinants, as well as by the availability and quality of clinical services. • Strategic objectives 6, 8 and 9: The present strategic objective is primarily concerned with the underlying determinants and structural factors (such as labour markets, education system, and gender inequality) defining people’s different positions in social hierarchies, which affect intermediate determinants such as the environment, including food (strategic objectives 8 and 9) and individual factors such as behaviours (strategic objective 6).

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

• Strategic objectives 10 and 11: Health policies and systems need to include intersectoral action on health determinants. Coherent action on health inequities also depends on the availability of appropriately disaggregated health data and the capacity to analyse and use such data to develop policies and services that respond to the needs of different social groups and address structural factors.

Issues and challenges

Rapid changes occurring in the Region have the potential to greatly affect health outcomes. These changes include increased trade and globalization, the ageing of populations, and rapid urbanization due to rural-to-urban migration contributing to the rise of several mega-cities and urban poverty. At the same time, sparse populations and the isolation of far-flung communities are a challenge for health services, particularly in the Pacific and in countries and areas such as Mongolia. Demographic and ecological changes in the Region—such as increased population growth and mobility, urban crowding and poor sanitation, mass food production and global distribution, and increased exposure to animals and other disease vectors and reservoirs—favour the spread of communicable diseases. Many low-income countries and areas in the Region traditionally face a high burden of known communicable diseases such as TB, HIV/AIDS and malaria. Simultaneously, new and emerging diseases pose significant challenges for public health and economic development. Alongside these trends, the burden of noncommunicable disease conditions is increasing in the Region and has outpaced communicable diseases, including in many low-income countries and areas. These observed trends are largely due to lifestyle changes associated with developments in global trade and marketing, rural-to-urban migration, dietary shifts, and reduced physical activity. The Region also faces important challenges in the form of increasing inequalities in access to health services and in health outcomes. Weak or inefficient health systems particularly disadvantage poor communities and

households. Some progress has been made, but more can be achieved. Health must be recognized as central to the broader development agenda and to poverty reduction. In addition, countries and areas must ensure more equitable access to health services for all sections of the population and address financial or social barriers to access, including poverty, gender and ethnicity.

Strategic approaches

Strategic approaches for Member States: • Since social determinants of health are multisectoral, health must be positioned as a common goal across sectors and addressed in national development strategies. • Ensure coordinated integration of gender, poverty, ethics, and human rights-based perspectives into the design, implementation and monitoring of health policies, programmes and actions. • Increase fairness, responsiveness, accountability and coherence by following the principles of human rights and ethics.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

Strategic approaches for the WHO Secretariat: • Provide technical and policy support to Member States to strengthen their systems and capacity to collect, analyse and use health-related data and information that are disaggregated, and to develop, implement and monitor health policies based on a government-wide approach to health. • Support technical programmes to incorporate equity-enhancing, pro-poor, gender-responsive, and human rights-based approaches, by developing tools, enlarging the knowledge base, strengthening capacity and promoting coherent strategies. • Use the recommendations of the Commission on Social Determinants of Health to support Member States to initiate policy actions on the underlying causes of health inequities. Collaborate with other United Nations agencies and programmes, multilateral and bilateral partners, civil society and the non-state sector in these efforts.

ORGANIZATIONWIDE EXPECTED RESULT 07.001

Significance of social and economic determinants of health recognized throughout the Organization and incorporated into normative work and technical collaboration with Member States and other partners.

REGIONAL EXPECTED RESULT

Support provided to strengthen the capacity of the Organization and Member States to reduce health inequities, address socioeconomic determinants of health and promote more equitable and pro-poor policies, programmes and interventions.

07.001.WP01

REGIONAL INDICATORS

07.001.WP01.01 Number of countries and areas supported within the biennium to adopt effective tools, methods and strategies for action.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Increased attention to health equity and to addressing the socioeconomic determinants of health is needed. Capacities of Member States and technical programmes within WHO in this regard need to be strengthened.

ORGANIZATIONWIDE EXPECTED RESULT 07.002

Initiative taken by WHO in providing opportunities and means for intersectoral collaboration at national and international levels to address social and economic determinants of health, including understanding and acting upon the public health implications of trade and trade agreements, and to encourage poverty-reduction and sustainable development.

REGIONAL

Opportunities created and mechanisms used to facilitate action across sectors to reduce health

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

EXPECTED RESULT

inequities and address the socioeconomic determinants of health.

07.002.WP01

REGIONAL INDICATORS

07.002.WP01.01 Extent of action across sectors to reduce health inequities, measured by (proxy indicator) number of countries and areas whose health policies within the biennium target the social and economic determinants of health on an intersectoral basis, including through actions on trade and health.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Actions across sectors are needed to address the social determinants of health and improve health equity.

ORGANIZATIONWIDE EXPECTED RESULT 07.002

REGIONAL EXPECTED RESULT

Opportunities created and mechanisms used to facilitate action across sectors to address the socioeconomic determinants of health in specific settings (e.g. urban setting).

07.002.WP02

REGIONAL INDICATORS

07.002.WP02.01 Number of countries and areas receiving technical support within the biennium from WHO.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Actions across sectors are needed to address the social determinants of health and improve health equity.

ORGANIZATIONWIDE EXPECTED RESULT 07.003

Social and economic data relevant to health collected, collated and analysed on a disaggregated basis (by sex, age, ethnicity, income, and health conditions, such as disease or disability).

REGIONAL EXPECTED RESULT

Support provided to strengthen country capacity to collect, analyse and use information on health and social determinants that is disaggregated by various relevant indicators of social exclusion,

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

07.003.WP01

such as sex, age, ethnicity, income and location.

REGIONAL INDICATORS

07.003.WP01.01 Number of countries and areas supported within the biennium to analyse and use information on health and social determinants that is disaggregated by various relevant indicators of social exclusion.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Appropriate policy analysis and action on health equity depends on the availability of information that is disaggregated by the needed and relevant indicators of social exclusion.

ORGANIZATIONWIDE EXPECTED RESULT 07.004

Ethics- and rights-based approaches to health promoted within WHO and at national and global levels.

REGIONAL EXPECTED RESULT

Support provided to strengthen the capacity of the Organization and Member States to promote ethics- and human-rights based approaches to health.

07.004.WP01

REGIONAL INDICATORS

07.004.WP01.01 Number of countries and areas supported within the biennium to adopt effective tools, methods and strategies for action.

07.004.WP01.02 Number of technical programmes supported within the biennium to adopt effective tools, methods and strategies for action.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Increased attention to recognizing health as a human right and to adopting ethics- and humanrights-based approaches in health is needed. Capacities of countries and areas and technical programmes in this regard need to be strengthened.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

ORGANIZATIONWIDE EXPECTED RESULT 07.005

Gender analysis and responsive actions incorporated into WHO’s normative work and support provided to Member States for formulation of gender-responsive policies and programmes.

REGIONAL EXPECTED RESULT

Support provided to strengthen the capacity of the Organization and Member States to promote more gender-responsive health policies, programmes and interventions.

07.005.WP01

REGIONAL INDICATORS

07.005.WP01.01 Number of countries and areas supported within the biennium to adopt effective tools, methods and strategies for action.

07.005.WP01.02 Number of technical programmes supported within the biennium to adopt effective tools, methods and strategies for action.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY 2013

JUSTIFICATION

Increased attention to gender issues in health is needed in public health policy. Capacities of countries and areas and technical programmes in this regard need to be strengthened. Gender mainstreaming is an Organizational goal. The work under this regional expected result will be carried out in countries and areas in collaboration with technical units in regional and country offices.

ORGANIZATIONWIDE EXPECTED RESULT 07.005

Gender analysis and responsive actions incorporated into WHO’s normative work and support provided to Member States for formulation of gender-responsive policies and programmes.

REGIONAL EXPECTED RESULT

Support provided to build capacity of Member States to implement the Strategy for Integrating Gender Analysis and Actions into the Work of WHO, including support for Member States to mainstream gender and rights into reproductive, women, maternal and child health.

07.005.WP02

REGIONAL INDICATORS

07.005.WP02.01 Number of countries and areas supported within the biennium.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Increased attention to gender issues in health is needed. Capacities of countries and areas and technical programmes in this regard need to be strengthened. Gender mainstreaming is an

REGIONAL STRATEGIC OBJECTIVE STATEMENT 7

Organizational goal.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

STRATEGIC OBJECTIVE 8

To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health.

Scope

This work under this strategic objective focuses on the reduction of broad range of traditional, modern and emerging hazards to health and the environment. The work will encourage strong health-sector leadership for primary prevention of disease through environmental management and impart strategic direction and guidance to partners in non-health sectors for ensuring that their policies and investments also benefit health. Work will focus on the assessment and management of environmental and occupational health hazards, such as unsafe water and inadequate sanitation, indoor air pollution and solid fuel use, and vector transmission of diseases. Its scope also covers: health risks related to change in the global environment (e.g. climate change and biodiversity loss); development of new products and technologies (e.g. nanotechnology); consumption and production of energy from new sources and the increasing number and use of chemicals; and health risks related to changes in lifestyle, urbanization and working conditions (e.g. deregulation of labour, an expanding informal sector and export of hazardous working practices to poor countries).

Regional indicators and targets

• Proportion of countries and areas achieving reductions in environmental risks that significantly impact health in the Region, including an increase in the proportion of urban and rural populations with access to improved water sources and improved sanitation and a decline in the proportion of the population using solid fuels: 75% by 2013. • Number of national and regional processes and mechanisms that are put in place to reduce environmental health risks within different sectors (e.g. environment, transport, energy and agriculture) and development initiatives (e.g. poverty-reduction strategies): 20 by 2013. • Proportion of countries and areas taking action to ratify, implement and enforce international agreements related to health and environment (e.g. Stockholm Convention on Persistent Organic Pollutants, Rotterdam Convention, Kyoto Protocol: 90% by 2013. • Proportion of countries and areas with strengthened capacity for environmental and occupational health policy-making and service delivery: 75% by 2013.

Links with other strategic objectives

• Strategic objective 5: Preparedness and response to environmental health emergencies, crucial to achieving strategic objective 8, are linked with other aspects of emergency response. • Strategic objective 1: Strengthening health systems capacities to adapt to the health impacts of climate change, through enhanced early warning and strengthened communicable disease response capacities, will contribute to reducing vulnerability to public health security threats and will help reduce the potential health, social and economic impacts of climate change affected communicable diseases. • Strategic objectives 2 to 4: Given that eliminating environmental hazards to health can prevent up to a quarter

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

of the global burden of disease, work will contribute especially to the reduction in disease burden among children (strategic objective 4), from vectorborne diseases (strategic objective 2) and from noncommunicable diseases (strategic objective 3). • Strategic objective 10: Occupational and environmental health services are a key part of the preventive function of health services. • Strategic objectives 5, 6, 7, 9 and 12: Influencing sectors of the economy to reduce risks and promote health through their investments and policy decisions is essential in terms of work on determinants of health (strategic objectives 5, 6, 7 and 9) and for establishing partnerships to advance the global health agenda (strategic objective 12).

Issues and challenges

The Western Pacific Region includes some of the world's most rapidly developing countries, as well as developed and less developed countries. While traditional environmental health risks are still prevalent in less developed countries, rapidly developing countries face the challenge of more modern environmental and occupational risks. Emerging environmental risks, such as climate change, can affect any country. In some instances, these

environmental risks affect the health and safety of people beyond national borders, requiring concerted efforts of the countries involved. In 2002, an estimated 2.9 million deaths, or one quarter of the total deaths in the Region, were attributable to environmental and occupational health risks. Agenda 21, the Millennium Development Goals, the Johannesburg Plan of Implementation and a number of other international conventions and standards related to health, labour and the environment provide the international framework, goals, targets and strategies for action to reduce environmental and occupational health risks. Member States and the WHO Secretariat need to enhance health sector input to ensure that health issues are effectively incorporated into formulation and implementation of these international agreements. Many developing countries and areas, however, have limited resources and capacity in environmental and occupational health risk assessment and management to develop and implement national and local action plans and to provide input to international agreements on health and the environment. Also, in many countries and areas, multisectoral coordination to reduce environmental and occupational health risks is not always effective. In addition to responding to these country-specific needs, resolution WPR/RC56.R7 endorsed at the fifty-sixth session of the Regional Committee for the Western Pacific in 2005 encourages increased intercountry cooperation to share solutions to common environmental health problems and to harmonize policies to address trans-boundary and global environmental health issues.

Strategic approaches

Strategic approaches for Member States: • Provide evidence that will lead to action to reduce priority environmental health risks; develop and apply norms and guidance on priority environmental health risks; implement interventions to reduce these risks; and provide health input to international agreements related to environmental health.

• Prepare for and respond to environmental emergencies and disasters; and support environmental health

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

assessments and management in emergencies, conflicts and disasters, focusing on prevention, preparedness, response and planning for post-emergency reconstruction. • Focus primary prevention action through healthy settings approaches; and lead integrated primary prevention action to reduce environmental health risks in specific human settings (e.g. urban and rural areas, workplaces, or in specific ecosystems). • Assess and manage environmental and occupational health risks; upgrade the institutional and technical capacity for assessing environmental and occupational health risks; strengthen the capacity to develop occupational and environmental health policies; and deliver services to implement the policies. • Provide health leadership on national environment and sectoral policies; and advocate and establish partnerships for multisectoral actions and integrated policies that reduce health risks and promote development frameworks and strategies that benefit health. • Identify and respond to potential health impacts of climate change and other emerging threats; and facilitate and promote the development, sharing and use of knowledge, research, innovation and education about emerging environmental and occupational risks to health and equitable solutions among different stakeholders. Strategic approaches for the WHO Secretariat: • Provide technical guidance and leadership. • Enhance collaboration with other WHO regional offices, relevant United Nations agencies and regional partners. • Promote cooperation among Member States.

ORGANIZATIONWIDE EXPECTED RESULT 08.001

Evidence-based assessments made, and norms and standards formulated and updated on major environmental hazards to health (e.g. poor air quality, chemical substances, electromagnetic fields, radon, poor-quality drinking-water and waste-water reuse).

REGIONAL EXPECTED RESULT

Evidence-based assessments made, and norms and standards formulated and updated on major environmental hazards to health (e.g. poor air quality, chemical substances, electromagnetic force, radon, poor-quality drinking water and waste-water reuse).

08.001.WP01

REGIONAL INDICATORS

08.001.WP01.01 Number of Member States that have conducted assessments of specific environmental threats to health or have quantified the environmental burden of disease with WHO technical support during the biennium.

08.001.WP01.02 Number of new or updated norms, standards or guidelines on occupational or environmental health issues developed during the biennium.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

There is a need to strengthen national capacity to undertake health impact assessments of environmental threats, as well as develop and update the evidence-based norms and standards on priority environmental health hazards, particularly in target developing countries and areas of the Region.

ORGANIZATIONWIDE EXPECTED RESULT 08.002

Technical support and guidance provided to Member States for the implementation of primary prevention interventions that reduce environmental hazards to health, enhance safety and promote public health, including in specific settings (e.g. workplaces, homes or urban settings) and among vulnerable population groups (e.g. children).

REGIONAL EXPECTED RESULT

Technical support and guidance provided to countries and areas for the implementation of primary prevention interventions that reduce environmental hazards to health, enhance safety and promote public health, including in specific settings and among vulnerable population groups.

08.002.WP01

REGIONAL INDICATORS

08.002.WP01.01 Number of Member States implementing primary prevention interventions for reducing environmental risks to health, with WHO technical support, in at least one of the following settings: workplaces, homes or urban settings.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The healthy settings approach is widely used and many countries and areas implement various healthy settings activities. In target developing countries and areas, environmental determinants of health are major factors in these settings, and there is a need to organize national initiatives. Similarly, the environmental burden of disease is high for children and other vulnerable population groups in developing countries, and national policies or programmes are needed in these target countries.

ORGANIZATIONWIDE EXPECTED RESULT 08.003

Technical assistance and support provided to Member States for strengthening national occupational and environmental health risk management systems, functions and services.

REGIONAL EXPECTED RESULT

Technical assistance and support provided to Member States for strengthening national occupational and environmental health risk management systems, functions and services.

08.003.WP01

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

REGIONAL INDICATORS

08.003.WP01.01 Number of Member States that have implemented national action plans and/or policies for the management of occupational and environmental health risks with support from WHO.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The health sector's ability to address environmental and occupational health risks is limited. There is a need to increase and maintain effective multisectoral and intersectoral coordination and collaboration, particularly with environmental and labour sectors, in developing and implementing environmental and occupational health policies, plans and service delivery.

ORGANIZATIONWIDE EXPECTED RESULT 08.004

Guidance, tools and initiatives created in order to support the health sector in influencing policies in other sectors to allow policies that improve health, the environment and safety to be identified and adopted.

REGIONAL EXPECTED RESULT

Guidance, tools, and initiatives created in order to support the health sector in influencing policies in other sectors to allow policies that improve health, environment and safety to be identified and adopted.

08.004.WP01

REGIONAL INDICATORS

08.004.WP01.01 Number of Member States that have implemented health-related policies and/or frameworks in other sectors, with technical support from WHO, during the biennium.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Environmental determinants of health are often controlled and influenced by other sectors (e.g. agriculture, transport and energy). There is a need for the health sector to increase advocacy for and provide inputs to healthier and safer policies of these other sectors.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

ORGANIZATIONWIDE EXPECTED RESULT 08.005

Health-sector leadership enhanced for creating a healthier environment and changing policies in all sectors so as to tackle the root causes of environmental threats to health, through means such as responding to emerging and re-emerging consequences of development on environmental health and altered patterns of consumption and production and to the damaging effect of evolving technologies.

REGIONAL EXPECTED RESULT

Health-sector leadership enhanced for creating a healthier environment and changing policies in all sectors in order to tackle the root causes of environmental threats to health, through means such as responding to emerging and re-emerging consequences of development on environmental health and altered patterns of consumption and production and to the damaging effect of evolving technologies.

08.005.WP01

REGIONAL INDICATORS

08.005.WP01.01 Number of studies or reports on new or re-emerging occupational and environmental health issues published or co-published by WHO.

08.005.WP01.02 Number of reports published or jointly published by WHO on progress made in achieving water and sanitation objectives of major international development frameworks, such as the Millennium Development Goals

08.005.WP01.03 Number of high-level forums on environmental and/or occupational health that have been organized or technically supported by WHO biennially.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Environmental and occupational conditions and associated health risks are constantly changing with social and economic development, technological advance, and production and consumption patterns. The health sector needs to enhance its leadership to address health implications of these emerging and evolving issues.

ORGANIZATIONWIDE EXPECTED RESULT 08.006

Evidence-based policies, strategies and recommendations developed, and technical support provided to Member States for identifying, preventing and tackling public health problems resulting from climate change.

REGIONAL EXPECTED RESULT

08.006.WP01

REGIONAL STRATEGIC OBJECTIVE STATEMENT 8

REGIONAL INDICATORS

08.006.WP01.01 Number of studies or reports on the public health effects of climate change published or co-published by WHO.

08.006.WP01.02 Number of countries that have implemented plans to enable the health sector to adapt to the health effects of climate change.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

There is a scientific consensus that global warming is taking place, and if no adaptation to changing climate is made, there will be negative impacts on human health. There is a need for the health sector to take the lead on climate change and health; develop strategies and action plans to adapt to the effects of climate change; and strengthen surveillance, early warning and response systems to reduce the health impacts of climate change.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

STRATEGIC OBJECTIVE 9

To improve nutrition, food safety and food security, throughout the life-course, and in support of public health and sustainable development.

Scope

Work under this strategic objective focuses on: nutritional quality and safety of foods; promotion of healthy dietary practices throughout the life-course, starting with pregnant women, breastfeeding and adequate complementary feeding, and considering diet-related chronic diseases; prevention and control of nutritional disorders, including micronutrient deficiencies, especially among biologically and socially vulnerable groups, with emphasis on emergencies, and in the context of HIV/AIDS epidemics; prevention and control of zoonotic and non-zoonotic foodborne diseases; stimulation of intersectoral actions promoting the production and consumption of, and access to, food of adequate quality and safety; and promotion of higher levels of investment in nutrition, food safety and food security at the global, regional and national levels.

Regional indicators and targets

• Proportion of countries and areas providing data that demonstrate a reduction in the proportion of underweight children of all ages: 25% by 2013. • Proportion of countries and areas providing data that demonstrate a reduction in proportion of overweight children of all ages: 25% by 2013. • Proportion of countries and areas providing data that demonstrate a reduction in the number of annual cases of foodborne illness, including diarrhoeal diseases: 25% by 2013.

Links with other strategic objectives

Achievement of the strategic objective requires strong links and effective collaboration with other strategic objectives, in particular: • Strategic objective 1: in relation to prevention of zoonoses and foodborne diseases; • Strategic objective 2: especially in expanding and improving interventions related to HIV/AIDS prevention, treatment, care and support; • Strategic objective 4: in relation to public-health interventions for maternal, newborn, child and adolescent health; • Strategic objective 5: in relation to minimizing the impact of emergency situations on the nutritional status of populations; • Strategic objective 6: in relation to promotion of healthy dietary practices throughout the life-course; • Strategic objective 8: in relation to environmental health risks.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

Issues and challenges

Nutrition, food safety and food security are cross-cutting issues that affect people throughout their lives. They apply equally to stable and crisis situations and should be addressed also in the context of the HIV/AIDS epidemics. In the Western Pacific Region, 2100 children under 5 years of age die each day as a result of common preventable and treatable conditions including diarrhoea, pneumonia and perinatal events. About half of these deaths could be prevented if the nutritional status of these children was good and if foodborne and waterborne diseases could be prevented and properly treated. Hundred of millions of cases of foodborne and zoonotic diseases, many of which are fatal or lead to severe sequelae, affect both adults and children each year. Hundred of millions of people suffer damage, sometimes irreversible, from micronutrient deficiencies, especially of iron, iodine, zinc and vitamin A. Undernutrition is still a major threat to health and well-being in middle- and low-income countries and areas. At the same time, obesity is increasingly becoming a major public health problem, even in low-income countries and areas, for adults and even in children. Hundred of millions of adults are overweight or obese in the Region, with some of the highest rates of obesity and diabetes in the world seen in Pacific island countries and areas. Undernutrition and overnutrition are still perceived as separate problems. However, both are often rooted in poverty and coexist in communities, and even the same households, in most countries and areas; undernutrition in utero and in the early years of childhood can increase the likelihood of obesity and related noncommunicable diseases later in life. Access to safe food and adequate nutrition are fundamental human rights essential for health and development and necessary to achieve the Millennium Development Goals. The major obstacle to the achievement of this strategic objective is the current low level of investment, both in human resources and in funding, and the lack of leadership for the development and implementation of integrated policies and effective interventions. Despite the impact of malnutrition in all its forms on mortality, morbidity and national economies, only 1.8% of the total resources for health-related development assistance are allocated to nutrition activities. At the country level, the financial commitment is even less. Stagnant investment at all levels will seriously compromise the achievement of goals throughout the Organization. For both malnutrition and unsafe food, individual behaviour plays a role but efficient preventive systems and a supportive environment are essential for ensuring the public's ability to make informed choices.

Strategic approaches

Strategic approaches for Member States: • Make nutrition, food safety and food security central to national development policies and to agricultural development and food production processes. • Focus on the most biologically and socially vulnerable populations. • Mobilize local human and financial resources to implement such policies. • Ensure a human rights and gender perspective in all nutrition, food-safety and food-security planning and policies.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

• Identify beliefs and practices that promote and hinder good nutrition and food safety and develop and implement ethically and culturally acceptable essential interventions. • Scale up access to the essential interventions, build synergies, avoid duplication and strengthen links between programmes at the service delivery level. • Promote improved understanding at the individual, household and community levels about the role of good nutrition, healthy eating practices and food safety to overall health and well-being, with particular focus on the nutritional values of available local foods. • Promote interactions between health, environment and development actors to ensure safe and sustainable agricultural production methods that minimize occupational risk to health and maximize long-term health in terms of nutrition, food safety and food security. • Ensure supportive regulatory and legal frameworks, based as appropriate on existing international regulations and mechanisms. • Participate in international food standards-setting processes, including FAO/WHO Codex Alimentarius. • Work with actors in food production, manufacturing and distribution to improve the availability of healthier foods, promote a balanced diet and ensure compliance with the International Code of Marketing of Breast Milk Substitutes. • Develop and implement control programmes for foodborne diseases. • Strengthen national capacity for the generation of evidence through surveillance and research. Strategic approaches for the WHO Secretariat: • Build partnerships and provide leadership. • Develop norms, standards and knowledge. • Promote the integration of actions and approaches. • Provide policy development and technical support. • Support capacity-building. • Strengthen food control systems.

ORGANIZATIONWIDE EXPECTED RESULT 09.001

Partnerships and alliances formed, leadership built and coordination and networking developed with all stakeholders at country, regional and global levels, in order to promote advocacy and communication, stimulate intersectoral actions, increase investment in nutrition, food-safety and food-security interventions, and develop and support a research agenda.

REGIONAL EXPECTED RESULT

Partnerships formed and support provided to countries and areas to increase political, financial and technical commitment to addressing nutrition, food safety and food security through intersectoral action.

09.001.WP01

REGIONAL INDICATORS

09.001.WP01.01 Number of countries and areas able to demonstrate that nutrition, food safety and food security

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

are addressed intersectorally in an integrated manner in national policies, plans of action and funding.

BASELINE

TARGETS TO BE ACHIEVED IN

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The major obstacle to the achievement of this strategic objective is the current low level of investment, both in human resources and in funding, and the lack of leadership for the development and implementation of integrated policies and effective interventions. Effective advocacy and communication tools and funding mechanisms must be applied to develop and sustain programmes.

ORGANIZATIONWIDE EXPECTED RESULT 09.002

Norms, including references, requirements, research priorities, guidelines, training manuals and standards, produced and disseminated to Member States in order to increase their capacity to assess and respond to all forms of malnutrition, and zoonotic and non-zoonotic foodborne diseases, and to promote healthy dietary practices.

REGIONAL EXPECTED RESULT

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

09.002.WP01

REGIONAL INDICATORS

09.002.WP01.01 Number of countries and areas where costeffectiveness has been demonstrated in relation to nutrition programmes and/or where normative food safety guidance has been initiated and evaluated.

09.002.WP01.02 Number of new guidance documents or manuals developed, adapted where appropriate and disseminated, to enable countries and areas to implement costeffective interventions responding to all forms of malnutrition and foodborne diseases, and to promote healthy dietary practices in the Western Pacific.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

JUSTIFICATION

Resources will be used to support projects aimed at showing costs-effectiveness of interventions. This will include training and workshops to refine methodology, pilot projects and compilation of results at national and regional levels, building on existing tools, methods and best practice documents and focused dissemination strategies. Resources will also be used to inform policymakers at country level and to assist them with using this information for priority setting.

ORGANIZATIONWIDE EXPECTED RESULT 09.003

Monitoring and surveillance of needs and assessment and evaluation of responses in the area of nutrition and diet-related chronic diseases strengthened, and ability to identify best policy options improved, in stable and emergency situations.

REGIONAL EXPECTED RESULT

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

09.003.WP01

REGIONAL INDICATORS

09.003.WP01.01 Number of countries and areas that have adopted and implemented the WHO Child Growth Standards.

09.003.WP01.02 Number of countries and areas conducting periodic nutrition surveys and using these results as a basis for planning interventions to improve the nutrition situation.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Information on the prevalence, distribution and causes of nutrition-related diseases is essential for advocacy and for planning, monitoring and evaluation of nutrition programmes. Resources will be used to support countries and areas to better document the public health impact and costs of nutrition problems, i.e. to set up or improve data collection systems, support data analysis and dissemination. Resources will also be used to monitor and provide feedback on regional trends.

ORGANIZATIONWIDE EXPECTED RESULT 09.004

Capacity built and support provided to target Member States for the development, strengthening and implementation of nutrition plans, policies and programmes aimed at improving nutrition throughout the life-course, in stable and emergency situations.

REGIONAL EXPECTED RESULT

09.004.WP01

REGIONAL INDICATORS

09.004.WP01.01

09.004.WP01.02

09.004.WP01.03

09.004.WP01.04

09.004.WP01.05

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

Number of targeted countries that have developed and implemented at least three highpriority actions recommended by the Global Strategy for Infant and Young Child Feeding.

Number of countries that have developed and implemented strategies to prevent and control micronutrient malnutrition.

Number of countries that have developed and implemented strategies to promote healthy dietary practices in order to prevent dietrelated chronic disease.

Number of countries that have included nutrition in their responses to HIV/AIDS and other epidemics.

Number of countries that have strengthened national preparedness and response to nutritional emergencies.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The majority of countries and areas in the Region have developed national plan of action on nutrition or related policies, but only a few conduct regular reviews of the implementation and achievements of these plans and have sustained funding for programmes. The resources will be used to support regional and country processes to advance development and implementation of policies and plans, building on the successful experience of the training course on NPAN implementation in the Pacific.

ORGANIZATIONWIDE EXPECTED RESULT 09.005

Systems for surveillance, prevention and control of zoonotic and non-zoonotic foodborne diseases strengthened; food-hazard monitoring and evaluation programmes established and integrated into existing national surveillance systems, and results disseminated to all key players.

REGIONAL EXPECTED RESULT

Foodborne disease surveillance and food contamination monitoring programmes strengthened regionally and in targeted countries and areas.

09.005.WP01

REGIONAL INDICATORS

09.005.WP01.01 Number of targeted countries and areas that

09.005.WP01.02 A surveillance and monitoring network in the

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

have initiated action on foodborne disease surveillance and food contamination monitoring as defined by reports available to WHO.

Region has been set up.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Data collected from the foodborne disease surveillance and food contamination monitoring programmes can better direct food control strategies and actions in countries and areas of the Region.

ORGANIZATIONWIDE EXPECTED RESULT 09.006

Capacity built and support provided to Member States, including their participation in international standard-setting in order to increase their ability to assess risk in the areas of zoonotic and nonzoonotic foodborne diseases and food safety, and to develop and implement national food-control systems, with links to international emergency systems.

REGIONAL EXPECTED RESULT

National capacity built to enable countries and areas to set up food-control systems based on risk-analysis principles, implement effective food-safety education, and operate food-safety emergency response systems with links to international systems.

09.006.WP01

REGIONAL INDICATORS

09.006.WP01.01 Number of countries and areas that have revised their laws, regulations or standards such that they are more in line with Codex and/or FAO/WHO guidance.

09.006.WP01.02 Number of countries and areas that have introduced guidance on, and are initiating action on, risk-based food-inspection practices.

09.006.WP01.03 Number of countries and areas that have included WHO's "Five Keys to Safer Food" in their school curriculum or other national area of work.

09.006.WP01.04 Number of countries and areas that have initiated action to introduce food emergency response systems and have strengthened their INFOSAN networks.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

REGIONAL STRATEGIC OBJECTIVE STATEMENT 9

JUSTIFICATION

To enhance food safety in the Region, effective food-control systems need to be set up (1) with modern laws, regulations and standards; (2) based on risk analysis principles; (3) with effective food-safety education; and (4) with appropriate food emergency response protocols. The foodcontrol systems also need to be enforced by competent authorities.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

STRATEGIC OBJECTIVE 10

To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research.

Scope

The work under this objective aims to improve management and organization of health service delivery, reflecting the principles of integrated primary health care, so as to scale up coverage, equity and quality of health services and improve health outcomes. The work will improve national capacities for governance and leadership, improve the various mechanisms for coordination (including donor assistance) that support Member States in their efforts to achieve national targets. Work will contribute to strengthened country health-information systems, and will contribute to better knowledge and evidence for health decision-making. This will include global and regional work on generation, comparative analysis and synthesis of health statistics and evidence from research. Work will strengthen national health research knowledge management and e-health policies for health-systems development. The health workforce information and knowledge base will be strengthened and technical support to Member States will be provided to improve the production, distribution, skill mix and retention of their health workforce. Health systems financing will be improved through evidence-based policy, norms, standards and related measurement tools, and technical support, resulting in higher availability of funds, social and financial risk protection, equity, and better access to services and efficiency of resource use. Steps will also be taken to advocate for additional funds for health where necessary.

Regional indicators and targets

• Expanded coverage of key interventions including quality measures. • Evidence of improved performance of governance and regulatory systems. • Improved information on health workforce and increased number of countries and areas with health workforce strategic planning processes in place. • Increases in health research funding focused on priority problems for individual countries and areas. • Increased availability and use of sound health statistics and evidence. • Increased health care funding available, out-of-pocket payment for health care reduced, smaller numbers of people impoverished from catastrophic expenditure, and improved information on health care financing. • Increased number of countries and areas implementing knowledge management.

Links with other strategic objectives

• All strategic objectives concerned with the achievement of specific health outcomes, primarily strategic objectives 1 to 4. • All health- and disease-related strategic objectives: the work provides a platform for close collaboration with the evidence component. • Strategic objective 5: complementing the specific circumstances of service delivery in fragile states.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

• Strategic objective 7: particularly in relation to equity, pro-poor health policies and the progressive realization of the right to health – the work translates achievements in those areas into service delivery. • Strategic objective 11: essential drugs and health technology are essential parts of a health system. • Strategic objective 12: particularly work on providing leadership, strengthening governance and encouraging partnerships and collaboration in engagement with countries and areas.

Issues and challenges

The changing role of ministries of health due to public sector reforms, globalization and increasing privatization is an issue. The capacity to handle a more complex environment calls for different skills in leadership, management and regulation, so-called stewardship, while not neglecting the basic role of health service organization, financing and delivery, which in many states is still a major role of government. In some countries and areas, the

complexity of donor assistance provides an additional challenge as it has contributed to an increasingly fragmented health sector. Within the United Nations system, joint planning and programming is attempting to address this issue. The knowledge base and dissemination mechanism to manage the health sector, based on research and evidence, is inadequate. Information and evidence may not be available to those who need it. When it is

available, it may not be appropriate to individual country or area needs or may not be accurate and timely. And, when information and evidence is available and appropriate, it may not be used by decision-makers. The health workforce is often typified by one or all of the following: shortages, maldistribution, inappropriate skill mix, low quality, excessive migration, low salaries and remuneration packages, poor working environments, and inadequate supervision. Often there is a lack of sufficient information on human resources for health and

inadequate processes for comprehensive health workforce planning. Health care financing is typified by too little spending in some countries and areas, misallocation of expenditure so that health gain is not maximized, excessive reliance on out-of-pocket payments, and the lack of social safety nets to protect against catastrophic expenditure. The information base to analyse and manage health care financing is improving but is still inadequate.

Strategic approaches

Strategic approaches for Member States: • Develop and maintain integrated and comprehensive health systems based on primary health care principles with a focus on equity, efficiency, accountability, quality, and patient safety. • Develop improved mechanisms for working with partners both external and internal, including participation in United Nations reform. • Strengthen systems for policy formulation, organization, management, planning and governance, emphasizing the use of information and evidence for decision-making. • Ensure adequate financial resources through appropriate funding mechanisms. • Ensure an adequate, competent, productive, equitably distributed and supported health workforce.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

Strategic approaches for WHO Secretariat: • Maintain a country and area approach and ensure technical expertise supports national counterparts national plans and policies within internationally established norms and standards to the degree possible. • Assist in building national health systems that meet national needs as well as international norms and standards where practicable. • Facilitate establishing mechanisms to ensure that health system needs are identified and prioritized comprehensively and assist in building capacity for managing all aspects of health systems within countries and areas. • Develop partnerships at international, regional, national and subnational levels to define and reach common goals in a more efficient and cost-effective manner in line with the principles of alignment and harmonization. and

ORGANIZATIONWIDE EXPECTED RESULT 10.001

Management and organization of integrated, population-based health-service delivery through public and nonpublic providers and networks improved, reflecting the primary health care strategy, scaling up coverage, equity, quality and safety of personal and population-based health services, and enhancing health outcomes.

REGIONAL EXPECTED RESULT

Improved management and organization of health service delivery, through both public and nonpublic providers and networks, reflecting the principles of integrated primary health care with increased coverage, equity and quality of health services leading to better health outcomes.

10.001.WP01

REGIONAL INDICATORS

10.001.WP01.01 Number of countries and areas provided technical assistance for improving coverage, access and quality of health services to be measured through an agreed set of composite indicators over a range of interventions.

10.001.WP01.02 Number of countries and areas with plans and actions for embedding sustainable diseasespecific programmes within general health services to increase sustainability and effectiveness.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The management and organization of health services is a crucial factor in health outcomes. It is a complex issue and must be approached in a manner appropriate to each individual country or area within the context of its political, socioeconomic and cultural frameworks. However, composite indicators can be used across countries and areas to assess progress in improving management and organization of health services. The disease-specific programmes have brought needed resources to the health sector and have improved outcomes for their particular

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

area of interest, but the sustainability of these programmes is at risk with any decrease in funding. Unless such programmes become more fully embedded in the health sector, there is a risk of increased fragmentation of the health sector with an attendant loss of efficiency and effectiveness.

ORGANIZATIONWIDE EXPECTED RESULT 10.002

National capacities for governance and leadership improved through evidence-based policy dialogue, institutional capacity-building for policy analysis and development, strategy-based health system performance assessment, greater transparency and accountability for performance, and more effective intersectoral collaboration.

REGIONAL EXPECTED RESULT

Improved national capacities and practices for governing, steering and regulating the health sector through (1) evidence-based policy dialogue, (2) policy analysis, (3) greater transparency and accountability for performance, and (4) more effective intersectoral collaboration.

10.002.WP01

REGIONAL INDICATORS

10.002.WP01.01 Number of countries and areas provided technical assistance to improve institutional capacity for policy analysis and formation, for strategic planning, and for regulation.

10.002.WP01.02 Number of countries and areas provided technical assistance to improve accountability for performance and increased participation of civil society, community, consumers, and professional organizations in shaping policy and its implementation.

10.002.WP01.03 Number of countries and areas that received technical assistance and used it to make revisions or changes in law, regulation, policy formulation, and policy implementation.

10.002.WP01.04 Number of countries and areas provided technical assistance to assess or establish effective intersectoral collaboration mechanisms, including the private sector, to improve health systems performance for improved health outcomes.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Although individual actions are necessary within Member States, certain principles in governance and leadership are well established and can be fostered by WHO. Progress will be assessed in an objective way using country- or region- specific benchmarks. Areas to be assessed include service delivery models; essential public health functions; policies concerning pharmaceuticals, infrastructure, and health technologies; human resources policies; financing policies; and policies

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

coordinating the contributions of all major stakeholders. Assessment will include the use of evidence, accountability, participation, and collaboration. As WHO’s capacity to provide support grows, it is likely that demand for such capacity-building will grow and the level of support will need to increase.

ORGANIZATIONWIDE EXPECTED RESULT 10.003

Coordination of the various mechanisms (including donor assistance) that provide support to Member States in their efforts to achieve national targets for health-system development and global health goals improved.

REGIONAL EXPECTED RESULT

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

10.003.WP01

REGIONAL INDICATORS

10.003.WP01.01 Number of countries and areas that have harmonized the inputs of major stakeholders and aligned them with national policies in line with the Paris Declaration.

10.003.WP01.02 Number of countries and areas that have documented the methods of coordination of inputs from the multiple stakeholders in the health sector, including donors.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

The diverse set of inputs into the health sector can lead to fragmentation and inefficiency. This decreases the chance of reaching national, regional and worldwide health targets such as the MDG. Partner coordination is one of the primary stewardship roles of governments and WHO must support the ministry of health in taking a lead on these issues in the health sector. Increasing compliance with the Paris Declaration on Aid Effectiveness will change how donors, including WHO, interact with countries and areas.

ORGANIZATIONWIDE EXPECTED RESULT 10.004

Country health-information systems that provide and use high-quality and timely information for health planning and for monitoring progress towards national and major international goals strengthened.

REGIONAL EXPECTED RESULT

Strengthened country health information systems that provide and use high-quality and timely information for health planning and for monitoring of country and major international goals.

10.004.WP01

REGIONAL INDICATORS

10.004.WP01.01 Number of countries and areas that have developed national plans for health information systems and defined core health indicators to facilitate health monitoring and reporting.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

All countries and areas need a well-functioning health information system to support planning, management, monitoring and evaluation. The increasing demand for health information is likely to continue, and only through a major effort will health information systems become stronger.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

ORGANIZATIONWIDE EXPECTED RESULT 10.005

Better knowledge and evidence for health decision-making assured through consolidation and publication of existing evidence, facilitation of knowledge generation in priority areas, and global leadership in health research policy and coordination, including with regard to ethical conduct.

REGIONAL EXPECTED RESULT

Better knowledge and evidence for health decision-making, by consolidation and publication of existing evidence, facilitation of knowledge generation in priority areas and leadership in health research policy and coordination, including ensuring ethical conduct.

10.005.WP01

REGIONAL INDICATORS

10.005.WP01.01 Number of countries and areas that use the WHO database system of core health statistics and evidence that covers all priority issues.

10.005.WP01.02 Number of countries and areas in which the Regional Office for the Western Pacific plays a key role in supporting the generation and use of information and knowledge, including promotion of standards such as the International Classification of Disease.

10.005.WP01.03 Number of coordination and leadership mechanisms established and maintained at the regional level to improve knowledge and evidence for health-related decisionmaking.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

All countries and areas should have the capacity to create knowledge, to review and summarize available evidence, and to use available evidence in health policy-making and in health care management. WHO’s core function of contributing to better knowledge and evidence for health decision-making will expand modestly in this area, maintaining WHO’s position as a world and regional leader in monitoring the health situation.

ORGANIZATIONWIDE EXPECTED RESULT 10.006

National health research for development of health systems strengthened in the context of regional and international research and engagement of civil society.

REGIONAL EXPECTED RESULT

National health research for development of health systems strengthened in the context of regional and international research and engagement of civil society.

10.006.WP01

REGIONAL INDICATORS

10.006.WP01.01 Number of low- and middle-income countries and areas with national health research councils and functional health research

10.006.WP01.02 Number of countries and areas complying with the Mexico Summit commitment to dedicate 2% of national health budget to research and

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

systems.

research capacity-building.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

All Member States should have the capacity to produce locally relevant research and use the results for health planning, monitoring and evaluation. Overcoming the limitations of national health research for health systems development within the context of individual countries and areas and the Region is a major objective of this expected result.

ORGANIZATIONWIDE EXPECTED RESULT 10.007

Knowledge management and eHealth policies and strategies developed and implemented in order to strengthen health systems.

REGIONAL EXPECTED RESULT

Improved use of eHealth applications (such as electronic medical records and distance learning) and networking-including the network of WHO collaborating centres-to strengthen health systems.

10.007.WP01

REGIONAL INDICATORS

10.007.WP01.01 Number of countries and areas adopting knowledge management strategies to bridge the know-do gap.

10.007.WP01.02 Number of countries and areas with evidencebased eHealth frameworks and services.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

In all countries, policy-makers, health managers and the public should have access to scientific health information and knowledge.

ORGANIZATIONWIDE EXPECTED RESULT 10.007

Knowledge management and eHealth policies and strategies developed and implemented in order to strengthen health systems.

REGIONAL EXPECTED

Implementation of knowledge management strategy, including improved access to health

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

RESULT

information via portals such as the Global Health Library, Regional Index Medicus, and HINARI.

10.007.WP02

REGIONAL INDICATORS

10.007.WP02.01 Number of activities supported to improve access.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

WHO’s work in knowledge management, including policies and strategies to improve health care locally, regionally and worldwide by using information and communication technology (eHealth), will initially be largely normative, but will gradually shift to provision of support to countries and areas for implementation.

ORGANIZATIONWIDE EXPECTED RESULT 10.008

Health-workforce information and knowledge base strengthened, and country capacities for policy analysis, planning, implementation, information-sharing and research built up.

REGIONAL EXPECTED RESULT

Support provided to strengthen health-workforce information and knowledge base, build up the capacity of countries and areas for policy development and planning, and enhance research, networking and information-sharing.

10.008.WP01

REGIONAL INDICATORS

10.008.WP01.01 Number of countries and areas with a reliable health workforce database and information system that produces validated human resource development statistics and reports.

10.008.WP01.02 Number of countries and areas with updated human resources for health policies, guidelines and strategies that are being implemented, monitored and evaluated.

10.008.WP01.03 Number of countries and areas, and number partnerships and networks, engaged in research and the sharing of information, evidence and good practices.

BASELINE

TARGETS TO BE ACHIEVED BY 2009

At least 3 above the baseline.

At least 3 countries above the baseline and at least 1 partnership or network above the baseline.

TARGETS TO BE ACHIEVED BY

At least 6 above the baseline

At least 6 countries above the baseline at least 2 networks or partnerships above the baseline.

2011

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

TARGETS TO BE ACHIEVED BY

At least 8 above the baseline.

At least 8 countries and areas and 2 networks or partnerships above the baseline.

2013

JUSTIFICATION

The knowledge base in human resources for health (HRH) development needs to be further strengthened in many countries and areas. Areas such as assessment, planning, production, regulation and management of the health workforce need to be better understood. Aspects of health workforce development and management cut across domains of various organizational systems, functions and sectors (such as education, finance, training institutions, regulatory bodies, private sector, labour and immigration), so they cannot be dealt with by the health sector alone. Besides, many developing, low- and middle-income countries and areas need the support of partners, including financial and technical resources, to sustain adequate, competent, supported and productive health workforces to improve health outcomes. Therefore, dialogue between partners and stakeholders and working across sectors are necessary.

ORGANIZATIONWIDE EXPECTED RESULT 10.009

Technical support provided to Member States, with a focus on those facing severe healthworkforce difficulties in order to improve the production, distribution, skill mix and retention of the health workforce.

REGIONAL EXPECTED RESULT

Technical support provided to countries and areas to improve the production, distribution, skill mix, retention and the management of their health workforces.

10.009.WP01

REGIONAL INDICATORS

10.009.WP01.01 Number of countries and areas using evidenceinformed practices, tools and guidelines to develop and retain an adequate, balanced and responsive health workforce to meet population health needs.

10.009.WP01.02 Number of countries and areas with the capacity or established national mechanism to regulate, monitor and set norms/standards with regard to the education, training, performance and practice of different categories of health occupations, including managing migration.

10.009.WP01.03 Number of partnerships, collaborating centres and networks established at country and regional levels for research, advocacy, resources mobilization and for facilitating a common and coordinated approach to strengthen the healthworkforce capacity of countries and areas.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

BASELINE

TARGETS TO BE ACHIEVED BY

At least 3 above the baseline.

At least 3 partnerships, collaborating centres and networks above the baseline.

2009

TARGETS TO BE ACHIEVED BY

At least 6 above the baseline

An additional 1 partnership/collaborating centre/network formed above the baseline in at least 6 countries and areas

2011

TARGETS TO BE ACHIEVED BY

At least 8 above the baseline.

An additional 1 partnership/collaborating centre/network formed above the baseline in at least 8 countries and areas

2013

JUSTIFICATION

There is strong evidence that the availability of motivated and skilled health workers contributes to improved health outcomes such as increased maternal, infant and child survival, and is critical for the implementation of health programmes. The World Health Report 2006 – Working together for Health, World Health Assembly resolutions (WHA57.19; WHA59.23; WHA59.27) and a Western Pacific Regional Committee resolution (WPR/RC57.R7) urged Member States to take concerted actions to address health worker shortages through rapid scaling up of production, and the strengthening of nursing and midwifery as well as workforce management (including migration of health workers). The WHO Western Pacific’s Regional Strategy on Human Resources for Health 2006–2015, endorsed by the Regional Committee, provides Member States with a range of policy options and strategic actions from which to choose in the development and management of their health workforces.

ORGANIZATIONWIDE EXPECTED RESULT 10.010

Evidence-based policy and technical support provided to Member States in order to improve healthsystem financing in terms of the availability of funds, social and financial-risk protection, equity, access to services and efficiency of resource use.

REGIONAL EXPECTED RESULT

Technical support provided to improve health system financing in terms of the availability of funds, social and financial risk protection, equity, access to services and efficiency of resource use.

10.010.WP01

REGIONAL INDICATORS

10.010.WP01.01 Number of countries and areas provided technical support to improve health financing and social protection arrangements based on WHO technical briefs and regional strategy.

10.010.WP01.02 Number of countries with reduced out-of-pocket payments and extended prepayment schemes in health financing.

BASELINE

Not applicable – target is number that reduce from their 2007 levels

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

TARGETS TO BE ACHIEVED BY

At least 3 countries

2009

TARGETS TO BE ACHIEVED BY

At least 5 additional countries

2011

TARGETS TO BE ACHIEVED BY

At least 6 additional countries

2013

JUSTIFICATION

An increasing number of countries and areas need to improve their existing health financing arrangements. The regional strategy on health care financing that covers the period of 2006–2010 provides strategic policy interventions in the Region. Reduction of excessive out-of-pocket payments and expansion of prepayments in financing health services are the most important technical areas of work for most low-income developing countries and areas in the Region.

ORGANIZATIONWIDE EXPECTED RESULT 10.011

Norms, standards and measurement tools developed for tracking resources, estimating the economic consequences of illness, and the costs and effects of interventions, financial catastrophe, impoverishment, and social exclusion, and their use supported and monitored.

REGIONAL EXPECTED RESULT

Norms, standards and measurement tools are used for tracking resources and estimating economic consequences of illness, cost and effects of interventions, financial catastrophe and impoverishment, and social exclusion.

10.011.WP01

REGIONAL INDICATORS

10.011.WP01.01 Number of countries and areas receiving technical support for using WHO tools and methods advocated.

10.011.WP01.02 Number of studies supported and discussed.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Many countries and areas need country-specific evidence and estimates to assess and improve their health-financing performance with appropriate tool and methodologies. This demand needs to be responded to with expanded technical support both in developing appropriate norms, standards and methodologies and in building capacities for their application to produce evidence and estimates.

ORGANIZATIONWIDE EXPECTED RESULT 10.012

Steps taken to advocate additional funds for health where necessary; to build capacity in framing of health-financing policy and interpretation and use of financial information; and to stimulate the generation and translation of knowledge to support policy development.

REGIONAL EXPECTED

Health financing data, information and evidence are used for developing, implementing and monitoring

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

RESULT

health-financing policies and strategies.

10.012.WP01

REGIONAL INDICATORS

10.012.WP01.01 Number of countries and areas that have established reliable health-financing data and information systems such as national health accounts.

10.012.WP01.02 Number of countries and areas that have developed health-financing policies and strategies.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Improvements to health systems financing will result in higher availability of funds, social and financial risk protection, equity, and better access to services and efficiency of resource use.

ORGANIZATIONWIDE EXPECTED RESULT 10.013

Evidence based norms, standards and measurement tools developed to support Member States to quantify and decrease the level of unsafe health care provided.

REGIONAL EXPECTED RESULT

Implementation of norms, standards and measurement tools by Member States to quantify and decrease the level of unsafe health care provided and improve the quality of the health care system.

10.013.WP01

REGIONAL INDICATORS

10.013.WP01.01 Number of countries receiving technical assistance to develop, adapt and/or implement norms, standards and measurement tools to quantify or decrease the level of unsafe health care provided and to improve quality of care.

10.013.WP01.02 Number of countries that actively participate in each new global patient safety challenge.

BASELINE

TARGETS TO BE ACHIEVED BY

4 (per challenge)

2009

TARGETS TO BE ACHIEVED BY

8 (per challenge)

2011

TARGETS TO BE ACHIEVED BY

12 (per challenge)

2013

JUSTIFICATION

The number of patients that are injured by health care is estimated to be in the millions. It is a problem for both the developed and the developing world. The World Alliance for Patient Safety (WAPS) is a global health partnership that is responding to this problem through multiple strategies including

REGIONAL STRATEGIC OBJECTIVE STATEMENT 10

improving the availability of information, strengthening systems to improve safety and quality, raising awareness, patient advocacy, and operational research. WAPS also issues periodic patient safety challenges which countries can accept and pledge to work on specific patient safety issues.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 11

STRATEGIC OBJECTIVE 11

To ensure improved access, quality and use of medical products and technologies.

Scope

Medical products include chemical and biological medicines; vaccines; blood and blood products; cells and tissues mostly of human origin; biotechnology products; traditional medicines and medical devices. Technologies include, among others, those for diagnostic testing, imaging and laboratory testing. The work undertaken under this strategic objective will focus on making access more equitable (as measured by availability, price and affordability) to essential medical products and technologies of assured quality, safety, efficacy and cost-effectiveness, and on their sound and cost-effective use. For the sound use of products and technologies, work will focus on building appropriate regulatory systems; evidence-based selection; information for prescribers and patients; appropriate diagnostic, clinical and surgical procedures; vaccination policies; supply systems, dispensing and injection safety; and blood transfusion. independent product information and ethical promotion. Information includes clinical guidelines,

Regional indicators and targets

• Number of countries and areas that recognize access to essential medical products and technologies as part of the right to health in the national constitution or in legislation: five or more countries and areas by 2013. • Number of countries and areas with a functional regulatory system for medical products (including vaccines and traditional medicines) and technologies (including blood transfusion), adopting international norms and standards for the safety, quality and efficacy into national standards: 50% of developing countries and areas by 2013. • Number of countries and areas with sufficient capacity to provide an adequate supply of affordable vaccines of assured quality and immunization equipment: 4 countries and areas by 2013. • Number of countries and areas that have established nationally coordinated blood transfusion services based on full voluntary non-remunerated blood donation: 50% of developing countries and areas by 2013. • Number of countries and areas that have adopted and implemented policies to develop integrated laboratory systems that are well organized and managed at the national level: 50% of developing countries and areas by 2013.

Links with other strategic objectives

• Strategic objectives 1 to 5 (health outcomes): None of these objectives can be achieved without essential medical products, medicines and health technologies. With regard to access, work under this strategic objective will focus on “horizontal” issues such as comprehensive supply systems, pricing surveys and national pricing policies. On quality assurance and regulatory support, all WHO’s work is covered by this strategic objective. Work on rational use will focus on general aspects such as evidence-based selection of essential medical products and technologies, development of clinical guidelines, pharmacovigilance and patient safety, compliance with long-term treatment regimens and containing antimicrobial resistance.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 11

• Strategic objective 10: Work also contributes to health service delivery; sustainable financing of products and technologies, on which access also depends. An integrated approach to health systems in support of primary health care and universal access will be promoted. • Strategic objective 7: in relation to good governance. • Strategic objective 12: in relation to global public policy.

Issues and challenges

Medical products and technologies save lives, reduce suffering and improve health only if they are of good quality, safe and effective, available in the health care system, affordable, and properly utilized by providers and consumers. Although in many countries and areas expenditures on medical products and technologies account for over half of overall health expenditures, there are problems with reliable access to good-quality medicines, vaccines and medical technologies. The provision of basic services through primary health care, as well as scaling up interventions to control priority diseases such as HIV/AIDS, tuberculosis, malaria, childhood and maternal illnesses, require the timely delivery of good-quality medical products and technologies and their appropriate utilization. A balance needs to be struck between short-term gain through special vertical systems and long-term development of comprehensive national policies systems for medical products and technologies within comprehensive health systems. The development and implementation of comprehensive policies on medical products and technology, aimed at improving access to essential medical products and technologies of assured quality and improving their use, within a comprehensive health system, would contribute significantly in improving health and reducing morbidity and mortality, especially due to the priority diseases, including HIV/AIDS, malaria, tuberculosis, and childhood and maternal diseases. Problems of access to good-quality essential medicines and vaccines and the irrational use of medicines by providers and consumers are frequently encountered in the Western Pacific Region. Despite the availability of safe, effective and low-cost vaccines, at least 50 000 children die annually from vaccine-preventable illnesses in the Region. The prices of many essential medicines are often too high in relation to local purchasing power. Public funding remains low and medicines financing is mainly out-of-pocket. Several countries and areas

continue to face difficulties in ensuring a stable supply of essential medicines and vaccines. Weak regulatory systems and enforcement result in the production, distribution and sale of substandard products and counterfeit products. The Regional Strategy for Improving Access to Essential Medicines in the Western Pacific Region 2005–2010 and its subsequent revision, provide guidance to WHO and Member States for improving access to needed essential medicines within a comprehensive national health system. There is an increasing awareness of the need to standardize different aspects of traditional medicines in the Western Pacific Region. A combination of traditional medicine and modern medicine provides a new therapeutic modality to meet consumer health needs. Yet more systematic efforts are needed to integrate the traditional medicines into existing modern health care systems. With regard to policy, the strategic direction is to promote the integration of traditional medicine/complementary alternative medicine (TM/CAM) into the national health systems, with focus on better regulation of the quality, safety and efficacy of traditional medicines. Where

REGIONAL STRATEGIC OBJECTIVE STATEMENT 11

relevant and possible, the contribution of TM/CAM to primary health care will be explored.

Special emphasis will be put on promoting and upgrading the knowledge and skill of the providers of TM/CAM. Where needed, countries will be assisted in protecting the intellectual property rights on their traditional knowledge. In the Western Pacific Region, especially among the developing countries and areas, equitable access to safe and appropriate health technologies, including medical devices, are challenged by weak health infrastructures, a lack of financial and skilled human resources, poor management systems, and a lack or absence of comprehensive equipment management and maintenance. A lack of sufficient voluntary non-remunerated blood donors from low-risk populations and the absence of well-organized national blood transfusion services make the blood supply in many countries and areas unsafe or unavailable. Overuse of injections and unsafe injection practices in many countries and areas in the Region pose unnecessary health risks and waste the limited resources for health that instead could be used for more essential services.

Strategic approaches

Strategic approaches for Member States: • Develop and implement national medicines policies and monitor their impact on access, affordability, quality and rational use. Use the Regional Strategy for Improving Access to Essential Medicines as a guide. • Ensure the safe and proper use of blood and blood products. • Establish internationally harmonized standards of traditional medicines into national legislation. • Ensure equitable access to safe health technologies. Strategic approaches for the WHO Secretariat: • Advocate and support the establishment and implementation of national policies, programmes and systems on medical products and technologies; the adoption and use of international standards, norms and guidelines relating to quality, safety and efficacy; and the appropriate use of medical products and technologies within a comprehensive health system. • Promote a public health approach to innovation; support Member States to use the flexibilities in the TRIPS Agreement and take into account the works of the Intergovernmental Group on Public Health, Innovation and Intellectual Property discussed during the Sixty-first World Health Assembly. • Facilitate the exchange of information and sharing of experiences in medical products and technologies through meetings, newsletters, electronic communication networks and other means. • Promote subregional and intercountry collaboration in the area of medical products and technologies. • Promote and support the monitoring of policy implementation and evaluate the impacts with standardized methodology, including relevant surveillance systems.

ORGANIZATIONWIDE EXPECTED RESULT 11.001

Formulation and monitoring of comprehensive national policies on access, quality and use of essential medical products and technologies advocated and supported.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 11

REGIONAL EXPECTED RESULT

Support provided to countries and areas to develop, monitor or revise comprehensive policies on access, quality and use of essential medical products and technologies.

11.001.WP01

REGIONAL INDICATORS

11.001.WP01.01 Number of countries and areas that have received WHO support to develop, revise, implement and monitor national medicines policies and to improve access to essential medicines using the Regional Strategy as a guide.

11.001.WP01.02 Number of countries and areas supported to develop or strengthen policies and/or programmes on traditional medicine using the Regional Strategy as a guide.

11.001.WP01.03 Number of countries and areas that have received support to develop, revise, implement and monitor national policies to improve access to, quality of and use of blood, blood products and health technologies.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY 2013

JUSTIFICATION

Access to good-quality medical products and health technologies, including medicines, vaccines, blood and blood products, traditional medicines, medical devices, and diagnostic and laboratory tests, remain problematic in many countries and areas in the Western Pacific Region. In the area of medicines and vaccines, resolution WPR/RC/55.R4 requested the Regional Director to support Member States to improve access to essential medicines using the Regional Strategy for Improving Access to Essential Medicines in the Western Pacific Region, 2005–2010, as a guide.

ORGANIZATIONWIDE EXPECTED RESULT 11.002

International norms, standards and guidelines for the quality, safety, efficacy and cost-effective use of medical products and technologies developed and their national and/or regional implementation advocated and supported.

REGIONAL EXPECTED RESULT

Support provided to countries and areas to implement internationally accepted norms, standards and guidelines for the quality, safety, efficacy and cost-effectiveness of medical products and technologies, and to strengthen the national regulatory and quality-assurance systems.

11.002.WP01

REGIONAL INDICATORS

11.002.WP01.01 Number of countries and areas that have received WHO support to improve medicines regulation

11.002.WP01.02 Number of countries and areas that have received WHO support including standards and

11.002.WP01.03 Number of countries and areas that have received WHO support to improve the regulation

11.002.WP01.04 Number of vaccine-

producing countries and have areas that a national

regulatory authority

REGIONAL STRATEGIC OBJECTIVE STATEMENT 11

and quality assurance system.

guidelines to secure quality, safety, efficacy and costeffectiveness and to improve regulations on traditional medicine.

and quality assurance system for blood, blood products and health technologies.

that

has met all

successfully

six critical functions as prescribed by WHO.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Medical products and technologies save lives, reduce suffering and improve health only if they are of good quality, safe and effective. Ensuring efficacy, safety and quality of medical products and health technologies by strengthening national regulation and quality assurance systems in the Western Pacific Region is essential to prevent the health system and the market from being flooded with products that are unsafe, substandard or counterfeit. In the area of medicines, for instance, the sale and distribution of substandard and counterfeit products due to weak regulation and law enforcement in many countries and areas has become a serious public health threat.

ORGANIZATIONWIDE EXPECTED RESULT 11.003

Evidence-based policy guidance on promoting scientifically sound and cost-effective use of medical products and technologies by health workers and consumers developed and supported within the Secretariat and regional and national programmes.

REGIONAL EXPECTED RESULT

Support provided to countries and areas to promote evidence-based, scientifically sound and cost-effective use of medical products and technologies and traditional medicine by health workers, practitioners and consumers.

11.003.WP01

REGIONAL INDICATORS

11.003.WP01.01 Number of countries and areas that have received WHO support to improve the use of therapeutically effective, safe, and costeffective medicines by health care providers and consumers.

11.003.WP01.02 Number of countries and areas that have received WHO support to promote evidence-based, scientifically sound and cost-effective use of traditional medicine by practitioners and consumers.

11.003.WP01.03 Number of countries and areas that have received WHO support to promote evidence-based scientifically sound and cost-effective use of blood, blood products and health technologies.

BASELINE

TARGETS TO BE ACHIEVED BY

REGIONAL STRATEGIC OBJECTIVE STATEMENT 11

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Inappropriate and irrational use of medical products and health technologies by both providers and consumers drain limited resources for health and jeopardize the quality of health services. A number of studies and assessments have demonstrated the widespread occurrence of irrational prescribing practices in health facilities and medicines use in communities in many countries and areas. There is an obvious need to promote rational use of medical products and technologies through well-proven effective interventions, and such interventions should be systematically and continuously undertaken as part of related national policies and programmes.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 12

STRATEGIC OBJECTIVE 12

To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work.

Scope

This strategic objective facilitates the work of WHO to achieve all other strategic objectives. Responding to priorities in the Eleventh General Programme of Work, it recognizes that the context for international health has changed significantly. The scope of this objective covers three broad, complementary areas: leadership and governance of the Organization; WHO’s support for, presence in, and engagement with individual Member States; and the Organization’s role in bringing the collective energy and experience of Member States and other actors to bear on health issues of global and regional importance. The main innovation implicit in this objective is that it seeks to harness the depth and breadth of WHO’s country experience in order to influence global and regional debates, thereby to influence positively the environment in which national policy-makers work, and contribute to the attainment of the health-related Millennium Development Goals and other internationally agreed health-related goals.

Regional indicators and targets

• Proportion of countries and areas that adopt health as a high priority in their national development agendas: 100% by 2013. • Number of countries and areas that have adjusted their work plans and reallocated resources in order to address priority issues identified in the WHO Country Cooperation Strategy: 25 by 2013. • Proportion of health partnerships functioning in alignment with the WHO mandate in advancing the regional health agenda: 100% by 2013. • Proportion of countries and areas accessing and sharing relevant knowledge bases and publications, including health research: 100% by 2013.

Links with other strategic objectives

• This strategic objective is intrinsically linked to all the other objectives, as it builds on and supports the entire work of the Organization. As such it is closely related and complementary to strategic objective 13, to develop and sustain WHO as a flexible, learning Organization, enabling it to carry out its mandate more effectively and efficiently. The latter objective is more inward-looking, geared towards managerial and administrative issues, whereas strategic objective 12 is more outward-looking, focusing on issues of WHO leadership and governance, on work in Member States, and collaboration with partners, including the United Nations System, at global, regional and country levels.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 12

Issues and challenges

Effective political and technical leadership is required to maintain good-quality health services and to develop the health infrastructure necessary to achieve the health-related Millennium Development Goals. There is a need for WHO, as the specialized agency of the United Nations responsible for directing and coordinating international health, to provide leadership that reflects the priorities of Member States through the synergistic strengths of all levels of the Organization. Guided by the Regional Committee, Member States and the Secretariat should

formulate and implement effective policies and strategic directions for health development throughout the Region. Health should be a priority in the national social and economic development plans of countries and areas in the Region. WHO country offices in the Region need appropriate leadership, as well as the technical and

administrative capacity, to respond effectively and in a timely manner to the emerging health needs of countries and areas. The WHO Country Cooperation Strategy is now well established in the Region. By placing country health needs at the centre of WHO’s work, there will be a country perspective in all aspects of the Organization’s work. A key challenge for WHO is to mobilize and enable the Organization to support countries and areas to reach national health and development goals. With the increased recognition of the essential role of health in promoting social and economic development, there are more interregional and bilateral agencies, as well as private sector organizations, involved financially and technically in the health sector at all levels. There is the potential for both the duplication of effort and the reduced harmonization of health programmes and implementation of activities that are not in line with the national health strategic plans of countries and areas. WHO should continue to coordinate and harmonize public health work within the United Nations system, and with other intergovernmental agencies, civil society organizations, nongovernmental organizations and other partners in the areas of health and development, through new and innovative approaches. Access to knowledge between and within countries and areas must be improved and sharing of health information must be strengthened.

Strategic approaches

Strategic approaches for Member States: • Strengthen the governance of WHO and regional health policy-making through active engagement in the preparation and conduct of meetings of the Regional Committee. • Support WHO in directing and implementing regional health policies, strategic programmes and initiatives that reflect the priorities of countries and areas as outlined in the WHO Country Cooperation Strategy. • Work with the Secretariat to coordinate planning, development and implementation of activities supported and executed by various partners and partnerships in the health sector, according to the national health development plan and the approved Medium-term Strategic Plan and Programme Budget, in line with the priorities outlined in Country Cooperation Strategy. • Increase collaboration with WHO and among Member States in sharing relevant knowledge.

Strategic approaches for the WHO Secretariat:

REGIONAL STRATEGIC OBJECTIVE STATEMENT 12

• Strengthen the regional governance of WHO through improved communication and coordination between Member States and the Secretariat, and through effective Secretariat support in the organization and conduct of the Regional Committee. • Provide leadership and direction to the work of WHO at country and regional levels. • Orient the work of WHO around Country Cooperation Strategies that reflect national needs and priorities and provide appropriate support to countries and areas in building national capacity for governance and health development through WHO's core country presence. • Promote multisectoral approaches to advance the global health agenda and harmonized approaches to health development in the Region by developing and fostering strategic alliances, coordinating functional partnerships and effectively communicating the work of WHO. • Facilitate access to knowledge bases and publications, including health research.

ORGANIZATIONWIDE EXPECTED RESULT 12.001

Effective leadership and direction of the Organization exercised through enhancement of governance, and the coherence, accountability and synergy of WHO’s work.

REGIONAL EXPECTED RESULT

Effective leadership and direction of WHO in the Region through enhancement of governance, coherence, accountability and synergy of the work of WHO.

12.001.WP01

REGIONAL INDICATORS

12.001.WP01.01 Proportion of documents submitted to the Regional Committee within the constitutional deadline in the WHO official languages of the Region.

12.001.WP01.02 Level of understanding by key stakeholders of WHO's role, priorities and key messages as provided by a stakeholder survey.

BASELINE

90%

76% stakeholders familiar/very familiar with WHO roles and priorities

TARGETS TO BE ACHIEVED BY

95%

86% stakeholders familiar/very familiar with WHO roles and priorities

2009

TARGETS TO BE ACHIEVED BY

100%

90% stakeholders familiar/very familiar with WHO roles and priorities

2011

TARGETS TO BE ACHIEVED BY

100%

96% stakeholders familiar/very familiar with WHO roles and priorities

2013

JUSTIFICATION

The main regional-level mechanism for the formal contribution of Member States to the good governance, policies and work of WHO is the Regional Committee. Regional Committee deliberations and decisions must be cognizant of the global agenda set by the World Health Assembly for WHO and be relevant to the needs and feasible responses for Member States in the Region. Communication and other barriers to Member States’ participation in policy implementation must be minimized.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 12

ORGANIZATIONWIDE EXPECTED RESULT 12.002

Effective WHO country presence established to implement WHO country cooperation strategies that are aligned with Member States’ health and development agendas, and harmonized with the United Nations country team and other development partners.

REGIONAL EXPECTED RESULT

WHO country presence is effectively led at the country level, harmonized with other development partners and guided by Country Cooperation Strategies that support the national health agendas of Member States in the context of the 11th General Programme of Work.

12.002.WP01

REGIONAL INDICATORS

12.002.WP01.01 Number of countries and areas where WHO is aligning its Country Cooperation Strategy with country priorities and development cycle and harmonizing its work with the United Nations and other development partners within relevant frameworks such as UNDAF, PRSP and SWAp.

12.002.WP01.02 Proportion of WHO country offices that have reviewed and adjusted their core capacity in accordance with the Country Cooperation Strategy.

BASELINE

20%

TARGETS TO BE ACHIEVED BY

40%

2009

TARGETS TO BE ACHIEVED BY

60%

2011

TARGETS TO BE ACHIEVED BY

80%

2013

JUSTIFICATION

Understanding national health priorities is critical in determining WHO's country focus and developing WHO Country Cooperation Strategies. WHO's in-country presence facilitates close working relationships with government and partners to ensure ongoing and timely relevance of WHO activities and also provides strong leadership and support of the WHO technical collaboration.

ORGANIZATIONWIDE EXPECTED RESULT 12.003

Global health and development mechanisms established to provide more sustained and predictable technical and financial resources for health on the basis of a common health agenda which responds to the health needs and priorities of Member States.

REGIONAL EXPECTED RESULT

Global and regional health development architecture effectively providing more sustained and predicable technical and financial resources for health based on a common health agenda that responds to the health needs and priorities of Member States in the Region.

12.003.WP01

REGIONAL INDICATORS

12.003.WP01.01 Amount of external aid for health that flows into the Region through flexible and long-term instruments.

12.003.WP01.02 Number of WHO regional health partners that implement coordinated health activities in line with priorities identified in the WHO Regional strategic objective and work plans.

12.003.WP01.03 Number of countries and areas where WHO is leading or actively engaged in health and development partnership (formal and informal), including within the context of

REGIONAL STRATEGIC OBJECTIVE STATEMENT 12

United Nations Reform.

BASELINE

US$ 30 million

TARGETS TO BE ACHIEVED BY

US$ 40 million

2009

TARGETS TO BE ACHIEVED BY

US$ 50 million

2011

TARGETS TO BE ACHIEVED BY

US$ 50 million

2013

JUSTIFICATION

An increasing number of multilateral and bilateral agencies and entities in the private sector have become more interested in and involved financially and technically in the health sector at both regional and country levels, which has brought about challenges related to coordination with those partners to avoid duplication of activities, waste of limited resources, and incoherent policy and technical guidance at regional and country levels. WHO has an important role to play in facilitating coordination, communication and cooperation among different partners and ensuring that increasing and sustainable resources made available for priority health programmes at regional and country levels and Member States can make the best possible use of technical and financial resources based on a common health agenda.

REGIONAL STRATEGIC OBJECTIVE STATEMENT 12

ORGANIZATIONWIDE EXPECTED RESULT 12.004

Essential multilingual health knowledge and advocacy material made accessible to Member States, health partners and other stakeholders through the effective exchange and sharing of knowledge.

REGIONAL EXPECTED RESULT

Essential multilingual health knowledge and advocacy material made accessible to Member States, regional health partners and other stakeholders in the Region through effective exchange and sharing of knowledge.

12.004.WP01

REGIONAL INDICATORS

12.004.WP01.01 Average number of page views/visits to the WHO Regional Office for Western Pacific website.

12.004.WP01.02 Number of pages in languages other than English available on countries' and Regional Office websites.

BASELINE

1 211 800 visits during 2007

971 pages

TARGETS TO BE ACHIEVED BY

20% above the baseline

1500 pages

2009

TARGETS TO BE ACHIEVED BY

30% above the baseline

2000 pages

2011

TARGETS TO BE ACHIEVED BY

40% above the baseline

2500 pages

2013

JUSTIFICATION

Public opinion on critical health issues can be changed and strengthened using WHO publications, websites and advocacy material.

100

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

STRATEGIC OBJECTIVE 13

To develop and sustain WHO as a flexible, learning Organization, enabling it to carry out its mandate more efficiently and effectively.

Scope

The scope of this objective covers the functions that support the work of the Secretariat in country and regional offices and at headquarters. Work is organized according to entire results-based management framework and processes, from strategic and operational planning and budgeting to performance monitoring and evaluation; management of financial resources through monitoring, mobilization and coordination Organization-wide, ensuring an efficient flow of available resources throughout the Organization; management of human resources, including human resources planning, recruitment, staff development and learning, performance management, and conditions of service and entitlements; provision of operational support, ranging from the management of infrastructure and logistics, language services, staff and premises security, and staff medical services, to the management of information technology; and appropriate accountability and governance mechanisms across all areas. The strategic objective also covers broad institutional reform that will ensure that the above functions continuously strengthened and provide better, more efficient and cost-effective support to the are

Organization.

It is closely linked to broader reforms within the United Nations system at both country and global levels.

Regional indicators and targets

• Cost-effectiveness of operational support services, ensuring best value for money: increase by 2013 compared to 2008. • Resources aligned to the Programme Budget: increase by 2013 compared to 2008. • Managerial and administrative capacity at the country level: increase by 2013 compared to 2008.

Links with other strategic objectives

• This objective should not be considered in isolation from the other strategic objectives, as its scope reflects and is responsive to the needs of the Organization as a whole. In particular, it should be read in conjunction with strategic objective 12, to provide leadership, strengthen governance and foster partnership and collaboration with countries and areas and to fulfil the mandate of WHO in advancing the global health agenda. Strategic objective 13 is more inward-looking, geared towards managerial and administrative issues, whereas strategic objective 12 is more outward-looking, focusing on issues of WHO leadership and governance and on collaboration with Member States and partners at global, regional and country levels.

Issues and challenges

The Organization must continue to evolve in a flexible and responsive manner to successfully respond to the evolving regional health challenges. Harmonization efforts in the development community and broader reforms within the United Nations system influence the way other stakeholders act. WHO needs to actively participate in these developments and ensure it

100

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

works proactively to reflect this changing environment. The Western Pacific Region is being held to a higher standard by our governing body (the Regional Committee) and donor agencies vis-à-vis transparency and accountability in terms of measurable results and the use of financial resources. In addition, given that approximately 70% of our financial resources are voluntary

contributions, mechanisms need to be in place to ensure better alignment of resources with the Programme Budget and to lower transaction costs. Funding this strategic objective has become increasingly more difficult and threatens to reduce the level of support that we can provide to technical programmes. While cost-cutting measures have been successfully introduced, inflationary forces, as well as shifts in currency valuations, are beyond the control of the Organization and difficult to predict with any degree of certainly. In addition, the reduced level of programme support cost generated by implementing voluntary contributions has and will continue to have a negative effect on financing. While progress has been made in implementing human resources reforms, there remains a need to develop better human resources planning and a culture that promotes learning, manages performance and facilitates greater staff mobility. In addition, more work needs to be done to create an environment that attracts suitable qualified women in the professional workforce, which has been a challenge in the Region. Given the vast differences in capacity of country offices in the Region and the decentralization agenda of the Organization, training and the articulation of clear guidelines on responsibility and authority need to be developed and communicated. In order to maximize efficiency and effectiveness, much thought needs to be given to

determining at which locations decision-making and programme implementation should take place. The twin aims of the newly implemented Global Management System are to improve the efficiency and effectiveness of the Organization and to enhance the impact of WHO's programmes at country level. The Global Management System has been supported by administrative, procedural and structural changes, including the establishment of the global service centre in Malaysia.

Strategic approaches

Strategic approaches for the WHO Secretariat: • Shift from management through tight, overly bureaucratic controls to ex post facto monitoring in support of greater delegation and accountability, resulting in shifting responsibility and decision-making on the use of resources closer to where programmes are implemented. • Strengthen managerial and administrative capacities and competencies in the Region with specific emphasis on country offices. • Provide increased operational support to country offices and technical units through clearly articulated policies and procedures. • Increase site visits to assess the situation at the country level and propose pragmatic solutions that enable work at the country level.

• Strengthen the results-based approach which emphasizes joint planning, importance of learning and

101

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

collaboration. • Ensure that adequate mechanisms are in place to ensure that accountability is an integral part of the system. This goes hand in hand with appropriate delegation of authority and support from management.

ORGANIZATIONWIDE EXPECTED RESULT 13.001

Work of the Organization guided by strategic and operational plans that build on lessons learnt, reflect country needs, are elaborated across the Organization, and used to monitor performance and evaluate results.

REGIONAL EXPECTED RESULT

Work towards achievement of WHO strategic objectives in the Region is supported by effective programme planning and development, reflecting country needs, and including strategic and operational planning through a results-based approach, performance monitoring and evaluation.

13.001.WP01

REGIONAL INDICATORS

13.001.WP01.01 Proportion of country workplans that have been peer reviewed with respect to their technical quality, that incorporate lessons learnt and that reflect country needs.

13.001.WP01.02 Proportion of Office Specific Expected Results (OSERs) for which progress status has been updated within the established timeframes for periodic reporting.

BASELINE

75%

TARGETS TO BE ACHIEVED BY

20%

95%

2009

TARGETS TO BE ACHIEVED BY

30%

100%

2011

TARGETS TO BE ACHIEVED BY

60%

100%

2013

JUSTIFICATION

With the WHO commitment to move resources to regions, countries and areas, progress towards the identified global health agenda and strategic objectives requires the consistent application of effective results-based management systems at all levels of the Organization.

ORGANIZATIONWIDE EXPECTED RESULT 13.002

Sound financial practices and efficient management of financial resources achieved through continuous monitoring and mobilization of resources to ensure the alignment of resources with the programme budgets.

REGIONAL EXPECTED RESULT

Sound financial practices and efficient management of financial resources is facilitated in the Region through timely and accurate guidance and the provision of relevant management reports. Accounting procedures to be inline with IPSAS.

13.002.WP01

REGIONAL INDICATORS

13.002.WP01.01 Timely costing and awarding of funds to approved workplans.

13.002.WP01.02 Timely reporting to internal management.

13.002.WP01.03 Proportion of donor reports submitted and accepted according to standards agreed with donors.

BASELINE

4 days

3 days prior to meeting

70%

102

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

TARGETS TO BE ACHIEVED BY

3 days

6 days prior to meeting

80%

2009

TARGETS TO BE ACHIEVED BY

3 days

6 days prior to meeting

90%

2011

TARGETS TO BE ACHIEVED BY

2 days

8 days prior to meeting

100%

2013

JUSTIFICATION

Transparent and accurate reports are available to all stakeholders, thereby raising donor confidence and aiding the technical programmes to operate efficiently and effectively.

ORGANIZATIONWIDE EXPECTED RESULT 13.003

Human resource policies and practices in place to attract and retain top talent, promote learning and professional development, manage performance, and foster ethical behaviour.

REGIONAL EXPECTED RESULT

Human resource policies and practices in place to attract and retain top talent, promote learning and professional development, manage performance and foster ethical behaviour.

13.003.WP01

REGIONAL INDICATORS

13.003.WP01.01 Percentage of female professional staff in the Region.

13.003.WP01.02 Percentage of staff in the Region that have access to staff development and learning programmes.

13.003.WP01.03 Proficient and effective use of the Global Management System to process and monitor various human resources activities.

BASELINE

22% of Fixed-term Professional Staff

65% of staff

TARGETS TO BE ACHIEVED BY

25% of Fixed-term Professional Staff

80% of staff

100%

2009

TARGETS TO BE ACHIEVED BY

30% of Fixed-term Professional Staff

90% of staff

100%

2011

TARGETS TO BE ACHIEVED BY

35% of Fixed-term Professional Staff

100% of staff

100%

2013

JUSTIFICATION

It is critical that the right people are in place, trained and supported to deliver the expected results of the Organization.

ORGANIZATIONWIDE EXPECTED RESULT 13.004

Management strategies, policies and practices in place for information systems, that ensure reliable, secure and cost-effective solutions while meeting the changing needs of the Organization.

REGIONAL EXPECTED RESULT

Country-level ongoing support and development of secure and cost-effective solutions that meet the changing needs of the Organization.

13.004.WP01

REGIONAL INDICATORS

13.004.WP01.01 Availability of online, real-time, relevant

13.004.WP01.02 Percentage of country offices within a region-

103

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

regional information systems for management and administrative purposes in all country offices.

wide standard information and communication environment that reflects their practical needs.

BASELINE

50%

TARGETS TO BE ACHIEVED BY

60%

2009

TARGETS TO BE ACHIEVED BY

70%

2011

TARGETS TO BE ACHIEVED BY

80%

2013

JUSTIFICATION

Country-level provision of information technology systems and required information management support is essential to the work of the Organization.

ORGANIZATIONWIDE EXPECTED RESULT 13.004

Management strategies, policies and practices in place for information systems, that ensure reliable, secure and cost-effective solutions while meeting the changing needs of the Organization.

REGIONAL EXPECTED RESULT

Development of secure and cost-effective solutions that meet the changing needs of the Organization. Ongoing support to regional, country and global information systems and their users. Information products and their effective use is supported within a Knowledge Management System (KMS).

13.004.WP02

REGIONAL INDICATORS

13.004.WP02.01 Effective coordination and management of regional and global information and communication technology, in line with industry best practices and benchmarks.

13.004.WP02.02 Percentage of information products disseminated in the appropriate language and format to target users.

BASELINE

50% of technology, in line with industry best practices and benchmarks

50%

TARGETS TO BE ACHIEVED BY

60%

2009

TARGETS TO BE ACHIEVED BY

70%

2011

TARGETS TO BE ACHIEVED BY

80%

2013

JUSTIFICATION

Provision of information technology systems and required information management support is essential to the work of the Organization. Information products generated by the Organization must suit the intended audiences and also be within the overall organizational knowledge management systems.

104

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

ORGANIZATIONWIDE EXPECTED RESULT 13.005

Managerial and administrative support services necessary for the efficient functioning of the Organization provided in accordance with service-level agreements that emphasize quality and responsiveness.

REGIONAL EXPECTED RESULT

Provision of management and administrative support at both regional and country level through service-level agreements (SLAs).

13.005.WP01

REGIONAL INDICATORS

13.005.WP01.01 Number of SLAs concluded.

13.005.WP01.02 Client surveys to assess the extent to which SLAs have been complied with.

13.005.WP01.03 Number of training courses for country staff and Regional Office staff to develop the skills to achieve the SLAs.

BASELINE

TARGETS TO BE ACHIEVED BY

2009

TARGETS TO BE ACHIEVED BY

2011

TARGETS TO BE ACHIEVED BY

2013

JUSTIFICATION

Programmes should be provided with efficient service delivery to allow them to achieve their expected results.

ORGANIZATIONWIDE EXPECTED RESULT 13.006

Working environment conducive to the well-being and safety of staff in all locations.

REGIONAL EXPECTED RESULT

A safe environment in the Regional Office and country offices for all staff.

13.006.WP01

REGIONAL INDICATORS

13.006.WP01.01 Number of country offices that have achieved Minimum Operating Security Standards (MOSS) compliance.

13.006.WP01.02 Number of country offices that have implemented the Capital Master Plan on a timely manner.

13.006.WP01.03 Renovation of the Regional Office conference hall.

13.006.WP01.04 Maintenance of satisfactory working conditions in the regional and country offices (continuing activity).

BASELINE

9 country offices

0 country offices

Architectural plans

70% satisfaction

TARGETS TO BE ACHIEVED BY

11 country offices

3 country offices

80% of work completed

80% satisfaction

2009

TARGETS TO BE ACHIEVED BY

13 country offices

4 country offices

100% of work completed

85% satisfaction

2011

105

REGIONAL STRATEGIC OBJECTIVE STATEMENT 13

TARGETS TO BE ACHIEVED BY

All country offices

5 country offices plus compliance with the study recommendation

100% of work completed

90% satisfaction

2013

JUSTIFICATION

Provision of a safe and secure office environment is an essential component for maintaining a motivated workforce within the Organization.

106

Draft Proposed Programme Budget 2010-2011 of the Western Pacific Region

Table 1: Financing sources summary: 2008-2009 and 2010-2011

Sources of financing

2008-2009

2010-2011*

Increase (decrease)

US$

Assessed contributions

80 159 000

Estimated voluntary contributions

267 679 000

268 241 000

562 000

Total

347 838 000

348 400 000

562 000

* Note: 2010-2011 figures are provisional and will be adjusted in the WHA Proposed Programme Budget document.

Table 2: Regional allocation of assessed and voluntary contributions for 2008-2009 and 2010-2011 by organizational level 2008-2009 2010-2011*

Assessed contributions

Voluntary contributions

Assessed contributions

Voluntary contributions

US$ (000)

% to total budget

US$

(000)

% to total budget

US$ (000)

% to total budget

US$ (000)

% to total budget

DISTRIBUTION OF REGIONAL ALLOCATION

Country activities including WHO's presence in countries (included in stratregic objectives 12 and 13)

45 377

56.61

161 767

60.43

45 377

56.61

162 102

60.43

Regional Office and Intercountry activities

34 782

43.39

105 912

39.57

34 782

43.39

106 139

39.57

Total

80 159

100.00

267 679

100.00

80 159

100.00

268 241

100.00

DISTRIBUTION OF COUNTRY ACTIVITIES

Country programmes

32 907

41.05

154 457

57.70

32 907

41.05

154 760

57.69

WHO's core presence in countries

12 470

15.56

7 310

2.73

12 470

15.45

7 342

2.74

Total

45 377

56.61

161 767

60.43

45 377

56.50

162 102

60.43

DISTRIBUTION OF REGIONAL AND INTERCOUNTRY ACTIVITIES Regional Director's development programme

697

0.87

0.00

697

0.87

0.00

Regional committee

433

0.54

300

0.11

433

0.54

300

0.11

Regional Office and Intercountry activities

33 652

41.98

105 612

39.46

33 652

41.98

105 839

39.46

Total

34 782

43.39

105 912

39.57

34 782

43.39

106 139

39.57

* Note: 2010-2011 figures are provisional and will be adjusted in the WHA Proposed Programme Budget document.

107

WPR/RC59/4 ANNEX 1

MEDIUM-TERM STRATEGIC PLAN 2008–2013 AMENDED (DRAFT)

The full text of this document is available on the WHO Regional Committee Internet page http://www.wpro.who.int/rcm/en/rc59/documents/

This document represents the draft of an amended version of the Medium-term strategic plan 2008–2013 for discussion at regional committee meetings to be held during the period September–October 2008. It includes revisions of or additions to the explanatory text for several strategic objectives, as well as the refinement, replacement or deletion of indicators. In the resources tables, “Budget 2008–2009” refers to the budget approved by the Health Assembly in resolution WHA60.12; “Proposed budget 2010–2011” refers to the Proposed programme budget 2010–2011; and “Estimates 2012–2013” refers to initial estimate presented to the Sixtieth World Health Assembly in the Draft Medium-term strategic plan 2008–2013. Throughout the document, underlining indicates that the text has been changed.

Geneva, June 2008

MEDIUM-TERM STRATEGIC PLAN 2008–2013 AMENDED (DRAFT)

MEDIUM-TERM STRATEGIC PLAN 2008–2013 (AMENDED)

CONTENTS

Page INTRODUCTION........................................................................................................................... STRATEGIC OBJECTIVES .......................................................................................................... 1. To reduce the health, social and economic burden of communicable diseases ....................................................................................................................... 2. To combat HIV/AIDS, tuberculosis and malaria........................................................ 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment.................................................................................................................. 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals ............................................................................... 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact. ........................................ 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex ................................. 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches ............................................ 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health........................................................................................................... 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development. ................................... 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research ................. 11. To ensure improved access, quality and use of medical products and technologies .. 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. ..................................................... 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively. .......................................... Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. WHO’s framework for results-based management .................................................... Trend in the composition of WHO income ................................................................ Financing the Medium-term strategic plan: three sources of funding ........................ Stratification of voluntary income by flexibility ........................................................ Monitoring, assessment and evaluation instruments .................................................. 1 17 17 26

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INTRODUCTION Challenges, gaps and future needs 1. The Eleventh General Programme of Work 2006–2015 analyses current health challenges. Health is increasingly seen as a key aspect of human security and occupies a prominent place in debates on priorities for development. Over the past 20 years, there have been major gains in life expectancy overall, but there are 2. widening gaps in health status; some countries have witnessed reversals of earlier gains, because of such factors as infectious diseases, in particular HIV/AIDS, collapsing health services, and deteriorating social and economic conditions. Prospects for achieving the health-related Millennium Development Goals are not encouraging. 3. The analysis in the General Programme of Work reveals several areas of unrealized potential for improving health, particularly the health of the poor. The missing elements can be summarized as: • gaps in social justice: efforts have been insufficient to ensure equity, health-related human rights and gender equality in health policy and action • gaps in responsibility: the increasing number of sectors, actors and partners involved in health work has led to gaps in accountability and lack of synergy in the coordination of actions to improve health • gaps in implementation: many populations still do not have adequate access to essential public-health interventions; international assistance is often insufficiently aligned to national priorities and systems or harmonized across organizations • gaps in knowledge: knowledge of ways to tackle some of the major health challenges is still weak; research is not always focused on areas of greatest need, and health policy is not always based on best available evidence. 4. Future progress requires strong political will, integrated policies and broad participation. Any significant progress towards achieving the health-related Millennium Development Goals will require action in many sectors and at all levels – individual, community, national, regional and global. The past 10 years have seen a dramatic increase in the number of international partnerships in health. Global health partnerships offer the potential to combine the different strengths of public and private organizations, along with civil society, in tackling health problems. Demands on the United Nations system as a whole are increasing, as are demands for it to reform and show more clearly where it can add value. Academic, industrial, government and nongovernmental research continues to shape the generation of knowledge and its use. 5. In September 2000, the United Nations Millennium Declaration committed countries to a global partnership to reduce poverty and improve health and education, along with promoting peace, human rights, gender equality and environmental sustainability. The seven-point global health agenda contained in the Eleventh General Programme of Work reflects this and other agreements adopted by world leaders, and requires action from many different players across the international community, across society and across government, in the following areas: investing in health to reduce poverty; building individual and global health security; promoting universal coverage, gender equality and health-related human rights; tackling the determinants of health; strengthening health systems and equitable access; harnessing knowledge, science and technology; strengthening governance, leadership and accountability. 6. In effectively addressing these challenges and gaps and in meeting future needs, WHO will continue to build upon the insights and lessons learnt over previous bienniums. Drawing upon

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information derived from the Organization’s formal monitoring and evaluation mechanisms, and input received from the Governing bodies, individual Member States, and other partners, key lessons have been identified which have helped to shape the content of the Medium-term strategic plan.

Lessons learnt 7. WHO is in a unique position to shape the global public-health agenda through consensus building and binding agreements. Examples of the latter include WHO’s Framework Convention on Tobacco Control and the International Health Regulations (2005). These experiences have enabled the Organization to identify which health issues require a formal negotiated agreement, and which are best approached through consensus building. 8. WHO participates in more than 80 global health partnerships and in numerous global, regional and national health networks. These partnerships and networks contribute to the achievement of WHO’s objectives, and benefit from the Organization’s convening power and technical expertise. WHO continues to learn optimal ways of participating in these partnerships, while maintaining its identity and mandate. 9. In response to increasing demands and current reform of the United Nations system, the Organization will strive to build more effective alliances within both the system and the broader development community. It will work to harmonize the health environment at country level and will engage in the reform process aimed at creating an effective country team under a common United Nations lead. 10. Over the past 60 years WHO has played a prominent role in launching, coordinating, and implementing public-health programmes and initiatives. Some examples are eradication of smallpox, the Expanded Programme on Immunization, the Action Programme on Essential Drugs, the Stop TB Partnership, and efforts to eradicate poliomyelitis, to eliminate leprosy, and to control SARS and avian influenza. WHO has been able to adapt or transform itself in order to meet the needs of specific public-health programmes. For Member States, however, these and other challenges are placing increasing demands on health systems in critical areas related to health workforce, financing, and information. In this regard, work in recent years has revealed the pressing need for greater international consensus about the way health systems should function and how their core functions can be strengthened. 11. Many important determinants of health fall outside of the direct sphere of influence of the health sector. Although WHO continues to draw from experience and develop capacity to work with sectors other than health in order to enhance their understanding of what can realistically be done to improve national health, it is evident that more needs to be done to monitor global trends that are of significance to health in such areas as trade and agriculture. WHO will work with ministries of health and other sectors to craft appropriate responses. 12. Experience over the last bienniums has shown that clarity and consistency is required on the concept of health equity, which needs to be built into all relevant aspects of WHO’s work. WHO will lead by example, integrating gender in the mainstream of its activities, building it into its technical guidance and normative work, and using sex-disaggregated data in the planning and monitoring of its programmes. 13. WHO will need to be more systematic in its contacts with civil society and industry, including the international health-care and pharmaceutical industries. As scientific advances continue, WHO will be more proactive in leading a dialogue on setting priorities and ethical standards for research. The past years have seen many new initiatives in the area of management and administration. The challenge now lies in the need to consolidate and institutionalize changes already introduced, and to complete reforms without compromising operational capability or staff confidence.

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14. Although WHO has been fairly successful in mobilizing resources, a key challenge has been to ensure alignment between the activities planned and the resources mobilized, as voluntary contributions are often earmarked for specific programmes and projects. Internal mechanisms, such as the advisory group on financial resources to channel resources to where they are most needed, require strengthening. 15. In an organization using nearly half its resources on personnel, efficient management of human resources is a key challenge. Personnel policy and practice in the past have not, for example, facilitated the mobility of staff to ensure that the right skills and competencies are always in the right place. The individual performance management system is not being used effectively and needs to be strengthened. The initial work around WHO’s global leadership programme needs to be consolidated. 16. Recent bienniums have seen a shift in the pattern of expenditure across the three levels of the Organization, with more resources being put to work in countries and regions. This trend needs to be supported by increased managerial skills and capacities in countries and regions and by more robust accountability. 17. Experience with results-based management over the past 10 years has significantly influenced the Medium-term strategic plan, and some key lessons learnt are reflected in definition of its priorities, strategic objectives and expected results. 18. First, it has become clear that a two-year time frame is inadequate to reflect the work of the Organization in many aspects of health. Successful activities require a significantly longer period to achieve the results expected. A medium-term plan provides an opportunity to adopt a more strategic and realistic approach to planning and the achievement of health outcomes. 19. Second, the plan is structured so as to create synergies between the different programmes and levels of WHO. The former planning structure of areas of work reinforced the tendency to compartmentalization, as organizational structures reflected those areas. Although such a division of labour facilitated resource allocation, it limited opportunities for collaboration across the Secretariat. The move to a smaller number of strategic objectives will significantly facilitate such collaboration. The strategic objectives are not mutually exclusive; they encourage differing but complementary perspectives for tackling common priorities. 20. Third, achievement of desired health outcomes is rarely attributable to a single intervention, or work by any one organization; the plan highlights work conducted within many collaborative arrangements. WHO will need to provide forums for engaging in dialogue with the increasing number and type of entities involved in health and development, including systematic contact with civil society and industry, including the international health-care and pharmaceutical industries. 21. Lastly, new business processes are required to support new ways of working. Greater dependence on voluntary contributions, increased internal collaboration across organizational structures, decentralization of resources, larger role played in operational aspects of health emergencies and disease outbreaks, and the growth of health-related legal frameworks, all require modern and flexible management systems. Introduction of the Global Management System and related enterprise resource planning, along with the service delivery model will back up these innovations.

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Strategic direction for 2008–2013 22. During the six years 2008–2013, WHO will continue to provide leadership in matters of public health, optimizing its impartiality and near universal membership. Guidance from governments through the Executive Board, the Health Assembly and the regional committees ensures legitimacy for the work of the Organization; in turn, the Secretariat’s reporting to the governing bodies ensures its accountability for implementation. WHO’s convening power enables diverse groups to stimulate collective action worldwide. 23. WHO’s role in tackling diseases is unparalleled, whether it acts by marshalling the necessary scientific evidence, promoting global strategies for eradication, elimination or prevention, or by identifying and helping to control outbreaks. 24. WHO will promote evidence-based debate, analysis and framing of policy development for health through the work of the Secretariat, expert and advisory groups, collaborating centres, and the numerous formal and informal networks in which it participates. 25. The structure of WHO’s Secretariat assures involvement with countries. Headquarters focuses on issues of global concern and technical backstopping for regions and countries. Regional offices focus on technical support and building of national capacities. WHO’s presence in countries allows it to have a close relationship with ministries of health and with its partners inside and outside government. The Organization collaborates closely with bodies of the United Nations system and provides channels for emergency support. 26. Through its decentralized structure and close working relations with governments, the Secretariat is able to gather health information and monitor trends over time, across countries, regions, and worldwide. 27. WHO is operating in an increasingly complex and rapidly changing landscape. The boundaries of public health action have become less clear, extending into other sectors that influence health opportunities and outcomes. The importance of economic, social, and environmental determinants of health has grown. Demographic and epidemiological transitions now combine with nutritional and behavioural transitions, influenced by globalization and urbanization, to create unfavourable new trends.

A six-item agenda: health development and security, systems and evidence, partnerships and performance 28. In its role as the directing and coordinating authority on international health work, WHO is expected to address, directly or indirectly, the problems outlined above. The complex task of improving world health, for which the strategic objectives provide a structure, can be envisaged as a six-item agenda. Two items address fundamental needs: for health development and health security. Two items are strategic: strengthening health systems and gathering and analysing the evidence needed to set priorities and measure progress. Two items are operational: managing partnerships to achieve the best results in countries, and ensuring that WHO performs well. 29. The clear links between health and development have brought welcome attention, resources, and impetus to international health work. Nevertheless, the multiple activities under way are an added burden in a number of recipient countries. A central role of WHO is to align these activities in ways that avoid duplication, consistently adhere to best technical practices, and have a measurable impact on health outcomes. Such activities need to be firmly rooted in the capacities of recipient countries and driven by their priorities.

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30. At the policy level, health development is directed by the ethical principle of equity: access to life-saving or health-promoting interventions should not be denied for unfair reasons, including those with an economic or social basis. Commitment to this principle ensures that WHO activities aimed at developing health give priority to health outcomes in poor, disadvantaged, or vulnerable groups. This guiding principle applies to, among others, two large populations: women and the African people. The health problems in both groups are multiple, and are addressed by many programmes and partnerships. Changes in the health status of these two groups are an important indicator of the overall performance of WHO. WHO will keep health improvements in these two populations at the forefront of international health policy. 31. The pressing need to address the global burden of communicable diseases is reflected in the formulation of several WHO strategies for expanding interventions to reduce the burden of HIV, tuberculosis, malaria and vaccine-preventable diseases, and to make rapid progress in eradicating, eliminating or controlling diseases such as poliomyelitis, leprosy, dracunculiasis, onchocerciasis, schistosomiasis, and lymphatic filariasis. 32. Several high-level strategies reviewed by Member States will guide the work of the Organization in improving sexual and reproductive health and child health, increasing immunization coverage, and tackling noncommunicable diseases, such as cancer and cardiovascular diseases. Interventions related to the health of mothers and children will be linked through a continuum of care throughout the life-cycle. 33. Population-based, environmental and behavioural approaches will be adopted to reduce such risks to health as obesity, high blood-pressure, harmful use of alcohol, and unsafe sex. Measures consistent with the Framework Convention on Tobacco Control will back up work to reduce tobacco consumption. WHO will also consolidate and expand its work on health promotion, nutrition, food safety, food security, and prevention of injury and violence. 34. Global health security is threatened by emerging and epidemic-prone diseases, which have become a greater menace under conditions prevailing in the current century. Vulnerability to these diseases and their consequences is universal. Application of the revised International Health Regulations (2005) implies a pre-emptive approach to outbreak alert and response, whereby action at the outbreak source can prevent a local event from becoming an international emergency. To ensure collective security under the Regulations, many countries will need support in strengthening core capacities for outbreak detection and response. 35. WHO has established infrastructures and mechanisms for disease-outbreak alert and response, and for addressing other public health emergencies when they arise. Clear responsibilities and time frames for action for WHO, both Member States and Secretariat, are set out in the Regulations. New in the Regulations are provisions for detecting and responding to threats from emerging diseases and the central importance given to surveillance. For example, once poliomyelitis is eradicated, the infrastructure established to ensure surveillance and programme delivery will adapt to the growing needs for outbreak alert and response, and disease surveillance. 36. Abrupt shocks to health can arise from conflicts and natural disasters, especially when routine services are disrupted or infrastructures are damaged. In such situations, WHO is increasingly called upon to ensure continuity of essential care and to prevent outbreaks of epidemic-prone diseases. To meet broader population needs, reforms within the United Nations system aimed at better coordination are continuing to improve the speed and efficiency of responses. 37. WHO has well-tested mechanisms for mitigating the health consequences of emergencies arising from conflicts and natural disasters. In this regard, as the lead agency for the United Nations health cluster, it will continue to work in the context of reform of humanitarian action in the United Nations system, and to strengthen its partnerships with other organizations of the system, national institutions, and nongovernmental organizations.

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38. WHO has, for several years, underlined that the health risks posed by climate change are significant; that they are distributed across the globe and difficult to reverse; and that recent changes in the climate have had a significant and diverse impact on health. It is therefore essential to formulate clear responses that support the protection of human health and ensure that the risk to health is placed at the centre of the debate on climate change. WHO's response will focus on the following actions: assessing the implications of climate change for health and health systems; identifying appropriate and comprehensive strategies and measures for tackling these implications; providing support for appropriate health-sector capacity building; and fostering collaboration with government and nongovernmental partners in order to raise awareness of the health impacts of climate change. 39. Health systems are being required to perform better at a time when the demands on them are increasing. National systems in a number of countries face fundamental weaknesses. Shortcomings exist in infrastructure, financing, human resources, supplies of high-quality essential commodities, and equitable access to services. Numerous health initiatives are geared to delivering outcomes, often for a single disease; such delivery needs a functioning health system. WHO’s work on strengthening health systems will be based on the principle of primary health care and will promote ways to integrate service delivery: better and more equitable health outcomes depend on better service delivery. 40. The primary health care approach provides a reliable and sustainable way to address the pressing health needs of impoverished, disadvantaged, and vulnerable groups. Maternal and child health services have long served as the backbone of primary health care and a platform for other health programmes. Primary health care services are also well placed to deliver sexual and reproductive health services, and address the need for adequate nutrition, especially for children and elderly people. 41. Universal coverage with effective public-health interventions depends on well-functioning health systems. The world health report 20061 highlights the crisis in the global health workforce and identifies steps that countries and partners need to take if health commitments and targets such as those in the Millennium Development Goals are to be met. WHO also will enhance its capacity to provide support to Member States for putting in place strategies to improve other key components of health systems related to financing, information, research and essential medicines and technologies. These strategies will be fully integrated and coordinated with health systems, and will build on opportunities and resources included in priority programmes such as HIV/AIDS and immunization, and maternal health. 42. Evidence underpins the setting of priorities and the measurement of results, and is thus essential for formulating health strategies at both national and global levels. Populations need access to reliable information on health risks and how to avoid them. Evidence also contributes to the protection of public health on a daily basis, and WHO has well-established mechanisms for determining international norms and standards based on the best science. Building on this work WHO will aim to close the gap between knowing what to do and doing it. 43. The management of partnerships has become a high priority for WHO. Although WHO cannot be the principal implementing agency within countries, it is expected to set the global health agenda and to establish best technical practices. Delivery of packages of services in an integrated way contributes to amplifying the health impact of partnerships. 44. The complexity of the public-health landscape requires WHO to operate flexibly, to optimize its capacity for direct contact with ministries of health, and to adapt to changing needs and priorities. The health agenda is set at global level, with headquarters providing best technical practices as guidance for health ministries and international partners. Regional offices focus on specific needs for technical support at regional level, and on the building of national capacities. WHO country offices coordinate work with health ministries and with implementing agencies working at country level.

The world health report 2006. Working together for health. Geneva, World Health Organization, 2006.

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45. The number of stakeholders working in health at both national and international levels has increased. WHO has responded flexibly and rapidly to this evolution. It has helped to ensure that national policy-makers are fully involved in international forums that discuss health-related issues, and that the numerous actors in public health outside government and intergovernmental bodies have forums enabling them to contribute to global and national debates on health-related policy. WHO will continue to use its convening power to stimulate action across different sectors, while building the capacity of governments to play this role nationally. It will take the lead in promoting effective partnerships for health, shaping the global health environment, and operationalizing reform of the United Nations system at global, regional and country levels. 46. To meet the challenges it faces, WHO will continue to evolve as a learning organization and to strengthen its managerial capacity. More integrated, strategic and equitable approaches to financing the programme budget and managing financial resources throughout the Organization will be instituted. More cost-effective ways to provide administrative, information and managerial systems and services will continuously be sought, optimizing the locations from which such services are delivered. The Organization will assure strong accountability mechanisms while supporting collaboration and coordination across its different levels. 47. The core functions of WHO will guide the work of the Secretariat, influence approaches for achieving the strategic objectives, and provide a framework for assuring consistency and output at global, regional and country levels. The core functions are: • providing leadership on matters critical to health and engaging in partnerships where joint action is needed • shaping the research agenda, and stimulating the generation, dissemination and application of valuable knowledge • setting norms and standards, and promoting and monitoring their implementation • articulating ethical and evidence-based policy options • providing technical support, catalysing change and building sustainable institutional capacity • monitoring the health situation and assessing health trends. 48. Expected achievements over the period of the Medium-term strategic plan reflecting the Director-General’s agenda for action, notably health development and security, systems and evidence, partnerships and performance, are described in 13 strategic objectives set out below. They provide clear, measurable and budgeted expected results for the Organization. They also promote collaboration across disease-specific programmes by capturing the multiple links among the determinants of health and health outcomes, policies, systems and technologies. 1. 2. 3. To reduce the health, social and economic burden of communicable diseases To combat HIV/AIDS, tuberculosis and malaria To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals

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To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health To improve nutrition, food safety and food security, throughout the life-course, and in support of public health and sustainable development To improve health services through better governance, financing, staffing and management informed by reliable and accessible evidence and research To ensure improved access, quality and use of medical products and technologies To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively.

10.

11. 12.

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49. The individual strategic objectives should not be viewed in isolation from one another as they reflect WHO’s different but interdependent actions for realizing the “agenda for action”. For example, those that relate to the specific disease interventions are supported by work undertaken to provide evidence and information and to strengthen the capacity of the health system for effective programme delivery. By tackling the social and economic determinants, the underlying conditions and behaviour that impact on health conditions are addressed. 50. The Medium-term strategic plan – an integral element in WHO’s framework for results-based management – translates the Eleventh General Programme of Work’s long-term vision for health into strategic objectives, reflects country priorities (particularly those expressed in country cooperation strategies) and provides the basis for the Organization’s detailed operational planning.

WHO’s framework for results-based management 51. The Eleventh General Programme of Work provides a long-term perspective on the determinants of health and the measures required for improving health while setting forth a global health agenda.1 52. The Medium-term strategic plan 2008–2013 stems from the General Programme of Work. It provides the strategic direction for the Organization for the six-year period, advancing the global health agenda through a multi-biennial framework. It guides preparation of three biennial programme budgets and operational plans through each biennium.

Document A59/25.

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53. The 13 strategic objectives set out above take into account the complementarities between strategic objectives. For example, they recognize that for health interventions effectively to achieve better health outcomes and reduce the burden of disease, it is as essential to strengthen health systems as it is to develop norms and standards for specific diseases and work with other sectors in tackling determinants of health. 54. As confirmed by the analysis of 132 country cooperation strategies, these broad strategic objectives and related expected results provide a flexible programme structure that better reflects the needs of countries and regions. Collaboration throughout the Organization is facilitated by means of Organization-wide teams built around strategic objectives. 55. On the basis of an analysis of the issues and challenges, taking into account the lessons learnt over the past bienniums, examining risks and considering various options, the plan identifies for each strategic objective a series of Organization-wide expected results for which the Secretariat will be accountable over the three bienniums. It provides indicators, targets and resources required for their achievement. Recognizing that flexibility and responsiveness are essential in order to respond effectively to the rapid changes foreseen in health needs and opportunities, WHO will continue to monitor trends and to modify expected results accordingly.

Figure 1. WHO’s framework for results-based management

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56. The Medium-term strategic plan requires technically sound approaches and an enabling environment to support efficient and effective implementation. The enabling environment includes responsive, flexible and efficient internal management of the Organization, and the ability to work strategically with a wide range of partners. Robust accountability mechanisms ensure integrity of the assessment of the Organization’s performance and management of its resources. 57. The programme budgets make the Medium-term strategic plan operational, identifying the scope of activities and specifying achievements expected. For each Organization-wide expected result, they set the targets for individual bienniums, and indicate the resources required for their achievement. 58. The programme budgets are the basis for operational planning. During the operational planning phase, country and regional offices and headquarters identify their contribution towards achieving the Organization-wide expected results. These operational plans, also referred to as workplans, establish the specific products and services that the Secretariat will provide in order to meet its commitments set out in the strategic plan and biennial budgets. In these workplans, time frames and responsibility and accountability for delivering products and services are identified for each organizational entity and level, thus linking strategic objectives and Organization-wide expected results with the organizational structure. 59. Comprehensive reform is under way to improve management of the Organization, the main thrust of which is set out in strategic objective 13. It is captured also in an Organization-wide guide, which is continuously under review to ensure that it effectively addresses the changing needs of the Organization. Managerial reform also is a standing item on the agenda of the Programme, Budget and Administration Committee of the Executive Board. The scope of these reforms spans the results-based management framework, management of financial resources, provision of effective operational support, and assurance of robust accountability.

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60. With the aim of measuring organizational effectiveness, a set of key operational performance indicators are currently under development. These indicators will be used across the Organization to analyse progress in areas such as programme performance, human resource management, financial management, and the promotion of multilingualism. The status of indicators will be regularly reviewed at a high level. Their development and utilization for decision-making and managerial reform are expected to progress steadily over the period of the Medium-term strategic plan. 61. The Organization faces the challenge of working efficiently across different, but related, programme areas, and across its three levels. Organizational processes such as joint planning and peer reviews can facilitate this work, together with collaborative methods that promote interdependence, such as greater staff mobility and rotation across the Organization. 62. As a decentralized organization, efficient and effective programme management requires balancing the need to assure an Organization-wide approach and responsibility, and to recognize regional specificities. Transparent governance mechanisms and common systems and approaches across the Organization will be increasingly adopted, linked to further devolution of decision-making and greater accountability. This trend will be facilitated by moving from managing through tight bureaucratic controls to greater reliance on performance monitoring. 63. Managers will play a crucial role, as they drive change within the Organization. Managers must foster integration and team work, ensure the effective use of resources, build and promote partnerships across the Organization, and provide a model of ethical behaviour. They also manage performance of both programmes and individual staff. WHO’s Global Leadership Programme aims to provide support for these aspects of their work. 64. Accountability is a critical element supporting the results-based management approach. WHO has adopted an accountability framework that brings together aspects of responsibility, accountability and authority, based on overarching principles that ensure good governance. These include having well-understood organizational values, behaviours and aims, managing risk competently, and reporting transparently to all stakeholders. 65. Mechanisms to ensure accountability and integrity in the work of the Organization include programme monitoring and assessment; programme-related evaluations; internal audits; an independent external auditor who reports directly to the Health Assembly; staff and financial regulations and rules; ombudsman functions; mechanisms to ensure internal justice, annual reporting on financial and human resources to governing bodies; and a performance evaluation system for staff. Increased attention is being paid to these important functions, both internally and by key stakeholders.

Effective financing of the Medium-term strategic plan 66. WHO has adopted a results-based management approach to determining resource requirements, with an integrated budget comprising all sources of funding. The costs of achieving the results concerned in a given time frame are therefore financed with funds from different sources. 67. WHO receives its funding principally through assessed contributions from Member States and voluntary contributions. Assessed contributions are gradually becoming a smaller proportion of the total resources received, and there is an increasing reliance upon voluntary contributions provided by a limited number of partners and donors, both large and small. 68. Voluntary contributions to the Organization have risen significantly and now constitute the major source of funding for WHO. This increase is accounted for by a greater awareness, especially within the donor community, of the relationship between development and public health. Further, increasingly frequent “public health crises” attract considerable partner and donor funding. Such crises include outbreaks of communicable diseases (e.g. severe acute respiratory syndrome and avian influenza) together with natural or man-made disasters (e.g. earthquakes, hurricanes, tsunamis and

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wars). Just as the size and characteristics of the demand for international public health assistance have evolved, so has the composition of the donor community financing international public health. Now, in addition to Member States, national overseas development assistance programmes are playing a more important role, and contributions from other multilateral organizations, development banks, and private foundations and charities are increasing.

Figure 2: Trend in the composition of WHO income

69. This evolving situation has also led to the international health and development community increasingly working through partnerships and other collaborative arrangements in which WHO often plays a key role. Several of these partnerships are hosted by WHO and included in the programme budget. However, their budgets and financing are by nature decided in collaboration with and, not solely by WHO. The income for outbreak and crisis response and for partnerships and collaborative arrangements has grown at a greater pace than the corresponding income for WHO programmes. In the biennium 2006-2007 the income for outbreak and crisis response and for partnerships and collaborative arrangements constituted more than one third of total income (see Figure 2). 70. As the different segments of income have different dynamics and different requirements for budget and resource management, allocations and spending in respect of the budget will be monitored, analysed and reported separately for each of the three, segments. This will start from the biennium 2008–2009, taking full effect from the biennium 2010–2011. 71. Financing the Medium-term strategic plan requires efficient management of the different sources of income in order to ensure that resources are made available where needed, for the purpose needed, and when needed. Although WHO has been fairly successful in mobilizing resources, a key challenge remains, namely: ensuring alignment between the activities planned and the resources mobilized. Despite improvements, additional efforts will be required to avoid situations where funds lie idle, or are underutilized, in one programme or location while resources are acutely needed in another. This will require contributors of voluntary funds to provide their resources in a more flexible and predictable manner, and the Organization to strengthen mechanisms for effective resource allocation and monitoring such as the global management system and the advisory group on financial resources, which recommends to the Director-General the allocation of resources on a corporate basis and in a transparent manner.

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72. For the duration of the Medium-term strategic plan, WHO will categorize funds according to the nature of their primary sources: assessed contributions, core voluntary contributions and specified voluntary contributions. The Organization will continue the work with partners and donors to improve the alignment of voluntary contributions with the achievement of results as set out in the programme budget.

Figure 3. Financing the Medium-term strategic plan: three sources of funding

73. Assessed contribution and miscellaneous income. WHO is a Member-State organization with global responsibility for normative technical work; it is therefore essential for the Organization's credibility and integrity that a significant portion of its budget should be financed through assessed contributions. 74. Miscellaneous income is derived mainly from interest earned on assessed-contribution funds, collections of arrears of assessed contributions, and assessed contributions remaining unspent at the end of a biennium. 75. The aim is for assessed contributions to continue to be a key source of financing for the Medium-term strategic plan. 76. Voluntary contributions. Seventy-one percent of the total expenditures in the biennium 2006-2007 were financed from voluntary contributions. Less than a dozen different sources accounted for more than 75% of all voluntary contributions received, with the remaining contributions coming from more than 400 different sources. 77. Most voluntary contributions are received for development work and humanitarian assistance, and come mainly from bilateral and multilateral development agencies and a few private foundations. Although all resources are welcome and indeed essential to execute WHO’s programme of work, the manner in which they are provided can pose a challenge to ensuring proper alignment between the programme budget and its implementation. Further, administering thousands of separate agreements requiring specific reporting significantly increases the transaction costs to the Organization. 78. Working with key partners and donors, WHO is moving towards acquiring a larger share of predictable, unearmarked, core voluntary contributions. This would help to align resources to the priorities of the Organization as determined by the governing bodies through the programme budget; to meet critical funding gaps; and to improve implementation of the programme budget.

14 MEDIUM-TERM STRATEGIC PLAN 2008–2013 (AMENDED)

Figure 4: Stratification of voluntary income by flexibility

79. Core voluntary contributions are those that provide significant flexibility, enabling them to be deployed wherever the most acute financing needs arise. Contributions that are flexible at the programme budget or strategic objective levels and that do not require donor attribution will be managed through the core voluntary contributions account (see Figure 4) overseen by the advisory group on financial resources, which is composed of the Assistant Directors-General and the Directors of Programme Management from the regional offices. 80. The core voluntary contributions account is a key strategic management tool that enables the advisory group on financial resources to improve the alignment between budget and resources, and to optimize delivery of results across the Organization. 81. About 1% of voluntary contributions are provided as fully flexible funds; and between 5% and 6% are provided as highly flexible funds. WHO will seek to at least double the share of these types of funds in financing the Medium-term strategic plan. 82. Contributions that are medium flexible funds, namely those whose application is to a particular Organization-wide expected result, will be managed by Organization-wide technical teams and major offices in accordance with particular needs. Contributions of this type represented about 10% of funding in the biennium 2006-2007. 83. Specified voluntary contributions. Currently the Organization is financed largely from voluntary contributions intended for a specific purpose. In the biennium 2006-2007 specified contributions constituted about 83% of all voluntary contributions received. Although all these contributions are provided with the aim of achieving the defined expected results and are thus critical for implementation of work plans, their limited flexibility and the large proportion of the total financing that they constitute continue to pose challenges to timely implementation and effective resource management.

15 MEDIUM-TERM STRATEGIC PLAN 2008–2013 (AMENDED)

84. In order for the Organization to continue to improve the effectiveness of financing, a robust framework is required for management, monitoring and evaluation. Such a framework should enable the different sources of funding to be better integrated, and should allow for more informed decisionmaking and the continuous fine-tuning of policies, strategies and programmes.

Monitoring, assessment and evaluation 85. A number of instruments within WHO’s results-based management framework serve to monitor, assess, evaluate and deal with potential issues related to performance of the Medium-term strategic plan and associated programme budgets.

Figure 5. Monitoring, assessment and evaluation instruments

86. Programmatic and financial implementation is monitored on the basis of operational plans (workplans) at least every six months throughout the biennium. This serves to review and adjust where needed the implementation of specific activities in light of the programmatic and financial situation. 87. An Organization-wide mid-term review is carried out at the end of the first year of each biennium, which assesses progress at each WHO office towards achievement of the specific results for which each is accountable. The mid-term review complements the unaudited financial report. 88. Programme budget performance is assessed at the end of the biennium and complements the audited financial report submitted at the same time. The assessment report provides an Organizationwide summary of the programmatic performance of the Secretariat, including in respect of the achievement of indicator targets, along with the broader lessons learnt across the Organization. 89. The Medium-term strategic plan is monitored through the assessment of programme-budget performance. At the end of the six-year period, the extent to which the 13 strategic objectives have been achieved will be assessed. Data on the strategic-objective indicators will be collected to establish the degree to which the targets have been reached. Performance will be analysed and the main achievements in delivery of the strategic objectives, factors contributing to, or impeding, success, and lessons learnt will be summarized to help in drawing up subsequent strategic plans.

16 MEDIUM-TERM STRATEGIC PLAN 2008–2013 (AMENDED)

90. The framework also includes the periodic evaluation of WHO’s programmes, which assess the outcomes of WHO’s work along the lines of thematic, programmatic or country evaluations. 91. Mechanisms such as peer reviews are employed in both the planning and monitoring phases of results-based management so as to ensure a high level of quality throughout the Organization. Collective reviews by senior management, along with the governing bodies, also serve to identify emerging needs, potential performance issues, and ensuing re-prioritization during the six-year period. 92. The General Programme of Work will also be monitored. Priorities will be assessed in depth, and WHO’s core functions monitored to ensure their continuing relevance, and the quality and influence of WHO’s work. 93. The impact of the work of WHO to the health of the people of Africa and the health of women, to which the Director-General has drawn particular attention,1 will be monitored specifically.

See paragraph 30.

WPR/RC59/4 ANNEX 2

DRAFT PROPOSED PROGRAMME BUDGET 2010-2011

RC/2008/2

DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

CONTENTS

Page INTRODUCTION........................................................................................................................... STRATEGIC OBJECTIVES .......................................................................................................... 1. 2. 3. 4. To reduce the health, social and economic burden of communicable diseases ....................................................................................................................... To combat HIV/AIDS, tuberculosis and malaria........................................................ To prevent and reduce disease, disability and premature death from chronic 25noncommunicable conditions, mental disorders, violence and injuries and visual impairment ....................................................................................................... To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals ............................................................................... To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact. ........................................ To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex ................................. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches ............................................ To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health........................................................................................................... To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development. ................................... To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research ................. To ensure improved access, quality and use of medical products and technologies .. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work............................................. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively ......................... 1 11

11 16 21

25 31 35 39 42 46 50 57

5. 6. 7. 8. 9. 10. 11. 12.

60 63

13.

Financial tables Summary table 1. Proposed programme budget by strategic objective and major office, 2010–2011 ........................................................................ Summary table 2. Proposed programme budget by strategic objective, organizational level and source of financing, 2010–2011...................... Summary table 3. Budget by strategic objective, major office and source of financing, 2010–2011 ........................................................................ Summary table 4. Individual partnerships and collaborative arrangements included in the Proposed programme budget by strategic objective, 2010–2011..... Summary table 5. Partnership and collaborative arrangements – movements between 2008–2009 and 2010–2011...................................................... - iii -

68 70 71 78 79

DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Page Annex Partnerships outside the programme budget 2010–2011 envelope ....................................... Biennial budgets of partnerships outside the programme budget 2010–2011 ...................... Alliance for Health Policy and Systems Research ................................................................ Global Health Workforce Alliance ....................................................................................... Health Metrics Network ........................................................................................................ Partnership for Maternal, Newborn and Child Health........................................................... Roll Back Malaria Partnership .............................................................................................. Secretariat of the Framework Convention on Tobacco Control............................................ Stop TB Partnership .............................................................................................................. Global Drug Facility.............................................................................................................. United Nations System Standing Committee on Nutrition ................................................... International Drug Purchase Facility, UNITAID .................................................................. Water Supply and Sanitation Collaborative Council ............................................................ 81 82 83 84 85 86 87 88 90 92 94 95 96

- iv -

1 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

INTRODUCTION WHO’s Draft Proposed programme budget 2010–2011 presents the expected results and budget requirements for the biennium 2010–2011 within the broader context of the Organization’s Mediumterm strategic plan, which covers the six-year period 2008–2013. The strategic plan defines the strategic objectives for WHO, and details the Organization-wide expected results for the Secretariat for the period. The overarching priorities for health are described in the Eleventh General Programme of Work 2006–2015, which also reflects WHO’s comparative advantages, its core functions, the main challenges it faces and its opportunities for the future. Since the Medium-term strategic plan lays out the strategic direction of WHO for 2008–2013, the Organization-wide expected results for 2010–2011 remain largely the same as those for the biennium 2008–2009. However, the Programme budget 2010–2011 includes some shifts in emphasis, reflecting the evolving global health situation and the corresponding changes needed in WHO’s work. The changes in emphasis of some strategic objectives are described in the amended Medium-term strategic plan. The result of an external review of the indicators of the Medium-term strategic plan has also shown that there is a need for improvement in the effort to make the indicators more measurable and meaningful.1 The revised indicators are shown for the individual strategic objectives. Budgetary implications of partnerships and outbreak and crises response Partnerships Recent discussions at meetings of WHO’s governing bodies have highlighted the importance, and also the complexity, of the global health architecture, including partnerships and the need to consider coordination and harmonization among the various parties. In the Programme budget 2008–2009 a number of partnerships were noted but this was not an exclusive list and their contribution to the delivery of the Organization-wide expected results was not defined. As the major partnerships usually have independent governance mechanisms, it was also unclear how changes in the budget levels of these partnerships affected the overall WHO programme budget. With a view to increasing the transparency of partnerships within the global governance of WHO, including their budget management, an analysis was undertaken of all the Organization’s partnerships and collaborative arrangements – 97 in total. The results indicated that the group was highly heterogeneous, ranging from large partnerships with a considerable degree of independence but administratively hosted by WHO, to other entities having the characteristics of internal expert groups or advocacy arrangements. Within the full grouping there is an identifiable subset involving major partnerships and collaborative arrangements that can be broadly divided in two groups: (i) those partnerships that contribute directly to the achievement of the Organization-wide expected results and follow the results hierarchy of the WHO programme budget, and which are therefore considered entirely inside the programme budget envelope; and (ii) those partnerships that do not contribute to the results hierarchy but which nonetheless have a strong link with WHO. Although the importance of these latter partnerships is recognized for the achievement of the strategic objectives of the Medium-term strategic plan, their budgets are outside the WHO programme budget envelope for the biennium 2010–2011.

The improvement of indicators will be incremental and there may be further refinement in subsequent versions of the Draft Proposed programme budget 2010–2011.

2 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Eleven such partnerships and collaborative arrangements outside the programme budget envelope are listed in Annex 1. The annex provides an explanation of their strategic approaches as well as the scope of their work and their synergy and coordination with WHO for the biennium 2010–2011.1 The partnerships and collaborative arrangements that are considered within the WHO programme budget envelope have increased their share of the total budget and it is recognized that a separate approach to budget management needs to be taken in their case. Over the last bienniums the budget growth of these partnerships has been difficult to predict and their total contribution to the overall WHO budget has not been clear. Outbreak and crisis response WHO has been playing an increasingly important role in outbreak and crisis response, and the activities concerned and their budgetary implications are by their very nature unpredictable. This has again led to budgetary increases that have not been fully distinguished from other types of increases. In recognition of the budgetary considerations mentioned above, the Draft Proposed programme budget 2010–2011 is presented in three segments. This segmentation applies both to the initial budget presentation and to budget management during the biennium. The three segments are: – WHO programmes – Partnerships and collaborative arrangements – Outbreak and crisis response In order to provide greater transparency and improve WHO’s monitoring, management and implementation of the programme budget, outbreak and crises response and partnerships and collaborative arrangements will be tracked and reported on separately. This will begin in the biennium 2008–2009, and will take full effect from the biennium 2010–2011. This segmentation has implications of varying complexity for the different technical strategic objectives. Four strategic objectives (numbers 3, 7, 9 and 11) are composed only of WHO programmes and have no components involving partnerships and collaborative arrangements; nor are these strategic objectives affected by crisis response. Conversely, strategic objectives 1 and 5 contain all three budget segments. Level of the Draft Proposed programme budget 2010–2011 The budgets of WHO have been increasing consistently over the past four bienniums, rising from US$ 1800 million in the biennium 2002–2003 to US$ 4200 million in the biennium 2008–2009. There is a growing recognition that the Organization needs to consolidate its growth and strengthen its implementation capacity, while at the same time ensuring there is a continuing focus on priorities. With that in mind, the Draft Proposed programme budget 2010–2011 has initially been established at the same nominal value as the baseline of the WHO programme segment of the revised programme budget for the biennium 2008–2009. In December 2007 the operational plans for the biennium 2008–2009 reflected the developments that had taken place and the increased demand registered since the approval by the Sixtieth World Health Assembly of the Programme budget 2008–2009. This was particularly evident in the partnership segment; however, it was also the case, albeit to a lesser extent, for the WHO programme segment.

The question of which partnerships should be included in the WHO programme budget envelope and which should remain outside is still under discussion.

3 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

On the basis of this analysis, the WHO programme segment of the Draft Proposed programme budget 2010–2011 is initially set at US$ 3888 million, showing no increase as compared with operational plans for the biennium 2008–2009. The relative distribution between headquarters and the regions is unchanged within this budgetary provision. This strategic decision is in line with the Director General’s commitment to maintain budgetary discipline and exercise restraint in line with the Organization’s capacity to scale up implementation. Within this overall budget envelope the Organization, (countries, regions and headquarters) has developed budget proposals across the 13 strategic objectives. The partnership and collaborative arrangement segment within the programme budget stands at US$ 747 million in the biennium 2008–2009; it has grown to US$ 1050 million for the biennium 2010–2011. The outbreak and crisis response segment is also estimated to increase against the level for the biennium 2008–2009. However, the budget for that segment has not been included at this point in view of the unpredictability of the needs concerned. These will be estimated nearer in time to the implementation of the Programme budget 2010–2011 and reported back to the governing bodies. More generally, the governing bodies will, at regular intervals, be kept abreast of developments concerning the budget of the outbreak and crisis response segment. Table 1. illustrates the problems with predicting the Organization’s response to outbreaks and crisis well in advance, and shows the steady increase in the budget value of partnerships and collaborative agreements. The lack of clarity on the full budgetary contribution of partnerships within the programme budget envelope has hitherto been a constraint in the overall budgetary process. It has become difficult to compare partnerships’ budgets across bienniums since in the past these were not delineated and because there are budgetary movements as new partnerships are created and others become less important. Table 1. Expenditure for the Programme budgets 2006–2007, 2008–2009 and for the Proposed programme budget 2010–2011 in budget segments. Budget segments 2006–2007 Actual 2008–2009 Approved budget Revised budget 2010–2011 (before currency adjustments) 3888.0 1049.9 0.0 4937.9

WHO programmes Partnerships and collaborative arrangements within the budget envelope Outbreak and crisis response Grand total

2103.2 705.0 290.0 3098.2

3741.7 369.9 115.9 4227.5

3888.4 747.0 316.2 4951.6

Partnerships and collaborative arrangements contribute more significantly to the achievement of some strategic objectives. Within strategic objective 1 the largest single component concerns the Global Polio Eradication Initiative, representing US$ 389 million. Details on the individual partnerships can be found in Summary Tables 4 and 5.

4 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Table 2. Proposed programme budget 2010–2011 by strategic objective (broken down by budget segment and compared with the approved Programme budget 2008–2009). Programme budget 2008–2009 (WHO programmes) Approved WHO programmes 2008–2009 Revised WHO programmes 2008–2009

Proposed programme budget 2010–2011 (before currency adjustments) Proposed WHO programmes 2010–2011 Change over approved Programme budget 2008–2009 % Partnerships and collaborative arrangements Outbreak and crisis response Total Programme budget 2010–2011

Strategic objectives 1 2 3 4 5 6 7 8 9 10 11 12 13 Total 625.2 634.6 158.1 319.2 134.0 162.1 65.9 130.5 126.7 494.6 134.0 214.3 542.4 3741.6 677.2 658.0 157.1 314.1 134.1 167.9 66.6 136.6 121.4 506.8 161.9 244.3 542.4 3888.4 664.3 653.7 161.8 313.7 123.7 164.1 71.9 145.5 118.9 510.2 160.7 253.9 545.6 3888.0

6.3 3.0 2.3 -1.7 -7.7 1.2 9.1 11.5 -6.2 3.2 19.9 18.5 0.6 3.9

878.7 78.0 40.5 3.0 13.0 1.2 35.5 1049.9

Note n.a n.a n.a Note n.a n.a n.a n.a n.a n.a n.a n.a Note 1

1543.0 731.7 161.8 354.2 126.7 177.1 71.9 146.7 118.9 545.7 160.7 253.9 545.6 4937.9

Although the WHO programme segment is unchanged in nominal terms between the biennium 2008–2009 and the biennium 2010–2011, Table 2 illustrates that some adjustments have been made between the strategic objectives in order to reflect increased emphases on the following: • Strategic objectives 3 and 6 as a result of the endorsement by the Sixty-first World Health Assembly of the action plan for the global strategy for the prevention and control of noncommunicable diseases2 • Strategic objective 7 in response to the recommendations of the Commission on Social Determinants of Health • Strategic objective 8 in order to accommodate the additional emphasis on climate change • Strategic objective 10 in support of WHO’s effort to revitalize primary health care, which is the focus of the World health report 2008 • Strategic objective11 in order to support prequalification and quality control of medicines • Strategic objective 12 in order to accommodate the increased number of meetings of the governing bodies and increased country presence.

The outbreak and crisis budget will be determined nearer the time of implementation. It will start at a low level and is likely to increase throughout the biennium 2010–2011. 2 Resolution WHA61.14.

5 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

In pursuance of the Organization’s strategy to strengthen the first-line support provided to countries with adequate back-up at regional and global levels, the major part of the programme budget will be spent in regions and countries while maintaining headquarters functions. The “70%–30%” principle continues to guide the overall distribution of resources between regions/countries and headquarters, with the understanding that there will be variations between the strategic objectives and their underlying programmes depending on the nature of the programmes concerned. The budget distribution between the individual regions is unchanged for the WHO programme segment and reflects regional needs in line with the ranges from the validation mechanism for strategic resource allocation reviewed by the Executive Board 1 (see Figure 1). Table 3. Proposed programme budget 2010–2011 by major office broken down by budget segment.

Location (major office)

Total approved Programme budget 2008–2009 US$ million

Proposed programme budget 2010–2011 (before currency adjustments) Total WHO Partnerships and programme programmes collaborative budget arrangements US$ million 1451.0 277.0 568.0 278.1 485.4 348.4 1530.0 4937.9 1026.0 272.0 459.0 268.0 433.0 322.0 1108.0 3888.0 425.0 5.0 109.0 10.1 52.4 26.4 422.0 1049.9

Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters Total

1193.9 278.5 491.5 274.8 465.0 347.9 1175.9 4227.5

Figure 1. Distribution between regions and headquarters of the budget segment for WHO programmes for the biennium 2010–2011 (excluding partnerships and collaborative arrangements and outbreak and crisis response)

See document EBSS-EB118/2006/REC/1, summary record of the fourth meeting, section 4.

6 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Mechanisms of financing the Programme budget 2010–2011 Strategic objectives 1 to 11 are financed from both assessed and voluntary contributions, although voluntary contributions account for an increasing share of the total funding. Voluntary contributions received by the Organization vary greatly in the degree to which they are earmarked for specific activities, in their predictability and in the time of their receipt. The voluntary contributions with both the least earmarking and a high level of predictability are obviously the easiest for WHO to align to its priorities and financing needs. The greater the earmarking of voluntary contributions, the more difficult it is for the Organization to fully finance all aspects of its work. It is encouraging that the number of donors contributing core voluntary contributions has increased since 2006. It is hoped that this trend will continue as the management of these funds becomes more refined and as donor confidence in WHO’s results-based management approach increases. Core voluntary contributions An important financing and management mechanism has been established, namely, the core voluntary contributions account. This account will manage those core voluntary contributions that are either fully flexible or flexible at strategic objective level. The account will help to ensure that funds are available to implement the programme budget so that the integrity of the strategic objectives and Organization-wide expected results is maintained, and so that there is a better programmatic delivery of the totality of the Medium-term strategic plan. The oversight of the core voluntary contributions account lies with the advisory group on financial resources. Discussions with major donors and partners have indicated growing support for this mechanism and the aim is to ensure approximately US$ 300 million of such highly flexible funds for the biennium 2010–2011. Core voluntary contributions that are specified to the level of Organization-wide expected results are referred to as “designated core voluntary contributions”. Such funds are managed through the Organization-wide technical programmes and networks in order to ensure efficient and timely delivery of the expected results. Designated core voluntary contributions are estimated at about US$ 400 million for the biennium 2010–2011. Oversight of the core voluntary contributions is exercised by the advisory group on financial resources. This group of senior WHO staff is in charge of monitoring financial and technical implementation of the programme budget and makes recommendations to the Director-General on corporate resource allocation. Other voluntary contributions In addition to the total of US$ 700 million of core voluntary contributions, about US$ 3500 million is expected to be raised in the form of specified contributions (Table 5). The expectation that the Organization will be able to mobilize the proposed level of voluntary contributions is considered justified on the basis of current trends. Strategic objectives 12 and 13 Successful implementation of WHO’s programme budget requires adequate financial, programmatic, infrastructure, monitoring, and accountability mechanisms. A proportion of the operating costs of these mechanisms is directly attributable to the programmes and their expected results, and is therefore part of the respective strategic objective budgets. However, other administrative and managerial functions are fixed and cannot be directly attributed to technical programmes. These include, within strategic objective 12, the governance mechanisms of the Organization including the various meetings of the governing bodies. The latter involve both statutory meetings and those arising from new emerging issues, such as the Intergovernmental Working Group on Public Health, Innovation and

7 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Intellectual Property. Functions such as legal services, the Ombudsman and the office of the Internal Auditor are also budgeted in this strategic objective. Strategic objective 12 also includes the work of the senior officers of the Secretariat throughout the Organization and associated costs. This includes country representatives, Regional Directors, Directors of Programme Management, Assistant Directors-General and the Office of the Director General. Strategic objective 13 includes costs for financial management, information technology, human resources, procurement, planning and performance management, building management and infrastructure, staff development and learning, and security. The growth in the Organization and its budget in recent years has placed increased demands on management and administrative support functions. In order to meet these demands some cost efficiencies have been made and further efforts are planned for the biennium 2010–2011. However, it is clear that any additional reduction in the resources available for administrative functions will affect the Organization’s ability to achieve its technical objectives. A proportion of voluntary contributions, referred to as “programme support costs”, is used to cover the costs incurred in implementation and in financing the administrative support services that underpin effective achievement of the expected results in all strategic objectives. In keeping with the authority given to the Director-General in both the Financial Regulations and Health Assembly resolutions, programme support costs of 13% are levied in order to help to meet the budgetary requirements of strategic objectives 12 and 13, together with these indirect costs. However, in practice, it has proven impossible to reach the 13% target. This is explained by the large number of exceptions, including a standard reduced cost for emergencies and crises and for the programme against poliomyelitis, as well as the general pressure on the United Nations system to reduce its charges for programme support costs. The current average collection rate amounts to only 7% of the overall voluntary contributions. This insufficient rate has lead to a financing gap for strategic objectives 12 and 13. The cost of delivering the administrative services has been increasing as a result of the growth in WHO’s level of operations. This increase has been exacerbated by the falling value of the dollar and has been particularly critical to the financing of support functions, given the high preponderance of costs at headquarters in Switzerland, which are denominated in Swiss francs. Similar situations exist in several of the regional offices but to varying extents. In view of this, during the biennium 2010–2011, the two instruments described below will be employed in order to close the financing gap. • An increased proportion of the assessed contributions will be applied to strategic objectives 12 and 13. At all locations, a minimum of 60% of the budget of these two strategic objectives should be financed from assessed contributions. • A mechanism for common administration costs, set initially at 2.5%, will be established. This income source is within the budgets of strategic objectives 1 to 11 and will be used for financing the following corporate management and administrative functions: United Nations common charges including security; real estate, exchange rate hedging; the global service centre; insurance costs and global information technology. Adjustments for currency fluctuations If expenditure financed by dollar income is to remain unchanged, such income will have to be adjusted upwards. In this way, the same amount of local currencies can continue to be purchased. WHO incurs expenditures in many currencies, and to the extent that these expenditures are financed by United States dollar income sources (assessed contributions and voluntary contributions in United States dollars), the dollar cost of these expenditures in the biennium 2010–2011 will be higher than in the biennium 2008–2009. This is the continuation of a trend that has been visible over the last three bienniums.

8 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Table 4. Estimated impact of exchange rate change on Programme budget 2010–2011 compared with exchange rate used for preparing Programme budget 2008–2009 Exchange rate at May 2006 Impact of exchange rate change (US$ million) US$ financed component of total budget Assessed contributions Voluntary contributions Subtotal US$ financed Financed in other currencies Total Programme budget Exchange rate at June 2008

929 1077 2006 2932 4938

301

23071 2932 5239 15%2

US$ currency fall as weighted average of WHO cash flows In Table 4 calculations are presented showing:

(i) The total component of United States dollar-based income, within the overall programme budget, based on the proposed level of assessed contributions, and expectations of donor agreements concluded in United States dollars. (ii) The weighted average fall in the value of the United States dollar against the currency of expenditure in each major office location within WHO. The exchange rates used for this purpose are those that prevailed at the time of preparation of the Programme budget 2008–2009 and those of June 2008. This assumes that June 2008 exchange rates will approximate to those during the biennium 2010–2011; however, given that there will be further exchange rate movement, and that it is impossible to forecast accurately future exchange rates, it is proposed that these calculations be subject to further review, in the event that there are further significant exchange rate movements before the Programme budget 2010–2011 has been finalized. (iii) Location-specific exchange rate movements have been weighted in accordance with the planned overall budget percentage distribution between offices. Table 4. indicates that an amount of US$ 301 million is required to ensure that the same absolute (nominal) values of local currency expenditures as those budgeted for the biennium 2008–2009 can be met across the Organization. This is before taking into consideration any inflation affecting activity cost increases or salary increases. Given that global inflation is on a sharply upward trend (current global inflation is running at 5.7% according to the World Bank), even this figure of US$ 301 million therefore falls significantly short of the amount required for zero real-terms maintenance in the value of WHO’s budget for the biennium 2010–2011, compared with the current biennium.

Exchange rate impact is assumed uniquely on that component of the total income in United States dollars and for which expenditures are incurred in the currencies of each of the major offices, in proportion to the overall budget distribution. For example, the United States dollar-denominated share of the budget allocation to headquarters is 28.5%, or US$ 572 million of the total US$ 2006 million. This financing is used to pay expenses denominated in Swiss francs, or that are correlated to the Swiss franc (e.g. salaries of staff members in the professional category). 2 Currency fall calculated between May 2006, being exchange rates at the time of preparation of the Programme budget 2008–2009, and exchange rates at June 2008. This analysis excludes further potential exchange rate costs associated with the fall in value of other significant income currencies versus currencies of expenditure, most notably the United Kingdom pound.

9 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Income projections for the Programme budget 2010–2011 Translating this US$ 301 million to the level of the overall approved Programme budget 2008–2009 so as to maintain the same nominal value requires an additional 7.1% increase. It is proposed that this increase be applied in the same proportion to both assessed and voluntary contributions so as to maintain the same proportionality between these different sources of financing. For assessed contributions this translates into an additional US$ 56.6 million. Thus the nominal level of assessed contributions amounting to US$ 985.4 million is proposed for the biennium 2010–2011, and an amount of US$ 4253.5 million will need to be raised from voluntary contributions. This will give a total budget of US$ 5238.9 million. Miscellaneous income, which is derived mainly from interest earnings on assessed contributions, collection of arrears of assessed contributions, and unspent assessed contributions at the end of a biennium, will no longer be included in the programme budget, but will instead be subject to separate appropriation by Member States, based on the actual income available in the year following recognition of income. Miscellaneous income is traditionally difficult to estimate, owing to the multiple, unpredictable sources involved, and it is therefore difficult to include on a forward-looking basis in the budget. Table 5. Proposed programme budget 2010–2011: financing compared with actual expenditures in the biennium 2006–2007 and the approved Programme budget 2008–2009 Source of income Actual expenditures 2006–2007 Approved Programme budget 2008–2009 US$ million 928.8 30.0 29.0 958.8 22.7 Proposed programme budget 2010–2011 US$ million 928.8 0.0 928.8 18.8 % Proposed programme budget 2010–2011 (currency adjusted) US$ million 985.4 0.0 985.4 18.8

US$ million Assessed contributions Miscellaneous income Total assessed contributions Flexible core voluntary contributions Designated core voluntary contributions Specified voluntary contributions Total voluntary contributions Total financing 863.3 35.3 898.6

150.0

300.0

220.0

300.0

400.0

1829.6 2199.6 3098.2 71.0 100.0

2668.7 3268.7 4227.5 77.3 100.0

3309.1 4009.1 4937.9 81.2 100.0

3553.5 4253.5 5238.9 81.2 100.0

The distribution of the overall currency adjustment with respect to headquarters and the regions will be determined nearer the date of implementation depending on the effect of the currency fluctuation at the location in question. Included in the total financing needs is the budgeted US$ 1049.9 million for partnerships and collaborative arrangements that are expected to be financed from specified voluntary contributions (see Table 1).

10 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Monitoring the programme budget Performance monitoring and assessment are essential for the proper implementation of the programme budget and for informing the revision of policies and strategies. Monitoring and assessment of the programme budget are Organization-wide processes conducted at the 12-month, mid-term period (the mid-term review) and upon completion of the biennium (the programme budget performance assessment). The documents resulting from the review and the assessment are both submitted to the governing bodies for their consideration. The mid-term review serves to track and appraise progress towards achievement of the expected results. It facilitates corrective action, and the reprogramming and reallocation of resources during implementation. For each strategic objective, colour ratings are assigned (red, yellow or green) in order to indicate progress in achieving the expected results at the mid-term. The review also describes the impediments, problems and risks encountered, together with the actions required to ensure that the expected results are achieved. The end-of-biennium programme budget performance assessment is a comprehensive appraisal of the performance of each organizational level and of the Organization as a whole, including the achievement of the targets set for the expected result indicators. The assessment focuses on achievements as compared with planned results, and on lessons learnt, in order to inform planning for the next biennium. The relevant findings provide essential information for subsequent programme budgets and for possible revisions to the Medium-term strategic plan. The performance assessment for the biennium 2006–2007 has noted the lessons learnt and these have informed the formulation of the Draft Proposed programme budget 2010–2011. The set of indicators for all Organization-wide expected results in the Medium-term strategic plan 2008–2013 has been carefully and systematically reviewed with the aim of improving clarity and facilitating measurement and reporting. Most of the indicators have been refined; some have been replaced when it was considered that they unable to provide an adequate measurement of the stated result. The refinement and tracking of indicators across all levels of the Organization represents an incremental process and work undertaken in the current biennium will also lead to improvements in processes and tools for the biennium 2010–2011.

11 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 1 To reduce the health, social and economic burden of communicable diseases Scope The work under this strategic objective focuses on prevention, early detection, diagnosis, treatment, control, elimination and eradication measures to combat communicable diseases that disproportionately affect poor and marginalized populations. The targeted diseases include but are not limited to: vaccine-preventable, tropical, zoonotic and epidemic-prone diseases, excluding HIV/AIDS, tuberculosis and malaria. Links with other strategic objectives • Strategic objectives 2, 3, 4, 6 and 9: in relation to integrated disease control, surveillance and harmonized research initiatives. • Strategic objective 5: in relation to mutual support in field operations and health security. • Strategic objective 8: in relation to the adoption of adequate solutions for management of health-care waste. • Strategic objective 9: in relation to water and sanitation aspects of zoonotic diseases. • Strategic objective 10: in relation to the implementation of programmes through financially sustainable health-system approaches. • Strategic objective 11: in relation to access to safe and effective vaccines, medicines and interventions, as well as quality assurance of diagnostics and laboratory services. Major WHO partnerships and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope • Effective collaboration with GAVI partners • Global Poliomyelitis Eradication Initiative • Partnership for the control of neglected tropical diseases • Special Programme for Research and Training in Tropical diseases • Vaccine research partnerships • Tri-partite Agreement WHO-FAO-OIE on avian influenza management and other emerging diseases

12 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

Total budget by location for the strategic objective for 2010–2011 (US$ thousand) Africa The Americas South-East Asia Budget (US$ thousand) Europe Eastern Mediterranean Western Pacific Headquarters TOTAL

605.0

34.4

209.0

38.7

155.7

84.4

415.8

1543.0

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 1.1 Policy and technical support provided to Member States in order to maximize equitable access of all people to vaccines of assured quality, including new immunization products and technologies, and to integrate other essential childhealth interventions with immunization. Africa

INDICATORS 1.1.1 Number of Member States with at least 90% national vaccination coverage (DTP3) BASELINE 2010 130 TARGETS TO BE ACHIEVED BY 2011 140

1.1.2 Number of Member States that have introduced Haemophilus influenzae type b vaccine in their national immunization schedule

135

150

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

345.1

1.2 Effective coordination and support provided in order to achieve certification of poliomyelitis eradication, and destruction, or appropriate containment, of polioviruses, leading to a simultaneous cessation of oral poliomyelitis vaccination globally. Africa

INDICATORS 1.2.1 Percentage of final country reports demonstrating interruption of wild poliovirus transmission and containment of wild poliovirus stocks accepted by the relevant regional commission for the certification of poliomyelitis eradication BASELINE 2010 75% TARGETS TO BE ACHIEVED BY 2011 98%

1.2.2 Percentage of Member States using trivalent oral poliovirus vaccine that have a timeline and strategy for eventually stopping its use in routine immunization programmes

75%

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

478.1

13 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

1.3 Effective coordination and support provided to Member States in order to provide access for all populations to interventions for the prevention, control, elimination and eradication of neglected tropical diseases, including zoonotic diseases.

INDICATORS 1.3.1 Number of Member States certified for eradication of dracunculiasis

1.3.2 Number of Member States that have eliminated leprosy at subnational levels

1.3.3 Number of reported cases of human African trypanosomiasis for all endemic countries

1.3.4 Number of Member States having achieved the recommended target coverage of population at risk of lymphatic filariasis, schistosomiasis and soil-transmitted helminthiases through regular anthelminthic preventive chemotherapy

BASELINE 2010 79

10 000

TARGETS TO BE ACHIEVED BY 2011 82 13

8 500

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

191.8 1.4 Policy and technical support provided to Member States in order to enhance their capacity to carry out surveillance and monitoring of all communicable diseases of public health importance INDICATORS 1.4.1 Number of Member States with surveillance systems and training for all communicable diseases of public health importance for the country

1.4.2 Percentage of Member States for which WHO/UNICEF joint reporting forms on immunization surveillance and monitoring are received on time at global level in accordance with established time-lines

BASELINE 2010 80 TARGETS TO BE ACHIEVED BY 2011 150

135

150

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

122.5 1.5 New knowledge, intervention tools and strategies that meet priority needs for the prevention and control of communicable diseases developed and validated, with scientists from developing countries increasingly taking the lead in this research. Africa

INDICATORS 1.5.1 Number of new and improved tools or implementation strategies, developed with significant contribution from WHO, introduced by the public sector in at least one developing country

1.5.2 Proportion of peer-reviewed publications based on WHO-supported research where the main author’s institution is in a developing country

BASELINE 2010 4 TARGETS TO BE ACHIEVED BY 2011 9

55%

58%

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

117.7

14 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

1.6 Support provided to Member States in order to achieve the minimum core capacities required by the International Health Regulations (2005) for the establishment and strengthening of alert and response systems for use in epidemics and other public health emergencies of international concern. Africa

INDICATORS 1.6.1 Number of Member States that have completed the assessment and developed a national action plan to achieve core capacities for surveillance and response in line with their obligations under the International Health Regulations (2005)

1.6.2 Number of Member States whose national laboratory system is engaged in at least one external quality-control programme for epidemicprone communicable diseases

BASELINE 2010 180 TARGETS TO BE ACHIEVED BY 2011

135

160

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

64.2

1.7 Member States and the international community equipped to detect, assess, respond to and cope with major epidemic and pandemic-prone diseases (e.g. influenza, meningitis, yellow fever, haemorrhagic fevers, plague and smallpox) through the development and implementation of tools, methodologies, practices, networks and partnerships for prevention, detection, preparedness and intervention. Africa

INDICATORS 1.7.1 Number of Member States having national preparedness plans and standard operating procedures in place for readiness and response to major epidemic-prone diseases

1.7.2 Number of international coordination mechanisms for supplying essential vaccines, medicines and equipment for use in mass interventions against major epidemic and pandemic-prone diseases

BASELINE 2010 135 TARGETS TO BE ACHIEVED BY 2011 165

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

163.3

15 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

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

INDICATORS 1.8.1 Number of WHO locations with the global event-management system in place to support coordination of risk assessment, communications and field operations for headquarters, regional and country offices

1.8.2 Proportion of requests for assistance from Member States for which WHO mobilizes coordinated international support for disease investigation and containment efforts, characterization of events, and sustained containment of outbreaks

BASELINE 2010 60 TARGETS TO BE ACHIEVED BY 2011 90

100%

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

60.3

1.9 Effective operations and response by Member States and the international community to declared emergencies situations due to epidemic and pandemic prone diseases. Africa

INDICATORS 1.9.1 Proportion of declared emergency situations due to epidemic and pandemic prone diseases where operations have been implemented in a timely fashion BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

16 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 2 To combat HIV/AIDS, tuberculosis and malaria Scope Work under this strategic objective will focus on: scaling up and improving prevention, treatment, care and support interventions for HIV/AIDS, tuberculosis and malaria so as to achieve universal access, in particular for seriously affected populations and vulnerable groups; advancing related research; removing obstacles that block access to interventions and impediments to their use and quality; and contributing to the broader strengthening of health systems. Links with other strategic objectives objective 1: particularly work related to delivery of interventions; strengthening research capacity and expanding access to new strategies and tools, such as vaccines; and strengthening systems for monitoring and surveillance of communicable diseases. • Strategic objective 3: particularly work relating to HIV and mental health • Strategic objective 4: particularly efforts related to supporting research and development of new tools and interventions; meeting specific needs of children, adolescents and women of child-bearing age; formulation and implementation of gender-sensitive interventions; and tackling sexually transmitted infections. • Strategic objective 6: specifically relating to prevention of tobacco use and its relationship with tuberculosis; and prevention of unsafe sex. • Strategic objective 7: specifically work relating to approaches that enhance equity and are propoor, gender-responsive, ethical and human rights based. • Strategic objective 8: particularly relating to environmental health and its relationship with malaria • Strategic objective 9: particularly work in the area of nutrition and its relationship to HIV/AIDs • Strategic objective 10: particularly efforts related to organization, management and delivery of health services; areas of human resource capacity strengthening, integrated training and widening of service provider networks; work related to minimizing the potential of financial catastrophe and impoverishment due to out-of-pocket health expenses. • Strategic objective 11: specifically work related to essential medicines, medical products and technologies for the prevention and treatment of HIV/AIDS, tuberculosis and malaria. • Strategic objective 12: specifically work related to health knowledge and advocacy material made accessible to member states. • Strategic

Major WHO partnerships and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope • HIV

Vaccine Initiative (including AAVP) Programme for Research, Development and Research Training in Human Reproduction • Special Programme for Research and Training in Tropical Diseases • Special

17 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

242.0

48.2

105.0

30.5

52.0

53.0

201.0

731.7

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 2.1 Guidelines, policy, strategy and other tools developed for prevention of, and treatment and care for patients with, HIV/AIDS, tuberculosis and malaria, including innovative approaches for increasing coverage of the interventions among poor people, and hardto-reach and vulnerable populations. Africa

INDICATORS 2.1.1 Number of low- and middleincome countries that have achieved 80% coverage for antiretroviral therapy and the prevention of mother-to-child transmission services BASELINE 2010

2.1.2 Proportion of endemic countries that have achieved their national intervention targets for malaria

2.1.3 Number of Member States that have achieved the targets of at least 70% case detection and 85% treatment success rate for tuberculosis

2.1.4 Proportion of high burden Member States that have achieved the target of 70% of persons with sexually transmitted infections diagnosed, treated and counselled at primary pointof-care sites

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

146.8

2.2 Policy and technical support provided to countries towards expanded gendersensitive delivery of prevention, treatment and care interventions for HIV/AIDS, tuberculosis and malaria, including integrated training and service delivery; wider service-provider networks; and strengthened laboratory capacities and better linkages with other health services, such as those for sexual

INDICATORS 2.2.1 Number of targeted Member States with comprehensive policies and medium-term plans in response to HIV, tuberculosis and malaria

2.2.2 Proportion of high burden countries monitoring provider initiated HIV testing and counselling in sexually transmitted infection and family planning services

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

18 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

and reproductive health, maternal, newborn and child health, sexually transmitted infections, nutrition, drug-dependence treatment services, respiratory care, neglected diseases and environmental health. Africa The Americas South-East Asia Budget (US$ thousand) Europe Eastern Mediterranean Western Pacific Headquarters TOTAL

235.3

2.3 Global guidance and technical support provided on policies and programmes in order to promote equitable access to essential medicines, diagnostic tools and health technologies of assured quality for the prevention and treatment of HIV/AIDS, tuberculosis and malaria, and their rational use by prescribers and consumers, and, in order to ensure uninterrupted supplies of diagnostics, safe blood and blood products, injections and other essential health technologies and commodities.

INDICATORS 2.3.1 Number of new or updated global norms and quality standards for medicines and diagnostic tools for HIV/AIDS, tuberculosis and malaria

2.3.2 Number of priority medicines and diagnostic tools for HIV/AIDS, tuberculosis and malaria that have been assessed and pre-qualified for United Nations procurement

2.3.3 Number of targeted countries receiving support to increase access to affordable essential medicines for HIV/AIDS, tuberculosis and malaria whose supply is integrated into national pharmaceutical systems (the number of targeted countries is determined for the six-year period)

2.3.4 Number of Member States implementin g qualityassured HIV/AIDS screening of all donated blood

2.3.5 Number of Member States administering all medical injections using sterile single use syringes

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

73.3

19 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

2.4 Global, regional and national systems for surveillance, evaluation and monitoring strengthened and expanded to keep track of progress towards targets and allocation of resources for HIV/AIDS, tuberculosis and malaria control and to determine the impact of control efforts and the evolution of drug resistance. Africa

INDICATORS 2.4.1 Number of Member States providing WHO with annual data on surveillance, monitoring or financial allocation data for inclusion in the annual global reports on control of HIV/AIDS, tuberculosis or malaria and the achievement of targets BASELINE 2010

2.4.2 Number of Member States reporting drug resistance surveillance data to WHO for HIV/AIDS, tuberculosis or malaria

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

100.5

2.5 Political commitment sustained and mobilization of resources ensured through advocacy and nurturing of partnerships on HIV/AIDS, tuberculosis and malaria at country, regional and global levels; support provided to countries as appropriate to develop or strengthen and implement mechanisms for resource mobilization and utilization and increase the absorption capacity of available resources; and engagement of communities and affected persons increased to maximize the reach and performance of HIV/AIDS, tuberculosis and malaria control programmes. Africa

INDICATORS 2.5.1 Number of Member States with functional coordination mechanisms for HIV/AIDS, tuberculosis and malaria control

2.5.2 Number of Member States involving communities, persons affected by the diseases, civilsociety organizations and the private sector in planning, design, implementation and evaluation of HIV/AIDS, tuberculosis and malaria programmes

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

62.7

20 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

2.6 New knowledge, intervention tools and strategies developed and validated to meet priority needs for the prevention and control of HIV/AIDS, tuberculosis and malaria, with scientists from developing countries increasingly taking the lead in this research. Africa

INDICATORS 2.6.1 Number of new and improved tools (e.g. medicines, vaccines and diagnostic tools) receiving internationally recognized approval for use in HIV/AIDS, tuberculosis or malaria

2.6.2 Number of new and improved interventions and implementation strategies for HIV/AIDS, tuberculosis and malaria, whose effectiveness has been determined and evidence made available to appropriate institutions for policy decisions

2.6.3 Proportion of peer-reviewed publications arising from WHOsupported research on HIV/AIDS, tuberculosis or malaria and for which the main author’s institution is based in a developing country

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

113.1

21 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 3 To prevent and reduce disease, disability and premature death from chronic chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment Scope The work under this strategic objective focuses on the following activities: policy development; programme implementation; monitoring and evaluation; strengthening of health and rehabilitation systems and services; implementation of prevention programmes and capacity building in the area of chronic noncommunicable conditions (including cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, hearing and visual impairment – including blindness, and genetic disorders, mental, behavioural and neurological disorders, including those provoked by psychoactive substance use; injuries due to road traffic crashes, drowning, burns, poisoning, falls, violence in the family, the community or between organized groups; and disabilities from all causes). Links with other strategic objectives • Strategic objective 6: in relation to population-wide approaches to combating tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity as risk factors; and in relation to approaches directed at individuals at high risk from these risk factors, as well as approaches directed at the prevention of other risk factors.

22 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

21.0

11.8

16.0

13.5

19.0

17.0

63.5

161.8

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 3.1 Advocacy and support provided to increase political, financial and technical commitment in Member States in order to tackle chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities together with visual impairment, including blindness. Africa

INDICATORS 3.1.1 Number of Member States whose health ministries have a focal point or a unit for injuries and violence prevention with its own budget

3.1.2 The world report on disability and rehabilitation published and launched, in response to resolution WHA58.23

3.1.3 Number of Member States with a mental health budget of more than 1% of the total health budget

3.1.4 Number of Member States with a unit in the ministry of health or equivalent national health authority, with dedicated staff and budget, for the prevention and control of chronic noncommunicable conditions

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

35.6

3.2 Guidance and support provided to Member States for the development and implementation of policies, strategies and regulations in respect of chronic noncommunicable conditions, mental and neurological disorders, violence, injuries and disabilities together with visual impairment, including blindness. Africa

INDICATORS 3.2.1 Number of Member States that have national plans to prevent unintentional injuries or violence

3.2.2 Number of Member States that have initiated the process of developing a mental health policy or law

3.2.3 Number of Member States that have adopted a multisectoral national policy on chronic noncommunicable conditions

3.2.4 Number of Member States that are implementing comprehensive national plans for the prevention of hearing or visual impairment

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

31.7

23 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

3.3 Improvements made in Member States’ capacity to collect, analyse, disseminate and use data on the magnitude, causes and consequences of chronic noncommunicable conditions, mental and neurological disorders, violence, injuries and disabilities together with visual impairment, including blindness.

INDICATORS 3.3.1 Number of Member States that have submitted a complete assessment of their national road traffic injury prevention status to WHO during the biennium BASELINE 2010

3.3.2 Number of Member States that have a published document containing national data on the prevalence and incidence of disabilities

3.3.3 Number of low- and middle-income Member States with basic mental health indicators annually reported

3.3.4 Number of Member States with a national health reporting system and annual reports that include indicators for the four major noncommunicable conditions

3.3.5 Number of Member States documenting, according to populationbased surveys, the burden of hearing or visual impairment

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

22.0

3.4 Improved evidence compiled by WHO on the cost-effectiveness of interventions to tackle chronic noncommunicable conditions, mental and neurological and substance-use disorders, violence, injuries and disabilities together with visual impairment, including blindness. Africa

INDICATORS 3.4.1 Availability of evidence-based guidance on the effectiveness of interventions for the management of selected mental, behavioural or neurological disorders including those due to use of psychoactive substances BASELINE 2010

3.4.2 Availability of evidence-based guidance or guidelines on the effectiveness or cost-effectiveness of interventions for the prevention and management of chronic noncommunicable conditions

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

21.7

24 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

3.5 Guidance and support provided to Member States for the preparation and implementation of multisectoral, population-wide programmes to promote mental health and to prevent mental and behavioural disorders, violence and injuries, together with hearing and visual impairment, including blindness. Africa

INDICATORS 3.5.1 Number of guidelines published and widely disseminated on multisectoral interventions to prevent violence and unintentional injuries BASELINE 2010

3.5.2 Number of Member States that have initiated community-based projects during the biennium to reduce suicides

3.5.3 Number of Member States implementing strategies recommended by WHO for the prevention of hearing or visual impairment

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

21.6

3.6 Guidance and support provided to Member States to improve the ability of their health and social systems to prevent and manage chronic noncommunicable conditions, mental and behavioural disorders, violence, injuries and disabilities together with visual impairment, including blindness.

INDICATORS 3.6.1 Number of Member States that have incorporated trauma-care services for victims of injuries or violence into their health-care systems using WHO traumacare guidelines

3.6.2 Number of Member States implementing communitybased rehabilitation programmes

3.6.3 Number of low- and middleincome Member States that have completed an assessment of their mental health systems using the WHO Assessment Instrument for Mental Health Systems (WHOAIMS)

3.6.4 Number of low- and middle-income Member States implementing primary healthcare strategies for screening and managing cardiovascular risk

3.6.5 Number of Member States with tobacco cessation support incorporated into primary health care, as defined in the WHO Report on the Global Tobacco Epidemic, 2008: the MPOWER package

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

29.2

25 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 4 To reduce morbidity and mortality and improve health during key stages of life, including including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals Scope Work under this strategic objective will focus on action towards ensuring universal access to, and coverage with, effective public health interventions to improve maternal, newborn, child, adolescent, and sexual and reproductive health, with emphasis on reducing gender inequality and health inequities; development of evidence-based, gender-sensitive, coordinated and coherent approaches to addressing needs at key stages of life and improving sexual and reproductive health, using a life-course approach; fostering synergies between maternal, newborn, child, adolescent, sexual and reproductive health interventions and other public health programmes, and supporting action to strengthen health systems; and formulation and implementation of policies and programmes that promote healthy and active ageing for all individuals. Links with other strategic objectives • Strategic objectives 1 and 2: in relation to ensuring the effective delivery, in an integrated manner, of immunization and other interventions for the control of major infectious diseases through services for maternal, newborn and child and adolescent health and sexual and reproductive health. • Strategic objectives 6 to 9, especially 6, 7 and 9: sufficient attention needs to be given to (a) social and economic determinants of ill-health that limit progress towards this strategic objective, (b) major risk factors, such as poor nutrition, and (c) human rights-based and genderresponsive approaches to ensure equitable access to key services. • Strategic objectives 10 and 11: with attention to specific actions required to strengthen health systems so that they can rapidly expand access to effective interventions for maternal, newborn, child, adolescent and sexual and reproductive health, while ensuring a continuum of care across the life course and across different levels of the health system, including the community. Major WHO partnerships and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope • Special Programme of Research, Development and Research Training in Human Reproduction

26 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

115.0

27.4

46.0

11.2

35.1

25.0

94.5

354.2

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 4.1 Support provided to Member States to formulate a comprehensive policy, plan and strategy for scaling up towards universal access to effective interventions in collaboration with other programmes, paying attention to reducing gender inequality and health inequities, providing a continuum of care throughout the life course, integrating service delivery across different levels of the health system and strengthening coordination with civil society and the private sector. Africa

INDICATORS 4.1.1 Number of targeted Member States that have an integrated policy on universal access to effective interventions for improving maternal, newborn and child health BASELINE 2010 20 TARGETS TO BE ACHIEVED BY 2011 40

4.1.2 Number of Member States that have developed, with WHO support, a policy on achieving universal access to sexual and reproductive health

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

38.1

27 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

4.2 National research capacity strengthened as necessary and new evidence, products, technologies, interventions and delivery approaches of global and/or national relevance available to improve maternal, newborn, child and adolescent health, to promote active and healthy ageing, and to improve sexual and reproductive health. Africa

INDICATORS 4.2.1 Number of research centres that have received an initial grant for comprehensive institutional development and support

4.2.2 Number of completed studies on priority issues that have been supported by WHO

4.2.3 Number of new or updated systematic reviews on best practices, policies and standards of care for improving maternal, newborn, child and adolescent health, promoting active and healthy ageing or improving sexual and reproductive health

BASELINE 2010 8

TARGETS TO BE ACHIEVED BY 2011 16 32 40

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

68.3

4.3 Guidelines, approaches and tools for improving maternal care applied at the country level, including technical support provided to Member States for intensified action to ensure skilled care for every pregnant woman and every newborn, through childbirth and the postpartum and postnatal periods, particularly for poor and disadvantaged populations, with progress monitored. Africa

INDICATORS 4.3.1 Number of Member States implementing strategies for increasing coverage with skilled care for childbirth BASELINE 2010 25 TARGETS TO BE ACHIEVED BY 2011 50

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

70.8

28 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

4.4 Guidelines, approaches and tools for improving neonatal survival and health applied at country level, with technical support provided to Member States for intensified action towards universal coverage, effective interventions and monitoring of progress. Africa

INDICATORS 4.4.1 Number of Member States implementing strategies for increasing coverage with interventions for neonatal survival and health BASELINE 2010 40 TARGETS TO BE ACHIEVED BY 2011 55

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

31.3

4.5 Guidelines, approaches and tools for improving child health and development applied at the country level, with technical support provided to Member States for intensified action towards universal coverage of the population with effective interventions and for monitoring progress, taking into consideration international and human-rights norms and standards, notably those stipulated in the Convention on the Rights of the Child. Africa

INDICATORS 4.5.1 Number of Member States implementing strategies for increasing coverage with child health and development interventions

4.5.2 Number of Member States that have expanded coverage of the integrated management of childhood illness to more than 75% of target districts

BASELINE 2010 40 TARGETS TO BE ACHIEVED BY 2011 60

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

58.4

29 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

4.6 Technical support provided to Member States for the implementation of evidence-based policies and strategies on adolescent health and development, and for the scaling up of a package of prevention, treatment and care interventions in accordance with established standards. Africa

INDICATORS 4.6.1 Number of Member States with a functioning adolescent health and development programme1 BASELINE 2010 50 TARGETS TO BE ACHIEVED BY 2011 75

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

31.2 4.7 Guidelines, approaches and tools made available, with provision of technical support to Member States for accelerated action towards implementing the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health, with particular emphasis on ensuring equitable access to good-quality sexual and reproductive health services, particularly in areas of unmet need, and with respect for human rights as they relate to sexual and reproductive health. Africa

INDICATORS 4.7.1 Number of Member States implementing the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health agreed at the 1994 International Conference on Population and Development (ICPD), its fiveyear review (ICPD+5), the Millennium Summit and the United Nations General Assembly in 2007 BASELINE 2010 30 TARGETS TO BE ACHIEVED BY 2011 40

4.7.2 Number of targeted Member States having reviewed their existing national laws, regulations or policies relating to sexual and reproductive health

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

48.3

A country with “an adolescent health and development programme” is defined as one that has officially established a programme focusing on the health of adolescents or young people, whether a stand-alone programme or a clearlydemarcated component of a health issue-specific programme such as the HIV programme. To be identified as “functioning”, the programme should have in place (a) a national-level plan of action, (b) a budget for activities, and (c) a record of activities undertaken during the past year.

30 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

4.8 Guidelines, approaches, tools, and technical assistance provided to Member States for increased advocacy for consideration of ageing as a public health issue, for the development and implementation of policies and programmes aiming at maintaining maximum functional capacity throughout the life course and for the training of healthcare providers in approaches that ensure healthy ageing. Africa

INDICATORS 4.8.1 Number of Member States with a functioning active healthy ageing programme consistent with WHA58.16 “Strengthening active and healthy ageing” BASELINE 2010 15 TARGETS TO BE ACHIEVED BY 2011 20

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

7.8

31 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 5 To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact Scope The joint efforts of the Member States and the Secretariat regarding this strategic objective involve the following: health-sector emergency preparedness; intersectoral action for reducing risk and vulnerability within the framework of the International Strategy for Disaster Reduction; responding to the health needs experienced during emergencies and crises (including nutritionrelated needs as well as those concerning water and sanitation); assessing needs of affected populations; health actions during the transition and recovery phases following conflicts and disasters; health of migrants; fulfilling WHO’s mandate within the framework of the reform process to enhance the United Nations humanitarian response; the global alert and response system for environmental and food-safety public health emergencies within the framework of the International Health Regulations (2005); risk reduction in respect of specific threats; and preparedness and response programmes for environmental and food-safety public health emergencies. In this way, WHO is making an important contribution to health security that also has critical implications for efforts to promote peace and responding to the Mandates of Member States contained in three relevant resolutions of recent World Health Assemblies (WHA 58.1; WHA 59.22 and WHA 61.17). Links with other strategic objectives • Strategic objective 1: in relation to the International Health Regulations (2005) and responding to public health emergencies involving epidemics. • Strategic objective 3: in relation to gender violence, responding to psychosocial needs of affected populations; responding to the health needs of the disabled; mass-casualty management; and health care for those suffering from chronic diseases. • Strategic objective 4: in relation to the response to the health needs of vulnerable populations, especially mothers and children in emergency situations. • Strategic objective 8: in relation to intersectoral action for emergency preparedness and risk reduction, and for dealing with environmental, chemical and radiological emergencies. • Strategic objective 9: in relation to nutrition in emergency situations. • Strategic objective 10: in relation to health of migrants, safe hospitals and health sector risk reduction measures Major WHO partnerships and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope – Health and Nutrition Tracking Service

32 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

34.0

15.9

14.0

8.8

8.0

5.0

41.0

126.7

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 5.1 Norms and standards developed, capacity built and technical support provided to Member States for the development and strengthening of national emergency preparedness plans and programmes. Africa

INDICATORS 5.1.1 Proportion of Member States with national emergency preparedness plans that cover multiple hazards BASELINE 2010 60% TARGETS TO BE ACHIEVED BY 2011

5.1.2 Number of Member States implementing programmes for reducing the vulnerability of health facilities to the effects of natural disasters

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

49.9 5.2 Norms and standards developed and capacity built to enable Member States to provide timely response to disasters associated with natural hazards and conflict-related crises. INDICATORS 5.2.1 Operational platforms for surge capacity in place in regions and headquarters ready to be activated in acuteonset emergencies BASELINE 2010 100% TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

5.2.2 Number of global and regional training programmes on public health operations in emergency response

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

18.5 5.3 Norms and standards developed and capacity built to enable Member States to assess needs and for planning interventions during the transition and recovery phases of conflicts and disasters. Africa

INDICATORS 5.3.1 Number of humanitarian action plans with a health component formulated for ongoing emergencies BASELINE 2010 12 TARGETS TO BE ACHIEVED BY 2011

5.3.2 Number of countries in transition that have formulated a recovery strategy for health

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

19.9

33 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

5.4 Coordinated technical support provided to Member States for communicable disease control in natural disaster and conflict situations.

INDICATORS 5.4.1 Proportion of acute natural disasters or conflicts where communicable disease-control interventions have been implemented, including activation of early-warning systems and diseasessurveillance for emergencies BASELINE 2010 100% TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

13.2

5.5 Support provided to Member States for strengthening national preparedness and for establishing alert and response mechanisms for food-safety and environmental health emergencies.

INDICATORS 5.5.1 Proportion of Member States with national plans for preparedness, and alert and response activities in respect of chemical, radiological and environmental health emergencies BASELINE 2010 60% TARGETS TO BE ACHIEVED BY 2011

5.5.2 Number of Member States with focal points for the International Food Safety Authorities Network and for the environmental health emergencies network

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

11.5

5.6 Effective communications issued, partnerships formed and coordination developed with other organizations in the United Nations system, governments, local and international nongovernmental organizations, academic institutions and professional associations at the country, regional and global levels Africa

INDICATORS 5.6.1 Proportion of Member States affected by acute-onset emergencies and those with ongoing emergencies and a humanitarian coordinator in which the Inter-Agency Standing Committee Humanitarian Health Cluster is operational in line with IASC cluster standards in line with IASC cluster standards BASELINE 2010 60% TARGETS TO BE ACHIEVED BY 2011

5.6.2 Proportion of Member States with ongoing emergencies and a humanitarian coordinator having a sustainable WHO technical presence covering emergency preparedness, response and recovery

60%

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

13.7

34 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

5.7 Acute, ongoing and recovery operations implemented in a timely and effective manner.

INDICATORS 5.7.1 Proportion of acute-onset emergencies for which WHO mobilizes coordinated national and international action BASELINE 2010 80% TARGETS TO BE ACHIEVED BY 2011

5.7.2 Proportion of interventions for chronic emergencies implemented in accordance with humanitarian action plans’ health components

100%

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

35 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 6 To promote health and development, development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex Scope The work under this strategic objective focuses on integrated, comprehensive, multisectoral and multidisciplinary health-promotion and prevention processes and approaches across all WHO’s relevant programmes; and on the prevention or reduction of the occurrence of six major risk factors: use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diet, physical inactivity and unsafe sex. The main activities involve capacity building for health promotion across all relevant programmes, risk-factor surveillance, the development of ethical and evidence-based policies, strategies, interventions, recommendations, standards and guidelines for health promotion, prevention and reduction of the occurrence of the major risk factors. Links with other strategic objectives objectives 2, 3, 4, 7, 8 and 9: although these seek to deal with the determinants of poor health and strengthen service provision, this strategic objective seeks in particular, to create healthy environments in order to enable individuals to make healthy choices.

• Strategic

Major WHO and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope • Special Programme of Research, Development and Research Training in Human Reproduction • WHO Centre for Health Development (KOBE)

36 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

26.0

13.9

16.0

9.7

21.0

25.0

65.5

177.1

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 6.1 Advice and support provided to Member States to build their capacity for health promotion across all relevant programmes, and to establish effective multisectoral and multidisciplinary collaborations for promoting health and preventing or reducing major risk factors. Africa

INDICATORS 6.1.1 Number of Member States that have evaluated and reported on at least one of the action areas and commitments of the Global Conferences on Health Promotion.

6.1.2 Number of cities that have implemented healthy urbanization programmes aimed at reducing health inequities

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 42

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

60.9

6.2 Guidance and support provided in order to strengthen national systems for surveillance of major risk factors through development and validation of frameworks, tools and operating procedures and their dissemination to Member States where a high or increasing burden of death and disability is attributable to these risk factors. Africa

INDICATORS 6.2.1 Number of Member States with a functioning national surveillance system for monitoring major risk factors to health among adults based on the WHO STEPwise approach to surveillance

6.2.2 Number of Member States with a functioning national surveillance system for monitoring major risk factors to health among youth based on the Global school-based student health survey methodology

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 60

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

14.6

37 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

6.3 Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed, and technical support provided to Member States with a high or increasing burden of disease and death associated with tobacco use, enabling them to strengthen institutions in order to tackle or prevent the public health problems concerned; support also provided to the Conference of the Parties to the WHO Framework Convention on Tobacco Control for implementation of the provisions of the Convention and development and implementation of protocols and guidelines. Africa

INDICATORS 6.3.1 Number of Member States having comparable adult tobacco prevalence data available from recent national representative surveys, such as the Global Adult Tobacco Survey (GATS) or STEPS

6.3.2 Number of Member States with smoke-free legislation covering all legislative elements, types of places and institutions as defined in the WHO Report on the Global Tobacco Epidemic, 2008

6.3.3 Number of Member States with bans on tobacco advertising, promotion and sponsorship as defined in the WHO Report on the Global Tobacco Epidemic, 2008

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 22 56

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

55.2 6.4 Evidencebased and ethical policies, strategies, recommendations, standards and guidelines developed, and technical support provided to Member States with a high or increasing burden of disease or death associated with alcohol, drugs and other psychoactive substance use, enabling them to strengthen institutions in order to combat or prevent the public health problems concerned. Africa

INDICATORS 6.4.1 Number of Member States that have developed, with WHO support, strategies, plans and programmes for combating or preventing public health problems caused by alcohol, drugs and other psychoactive substance use BASELINE 2010

6.4.2 Number of WHO strategies, guidelines, standards and technical tools developed in order to provide support to Member States in preventing and reducing public health problems caused by alcohol, drugs and other psychoactive substance use

TARGETS TO BE ACHIEVED BY 2011 50

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

17.1

38 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

6.5 Evidencebased and ethical policies, strategies, recommendations, standards and guidelines developed and technical support provided to Member States with a high or increasing burden of disease or death associated with unhealthy diets and physical inactivity, enabling them to strengthen institutions in order to combat or prevent the public health problems concerned. Africa

INDICATORS 6.5.1 Number of Member States that have adopted multisectoral strategies and plans for healthy diets or physical activity, based on the WHO Global Strategy on Diet, Physical Activity and Health BASELINE 2010

6.5.2 Number of WHO technical tools that provide support to Member States in promoting healthy diets or physical activity

TARGETS TO BE ACHIEVED BY 2011 65

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

15.3

6.6 Evidencebased and ethical policies, strategies, interventions, recommendations, standards and guidelines developed and technical support provided to Member States to promote safer sex and strengthen institutions in order to tackle and manage the social and individual consequences of unsafe sex. Africa

INDICATORS 6.6.1 Number of Member States generating evidence on the determinants or consequences of unsafe sex

6.6.2 Number of Member States generating comparable data on unsafe sex indicators using WHO STEPS surveillance tools

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 10

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

14.0

39 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 7 To address the underlying social and economic determinants of health through policies and programmes that enhance enhance health equity and integrate propro-poor, gendergender-responsive, and human rightsrights-based approaches Scope The work under this strategic objective focuses on leadership in intersectoral action on the broad social and economic determinants of health; improvement of population health and health equity by better meeting the health needs of poor, vulnerable and excluded social groups; connections between health, poverty and various social and economic factors (labour, housing and educational circumstances; trade and macroeconomic factors; and the social status of various groups such as women, children, elderly people, displaced people and ethnic minorities); formulation of policies and programmes that are ethically sound, responsive to gender inequalities, sustainable, effective in meeting the needs of poor people and other vulnerable groups, and consistent with human-rights norms. Links with other strategic objectives Issues of health equity, ethical standards, gender, pro-poor approaches and human rights are relevant to all other strategic objectives. • Strategic objectives 1 to 5: notwithstanding the technical complexities, it is firmly established that health outcomes are powerfully influenced by social and economic determinants, as well as by the availability and quality of clinical services. • Strategic objectives 6, 8 and 9: the present strategic objective is primarily concerned with the underlying determinants and structural factors (such as labour markets, education system, and gender inequality) defining people’s different positions in social hierarchies, which affect intermediate determinants such as the environment, including food (strategic objectives 8 and 9) and individual factors such as behaviours (strategic objective 6). • Strategic objectives 10 and 11: health policies and systems need to include intersectoral action on health determinants. Coherent action on health inequities also depends on the availability of appropriately disaggregated health data and the capacity to analyse and use such data to develop policies and services that respond to the needs of different social groups and address structural factors.

40 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

9.0

6.9

5.0

6.0

13.0

2.0

30.0

71.9

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 7.1 Significance of social and economic determinants of health recognized throughout the Organization and incorporated into normative work and technical collaboration with Member States and other partners. Africa

INDICATORS 7.1.1 Number of WHO regions with a regional strategy for addressing social and economic determinants of health as identified in the Report of the Commission on the Social Determinants of Health endorsed by the Director-General BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

17.5

7.2 Initiative taken by WHO in providing opportunities and means for intersectoral collaboration at national and international levels to address social and economic determinants of health, including understanding and acting upon the public health implications of trade and trade agreements, and to encourage povertyreduction and sustainable development. Africa

INDICATORS 7.2.1 Number of published country experiences on tackling social determinants for health equity

7.2.2 Number of tools to support countries in analysing the implications of trade and trade agreements for health.

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

21.9

41 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

7.3 Social and economic data relevant to health collected, collated and analysed on a disaggregated basis (by sex, age, ethnicity, income, and health conditions, such as disease or disability). Africa

INDICATORS 7.3.1 Number of country reports published during the biennium incorporating disaggregated data and analysis of health equity BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

11.8

7.4 Ethics- and rights-based approaches to health promoted within WHO and at national and global levels.

INDICATORS 7.4.1 Number of tools produced for Member States or the Secretariat giving guidance on using a human rights-based approach to advance health BASELINE 2010

7.4.2 Number of tools produced for Member States or the Secretariat giving guidance on use of ethical analysis to improve health policies

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

8.8

7.5 Gender analysis and responsive actions incorporated into WHO’s normative work and support provided to Member States for formulation of gender-responsive policies and programmes. Africa

INDICATORS 7.5.1 Number of WHO norms and standards developed or updated that are gender responsive BASELINE 2010

7.5.2 Number of Member States supported by WHO that have conducted one or more gendermainstreaming activities in health programmes

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

11.9

42 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 8: To promote a healthier environment, intensify intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health Scope This strategic objective is to reduce a broad range of traditional, modern and emerging hazards to health and the environment. The work will encourage strong health-sector leadership for primary prevention of disease through environmental management and impart strategic direction and give guidance to partners in non-health sectors for ensuring that their policies and investments also benefit health. Work will focus on the assessment and management of environmental and occupational health hazards such as unsafe water and inadequate sanitation, indoor air pollution and solid fuel use, and vector transmission of diseases. Its scope also covers: health risks related to change in the global environment (e.g. climate change and biodiversity loss); development of new products and technologies (e.g. nanotechnology); consumption and production of energy from new sources and the increasing number and use of chemicals; and health risks related to changes in lifestyle, urbanization, and working conditions (e.g. deregulation of labour, an expanding informal sector and export of hazardous working practices to poor countries). Links with other strategic objectives objective 5: preparedness and response to environmental health emergencies, crucial to achieving strategic objective 8, are linked with other aspects of emergency response. • Strategic objective 1: strengthening health systems capacities to adapt to the health impacts of climate change, through enhanced early warning and strengthened communicable disease response capacities, will contribute to reducing vulnerability to public health security threats and will help reduce the potential health, social and economic impacts of climate change affected communicable diseases. • Strategic objectives 2 to 4: given that eliminating environmental hazards to health can prevent up to a quarter of the global burden of disease, work will contribute especially to the reduction in disease burden among children (strategic objective 4), from vector-borne diseases (strategic objective 2) and from noncommunicable diseases (strategic objective 3) • Strategic objective 10: occupational and environmental health services are a key part of the preventive function of health services. • Strategic objectives 5, 6, 7, 9 and 12: influencing sectors of the economy to reduce risks and promote health through their investments and policy decisions is essential in terms of work on determinants of health (strategic objectives 5, 6, 7 and 9) and for establishing partnerships to advance the global health agenda (strategic objective 12). • Strategic

Major WHO partnerships and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope • Intergovernmental Forum on Chemical Safety

43 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

19.0

12.1

14.0

19.4

19.0

13.0

50.2

146.7

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 8.1 Evidencebased assessments made, and norms and standards formulated and updated on major environmental hazards to health (e.g., poor air quality, chemical substances, electromagnetic fields, radon, poorquality drinkingwater and wastewater reuse) Africa

INDICATORS 8.1.1 Number of Member States that

have conducted assessments of specific environmental threats to health or have quantified the environmental burden of disease with WHO technical support during the biennium BASELINE 2010

8.1.2 Number of new or updated WHO norms, standards or guidelines on occupational or environmental health issues published during the biennium

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

38.1

8.2 Technical support and guidance provided to Member States for the implementation of primary prevention interventions that reduce environmental hazards to health, enhance safety and promote public health, including in specific settings (e.g. workplaces, homes or urban settings) and among vulnerable population groups (e.g. children)

INDICATORS 8.2.1 Number of Member States implementing primary prevention interventions in order

to reduce environmental risks to health, with WHO technical support, in at least one of the following settings: workplaces, homes or urban settings BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

30.8

44 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

8.3 Technical assistance and support provided to Member States for strengthening national occupational and environmental health risk management systems, functions and services

INDICATORS 8.3.1 Number of Member States that have implemented national action plans or policies

for the management of occupational health risks, such as in relation to WHO’s global plan of action on workers’ health 2008–2017, with support from the Secretariat BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

19.8 8.4 Guidance, tools and initiatives created in order to support the health sector in influencing policies in other sectors to allow policies that improve health, the environment and safety to be identified and adopted Africa

INDICATORS 8.4.1 Number of Member States that have expressed interest in adopting healthy policies

or frameworks proposed by WHO in other sectors than health BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

14.9 8.5 Health-sector leadership enhanced for creating a healthier environment and changing policies in all sectors so as to tackle the root causes of environmental threats to health, through means such as responding to emerging and re-emerging consequences of development on environmental health and altered patterns of consumption and production and to the damaging effect of evolving technologies Africa

INDICATORS 8.5.1 Number of studies or

8.5.2 Number of reports

8.5.3 Number of high-level

reports on new and reemerging occupational and environmental health issues published or co-published by WHO

published or jointly published by WHO on progress made in achieving water and sanitation objectives of major international development frameworks, such as the Millennium Development Goals

regional forums on environment and health issues organized or technically supported by WHO biennially

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

19.0

45 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

8.6 Evidencebased policies, strategies and recommendations developed, and technical support provided to Member States for identifying, preventing and tackling public health problems resulting from climate change

INDICATORS 8.6.1 Number of studies or reports on the

public health effects of climate change published or co-published by WHO

8.6.2 Number of countries that have implemented plans to enable the health sector to adapt to the adverse effects on health of climate change

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

24.1

46 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 9 life-course, and To improve nutrition, food safety and food security, throughout the life in support of public health and sustainable sustainable development Scope Work under this strategic objective focuses on nutritional quality and safety of foods; promotion of healthy dietary practices throughout the life-course, starting with pregnant women, breastfeeding and adequate complementary feeding, and considering diet-related chronic diseases; prevention and control of nutritional disorders, including micronutrient deficiencies, especially among biologically and socially vulnerable groups, with emphasis on emergencies, and in the context of HIV/AIDS epidemics; prevention and control of zoonotic and nonzoonotic foodborne diseases; stimulation of intersectoral actions promoting the production and consumption of, and access to, food of adequate quality and safety; and promotion of higher levels of investment in nutrition, food safety and food security at global, regional and national levels. Links with other strategic objectives Achievement of the strategic objective requires strong links and effective collaboration with other strategic objectives, in particular: • strategic objective 1: in relation to prevention of zoonoses and foodborne diseases • strategic objective 2: especially in expanding and improving interventions related to HIV/AIDS prevention, treatment, care and support • strategic objective 4: in relation to public-health interventions for maternal, newborn, child and adolescent health • strategic objective 5: in relation to minimizing the impact of emergency situations on the nutritional status of populations • strategic objective 6: in relation to promotion of healthy dietary practices throughout the lifecourse • strategic objective 8: in relation to environmental health risks.

47 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

40.0

12.6

12.0

5.3

9.0

14.0

26.0

118.9

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 9.1 Partnerships and alliances formed, leadership built and coordination and networking developed with all stakeholders at country, regional and global levels, in order to promote advocacy and communication, stimulate intersectoral actions, increase investment in nutrition, foodsafety and foodsecurity interventions, and develop and support a research agenda. Africa

INDICATORS 9.1.1 Number of Member States that have functional institutionalized coordination mechanisms to promote intersectoral approaches and actions in the area of food safety, food security or nutrition

9.1.2 Number of Member States that have included nutrition, food-safety and food-security activities and a mechanism for their financing in their sectorwide approaches or Poverty Reduction Strategy Papers

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

20.9

9.2 Norms, including references, requirements, research priorities, guidelines, training manuals and standards, produced and disseminated to Member States in order to increase their capacity to assess and respond to all forms of malnutrition, and zoonotic and nonzoonotic foodborne diseases, and to promote healthy dietary practices.

INDICATORS 9.2.1 Number of new nutrition and foodsafety standards, guidelines or training manuals produced and disseminated to Member States and the international community BASELINE 2010

9.2.2 Number of new norms, standards, guidelines, tools and training materials for prevention and management of zoonotic and non-zoonotic foodborne diseases

TARGETS TO BE ACHIEVED BY 2011

48 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

28.5

9.3 Monitoring and surveillance of needs and assessment and evaluation of responses in the area of nutrition and diet-related chronic diseases strengthened, and ability to identify best policy options improved, in stable and emergency situations. Africa

INDICATORS 9.3.1 Number of Member States that have adopted and implemented the WHO Child Growth Standards BASELINE 2010

9.3.2 Number of Member States that have nationally representative surveillance data on major forms of malnutrition

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

16.7

9.4 Capacity built and support provided to target Member States for the development, strengthening and implementation of nutrition plans, policies and programmes aimed at improving nutrition throughout the lifecourse, in stable and emergency situations.

INDICATORS 9.4.1 Number of Member States that have implemented at least three highpriority actions recommended in the Global Strategy for Infant and Young Child Feeding BASELINE 2010

9.4.2 Number of Member States that have implemented strategies to prevent and control micronutrient malnutrition

9.4.3 Number of Member States that have implemented strategies to promote healthy dietary practices for preventing diet-related chronic diseases

9.4.4 Number of Member States that have included nutrition in their responses to HIV/AIDS

9.4.5 Number of Member States that have national preparedness and response plans for nutritional emergencies

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

21.8

49 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

9.5 Systems for surveillance, prevention and control of zoonotic and non-zoonotic foodborne diseases strengthened; foodhazard monitoring and evaluation programmes established and integrated into existing national surveillance systems, and results disseminated to all key players Africa

INDICATORS 9.5.1 Number of Member States that have established or strengthened intersectoral collaboration for the prevention, control and surveillance of foodborne zoonotic diseases BASELINE 2010

9.5.2 Number of Member States that have initiated a plan for the reduction in the incidence of at least one major foodborne zoonotic disease

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

14.8

9.6 Capacity built and support provided to Member States, including their participation in international standard-setting in order to increase their ability to assess risk in the areas of zoonotic and non-zoonotic foodborne diseases and food safety, and to develop and implement national food-control systems, with links to international emergency systems Africa

INDICATORS 9.6.1 Number of selected Member States receiving support to participate in international standard-setting activities related to food, such as those of the Codex Alimentarius Commission BASELINE 2010

9.6.2 Number of selected Member States that have built national systems for food safety with international links to emergency systems

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

16.2

50 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 10 To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research Scope The work under this objectives aims to improve management and organization of health service delivery, reflecting the principles of integrated primary health care, so as to scale up coverage, equity and quality of health services and improve health outcomes. The work will improve national capacities for governance and leadership, improve the various mechanisms for coordination (including donor assistance) that support member states in their efforts to achieve national targets. Work will contribute to strengthened country health-information systems, and will contribute to better knowledge and evidence for health decision-making. This will include global and regional work on generation, comparative analysis and synthesis of health statistics and evidence from research. Work will strengthen national health research knowledge management and e-health policies for health-systems development. The health workforce information and knowledge base will be strengthened and technical support to Member States will be provided to improve the production, distribution, skill mix and retention of their health workforce. Health systems financing will be improved through evidence-based policy, norms, standards and related measurement tools, and technical support, resulting in higher availability of funds, social and financial risk protection, equity, and better access to services and efficiency of resource use. Steps will also be taken to advocate for additional funds for health where necessary. Links with other strategic objectives strategic objectives concerned with the achievement of specific health outcomes, primarily strategic objectives 1 to 4. • All health- and disease-related strategic objectives: the work provides a platform for close collaboration with the evidence component. • Strategic objective 5: complementing the specific circumstances of service delivery in fragile states. • Strategic objective 7: particularly in relation to equity, pro-poor health policies and the progressive realization of the right to health - the work translates achievements in those areas into service delivery. • Strategic objective 12: particularly work on providing leadership, strengthening governance and encouraging partnerships and collaboration in engagement with countries. • All

Major WHO partnerships and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope • Special Programme of Research, Development and Research Training in Human Reproduction • World Alliance for Patient Safety

51 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

142.0

38.5

55.0

49.9

71.8

46.0

142.5

545.7

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 10.1 Management and organization of integrated, population-based health-service delivery through public and nonpublic providers and networks improved, reflecting the primary health care strategy, scaling up coverage, equity, quality and safety of personal and population-based health services, and enhancing health outcomes. INDICATORS 10.1.1 Proportion of Member states that show increased coverage, access and quality of personal (preventive, diagnostic, treatment and rehabilitation) and population-based services

10.1.2 Number of Member states that show progress in embedding disease-specific programmes in general health services

BASELINE 2010 15% increase TARGETS TO BE ACHIEVED BY 2011

20% increase

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

130.4

52 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

10.2 National capacities for governance and leadership improved through evidencebased policy dialogue, institutional capacity-building for policy analysis and development, strategy-based health system performance assessment, greater transparency and accountability for performance, and more effective intersectoral collaboration.

INDICATORS 10.2.1 Proportion of Member states that, against regionally agreed benchmarks, show evidence of improving institutional processes, structures and capacities for policy analysis, policy formulation, strategic planning, regulation, interinstitutional coordination and implementation of reform

10.2.2 Proportion of Member states that, against regionally agreed benchmarks, show evidence of improved accountability for performance and greater participation of civil society, community, consumers and professional organizations in shaping, implementing and reporting on policies

10.2.3 Proportion of Member states that, against regionally agreed benchmarks, show evidence of improved performance in law development and enforcement, policy formulation, policy implementation and regulation

10.2.4 Proportion of Member states that, against regionally agreed benchmarks, establish effective intersectoral cooperation mechanisms to improve healthsystems’ performance for better health outcomes

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

55.1

10.3 Coordination of the various mechanisms (including donor assistance) that provide support to Member States in their efforts to achieve national targets for healthsystem development and global health goals improved.

INDICATORS 10.3.1 Number of Member states where the inputs of major stakeholders are harmonized with national policies, measured in line with the Paris Declaration on Aid Effectiveness

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

14.7

53 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

10.4 Country health-information systems that provide and use high-quality and timely information for health planning and for monitoring progress towards national and major international goals strengthened. Africa

INDICATORS 10.4.1 Proportion of low- and middle-income countries with adequate health statistics and monitoring of health-related Millennium Development Goals that meet agreed standards BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

34.5

10.5. Better knowledge and evidence for health decisionmaking assured through consolidation and publication of existing evidence, facilitation of knowledge generation in priority areas, and global leadership in health research policy and coordination, including with regard to ethical conduct. Africa

INDICATORS 10.5.1 Proportion of countries for which high quality profiles with core health statistics are available from its open-access databases

10.5.2 Number of countries in which WHO plays a key role in supporting the generation and use of information and knowledge, including primary data collection through surveys, civil registration or improvement or analysis and synthesis of health facility data for policies and planning

10.5.3 Effective research for health coordination and leadership mechanisms established and maintained at global and regional levels

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

44.4

10.6 National health research for development of health systems strengthened in the context of regional and international research and engagement of civil society.

INDICATORS 10.6.1 Proportion of low- and middle-income countries in which national health-research systems meet internationally agreed minimum standards;

10.6.2 Number of Member states complying with the recommendation to dedicate at least 2% of their health budget to research (Commission on Health Research for Development, 1990)

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

20.0

54 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

10.7 Knowledge management and eHealth policies and strategies developed and implemented in order to strengthen health systems.

INDICATORS 10.7.1 Number of Member states adopting knowledge management policies in order to bridge the “know-how” gap particularly aimed to decrease the digital divide

10.7.2 Number of Member states with access to electronic international scientific journals and knowledge archives in health sciences as assessed by the WHO Global Observatory for eHealth biannual survey

10.7.3 Proportion of Member states with eHealth policies, strategies and regulatory frameworks as assessed by the WHO Global Observatory for eHealth biannual survey

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

27.4

10.8 Healthworkforce information and knowledge base strengthened, and country capacities for policy analysis, planning, implementation, informationsharing and research built up

INDICATORS 10.8.1 Number of countries reporting two or more national data points on human resources for health within the past five years, reported in the Global Atlas of the Health Workforce BASELINE 2010

10.8.2 Number of Member states with an national policy and planning unit for human resources for health

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

46.4

10.9 Technical support provided to Member States, with a focus on those facing severe health-workforce difficulties in order to improve the production, distribution, skill mix and retention of the health workforce.

INDICATORS 10.9.1 Proportion of 57 countries with critical shortage of health workforce, as identified in The world health report 2006 with a multi-year HRH plan

10.9.2 Proportion of 57 countries with critical shortage of health workforce, as identified in The world health report 2006 which have an investment plan for scaling up training and education of health workers

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

66.5

55 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

10.10 Evidencebased policy and technical support provided to Member States in order to improve health-system financing in terms of the availability of funds, social and financial-risk protection, equity, access to services and efficiency of resource use.

INDICATORS 10.10.1 Number of Member states provided with technical and policy support to raise additional funds for health; to reduce financial barriers to access, incidence of financial catastrophe, and impoverishment linked to health payments; or to improve social protection and the efficiency and equity of resource use

10.10.2 Number of key policy briefs prepared, disseminated and their use supported, which document best practices on revenue-raising, pooling and purchasing, including contracting, provision of interventions and services, and handling of fragmentation in systems associated with vertical programmes and inflow of international funds

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

33.2

10.11 Norms, standards and measurement tools developed for tracking resources, estimating the economic consequences of illness, and the costs and effects of interventions, financial catastrophe, impoverishment, and social exclusion, and their use supported and monitored.

INDICATORS 10.11.1 Key tools, norms and standards to guide policy development and implementation developed, disseminated and their use supported, according to expressed need, that comprise resource tracking and allocation, budgeting, financial management, economic consequences of disease and social exclusion, organization and efficiency of service delivery, including contracting, or the incidence of financial catastrophe and impoverishment BASELINE 2010

10.11.2 Number of Member states provided with technical support for using WHO tools to track and evaluate the adequacy and use of funds, to estimate future financial needs, to manage and monitor available funds, or to track the impact of financing policy on households

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

18.5

56 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

10.12 Steps taken to advocate additional funds for health where necessary; to build capacity in framing of health-financing policy and interpretation and use of financial information; and to stimulate the generation and translation of knowledge to support policy development.

INDICATORS 10.12.1 WHO presence and leadership in international, regional and national partnerships and use of its evidence in order to increase financing for health in low-income countries, or provide support to countries in design and monitoring of Poverty Reduction Strategy Papers, sector-wide approaches, medium-term expenditure frameworks, and other long-term financing mechanisms capable of providing social health protect consistent with primary health care BASELINE 2010

10.12.2 Number of Member states provided with support to build capacity in the formulation of health financing policies and strategies and the interpretation of financial data, or with key information on health expenditures, financing, efficiency and equity to guide the process

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

20.1

10.13 Evidence based norms, standards and measurement tools developed to support member states to quantify and decrease the level of unsafe health care provided.

INDICATORS 10.13.1 Key tools, norms and standards to guide policy development, measurement and implementation disseminated and their use supported

10.13.2 Number of Member states participating in global patient safety challenges and other global safety initiatives, including research and measurement

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

Africa

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

34.5

57 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 11 To ensure improved access, quality and use of medical products and technologies Scope Medical products include chemical and biological medicines; vaccines; blood and blood products; cells and tissues mostly of human origin; biotechnology products; traditional medicines and medical devices. Technologies include, among others, those for diagnostic testing, imaging, and laboratory testing. The work undertaken under this strategic objective will focus on making access more equitable (as measured by availability, price and affordability) to essential medical products and technologies of assured quality, safety, efficacy and costeffectiveness, and on their sound and cost-effective use. For the sound use of products and technologies, work will focus on building appropriate regulatory systems; evidence-based selection; information for prescribers and patients; appropriate diagnostic, clinical and surgical procedures; vaccination policies; supply systems, dispensing and injection safety; and blood transfusion. Information includes clinical guidelines, independent product information and ethical promotion. Links with other strategic objectives • Strategic objectives 1 to 5 (health outcomes): none of these objectives can be achieved without essential medical products, medicines and health technologies. With regard to access, work under this strategic objective will focus on “horizontal” issues such as comprehensive supply systems, pricing surveys and national pricing policies. On quality assurance and regulatory support, all WHO’s work is covered by this strategic objective. Work on rational use will focus on general aspects such as evidence-based selection of essential medical products and technologies, development of clinical guidelines, pharmacovigilance and patient safety, compliance with long-term treatment regimens and containing antimicrobial resistance. • Strategic objective 10: work also contributes to health service delivery; sustainable financing of products and technologies, on which access also depends. An integrated approach to health systems in support of primary health care will be promoted. • Strategic objective 7: good governance. • Strategic objective 12: global public policy.

58 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

23.0

8.9

14.0

5.6

17.2

15.0

77.0

160.7

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 11.1 Formulation and monitoring of comprehensive national policies on access, quality and use of essential medical products and technologies advocated and supported. INDICATORS 11.1.1 Number of Member States receiving support to formulate and implement official national policies on access, quality and use of essential medical products or technologies

11.1.2 Number of Member States receiving support to design or strengthen comprehensive national procurement or supply systems

11.1.3 Number of Member States receiving support to formulate and/or implement national strategies and regulatory mechanisms for blood and blood products or infection control

11.1.4 Publication of a biennial global report on medicine prices, availability and affordability, based on all available regional and national reports

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

65.2

11.2 International norms, standards and guidelines for the quality, safety, efficacy and costeffective use of medical products and technologies developed and their national and/or regional implementation advocated and supported.

INDICATORS 11.2.1 Number of new or updated global quality standards, reference preparations, guidelines and tools for improving the provision, management, use, quality, or effective regulation of medical products and technologies BASELINE 2010

11.2.2 Number of assigned International Nonproprietary Names for medical products

11.2.3 Number of priority medicines, vaccines, diagnostic tools and items of equipment that are prequalified for United Nations procurement

11.2.4 Number of Member States for which the functionality of the national regulatory authorities has been assessed or supported

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

72.2

59 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

11.3 Evidencebased policy guidance on promoting scientifically sound and cost-effective use of medical products and technologies by health workers and consumers developed and supported within the Secretariat and regional and national programmes. Africa

INDICATORS 11.3.1 Number of national or regional programmes receiving support for promoting sound and cost-effective use of medical products or technologies BASELINE 2010

11.3.2 Number of Member States using national lists, updated within the past five years, of essential medicines, vaccines or technologies for public procurement or reimbursement

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

23.3

60 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 12 To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work Scope This strategic objective facilitates the work of WHO to achieve all other strategic objectives. Responding to priorities in the Eleventh General Programme of Work, it recognizes that the context for international health has changed significantly. The scope of this objective covers three broad, complementary areas: leadership and governance of the Organization; WHO’s support for, presence in, and engagement with individual Member States; and the Organization’s role in bringing the collective energy and experience of Member States and other actors to bear on health issues of global and regional importance. The main innovation implicit in this objective is that it seeks to harness the depth and breadth of WHO’s country experience in order to influence global and regional debates, thereby to influence positively the environment in which national policy-makers work, and contribute to the attainment of the health-related Millennium Development goals and other internationally agreed health-related goals. Links with other strategic objectives This strategic objective is intrinsically linked to all the other objectives, as it builds on and supports the entire work of the Organization. As such it is closely related and complementary to strategic objective 13, to develop and sustain WHO as a flexible, learning Organization, enabling it to carry out its mandate more effectively and efficiently. The latter objective is more inward-looking, geared towards managerial and administrative issues, whereas strategic objective 12 is more outward-looking, focusing on issues of WHO leadership and governance, on work in Member States, and collaboration with partners including the United Nations System, at global, regional and country levels.

61 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

49.0

16.6

17.0

34.2

28.1

15.0

94.0

253.9

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 12.1 Effective leadership and direction of the Organization exercised through enhancement of governance, and the coherence, accountability and synergy of WHO’s work. Africa

INDICATORS 12.1.1 Proportion of documents submitted to governing bodies within constitutional deadlines in the six WHO official languages BASELINE 2010

12.1.2 Level of understanding by key stakeholders of WHO’s role, priorities and key messages as provided by a stakeholder survey

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

156.9

12.2 Effective WHO country presence1 established to implement WHO country cooperation strategies that are aligned with Member States’ health and development agendas, and harmonized with the United Nations country team and other development partners.

INDICATORS 12.2.1 Number of Member States where WHO is aligning its country cooperation strategy with the country’s priorities and development cycle and harmonizing its work with the United Nations and other development partners within relevant frameworks, such as the United Nations Development Assistance Framework, Poverty Reduction Strategy Papers and SectorWide Approaches BASELINE 2010

12.2.2 Proportion of WHO country offices which have reviewed and adjusted their core capacity in accordance with their country cooperation strategy

12.2.3 Proportion of country workplans that are consistent with their country cooperation strategy

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

30.8

WHO country presence is the platform for effective collaboration with countries for advancing the global health agenda, contributing to national strategies, and bringing country realities and perspectives into global policies and priorities.

62 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

12.3 Global health and development mechanisms established to provide more sustained and predictable technical and financial resources for health on the basis of a common health agenda which responds to the health needs and priorities of Member States.

INDICATORS 12.3.1 Number of health partnerships in which WHO participates that work according to the best practice principles for Global Health Partnerships

12.3.2 Proportion of health partnerships managed by WHO that comply with WHO partnership policy guidance

12.3.3 Proportion of countries where WHO is leading or actively engaged in health and development partnerships (formal and informal), including in the context of reforms of the United Nations system

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

33.8

12.4 Essential multilingual health knowledge and advocacy material made accessible to Member States, health partners and other stakeholders through the effective exchange and sharing of knowledge. Africa

INDICATORS 12.4.1 Average number of page views/visits per month to the WHO headquarters’ web site

12.4.2 Number of pages in languages other than English available on WHO country and regional offices’ and headquarters’ web sites

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

32.4

63 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

STRATEGIC OBJECTIVE 13 To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively Scope The scope of this objective covers the functions that support the work of the Secretariat in county and regional offices and at headquarters. Work is organized according to entire resultsbased management framework and processes, from strategic and operational planning and budgeting to performance monitoring and evaluation; management of financial resources through monitoring, mobilization and coordination Organization-wide, ensuring an efficient flow of available resources throughout the Organization; management of human resources, including human resource planning, recruitment, staff development and learning, performance management, and conditions of service and entitlements; provision of operational support, ranging from the management of infrastructure and logistics, language services, staff and premises security, and staff medical services to the management of information technology; and appropriate accountability and governance mechanisms across all areas. The strategic objective also covers broad institutional reform that will ensure that the above functions are continuously strengthened and provide better, more efficient and cost-effective support to the Organization. It is closely linked to broader reforms within the United Nations system at both country and global levels. Links with other strategic objectives This objective should not be considered in isolation from the other strategic objectives, as its scope reflects and is responsive to the needs of the Organization as a whole. In particular, it should be read in conjunction with strategic objective 12, to provide leadership, strengthen governance and foster partnership and collaboration with countries and to fulfil the mandate of WHO in advancing the global health agenda. Strategic objective 13 is more inward-looking, geared towards managerial and administrative issues, whereas strategic objective 12 is more outward-looking, focusing on issues of WHO leadership and governance and on collaboration with Member States and partners at global, regional and country levels.

64 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

126.0

29.8

45.0

45.3

36.5

34.0

229.0

545.6

Resource breakdown for the strategic objective for 2010–2011 (US$ thousand) Countries Regions Headquarters

TOTAL

All financing 2010–2011 Percentage by level

Budget by organization-wide expected result and location 13.1 Work of the Organization guided by strategic and operational plans that build on lessons learnt, reflect country needs, are elaborated across the Organization, and used to monitor performance and evaluate results. Africa

INDICATORS 13.1.1 Proportion of country workplans that have been peer reviewed with respect to their technical quality, that they incorporate lessons learnt and reflect country needs BASELINE 2010

13.1.2 Office Specific Expected Results (OSERs) for which progress status has been updated within the established timeframes for periodic reporting

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

40.8

13.2 Sound financial practices and efficient management of financial resources achieved through continuous monitoring and mobilization of resources to ensure the alignment of resources with the programme budgets. Africa

INDICATORS 13.2.1 Degree of compliance of WHO with International Public Sector Accounting Standards BASELINE 2010

13.2.2 Proportion of voluntary contributions that are classified as “core voluntary contribution “

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

67.8

65 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

13.3 Human resource policies and practices in place to attract and retain top talent, promote learning and professional development, manage performance, and foster ethical behaviour.

INDICATORS 13.3.1 Proportion of offices1 with approved human resources plans for a biennium

13.3.2 Number of staff assuming a new position or moving to a new location during a biennium (delayed until 2010–2011biennium)

13.3.3 Proportion of staff in compliance with the cycle of the Performance Management Development System

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

37.0

13.4 Management strategies, policies and practices in place for information systems, that ensure reliable, secure and costeffective solutions while meeting the changing needs of the Organization.

INDICATORS 13.4.1 Number of information technology disciplines2 implemented Organization-wide according to industry-best-practices benchmarks

13.4.2 Proportion of offices using consistent real-time management information

BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

120.3

13.5 Managerial and administrative support services3 necessary for the efficient functioning of the Organization provided in accordance with service-level agreements that emphasize quality and responsiveness. Africa

INDICATORS 13.5.1 Proportion of services delivered by the global service centre according to criteria in servicelevel agreements BASELINE 2010

TARGETS TO BE ACHIEVED BY 2011

The Americas

South-East Asia

Budget (US$ thousand) Europe Eastern Mediterranean

Western Pacific

Headquarters

TOTAL

130.1

1 2

Offices here refers to country offices (144), regional office divisions (~30) and headquarter departments (~40). This includes, for example, incidence management, configuration management, release management, service-desk

function. Includes services in the areas of information technology, human resources, financial resources, logistics, and language services. 3

66 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011

13.6 Working environment conducive to the well-being and safety of staff in all locations.

INDICATORS 13.6.1 Proportion of planned projects included in the Capital master plan completed for a given biennium BASELINE 2010

13.6.2 Proportion of locations that are compliant with Minimum Operating Safety Standards (MOSS)

TARGETS TO BE ACHIEVED BY 2011 Budget (US$ thousand) Europe Eastern Mediterranean

Africa

The Americas

South-East Asia

Western Pacific

Headquarters

TOTAL

149.6

68 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 1. Proposed programme budget by strategic objective US$ million Strategic objective Africa The Americas South-East Asia

1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, genderresponsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL

605.0 242.0

34.4 48.2

209.0 105.0

21.0

11.8

16.0

115.0

27.4

46.0

34.0

15.9

14.0

26.0

13.9

16.0

9.0

6.9

5.0

19.0

12.1

14.0

40.0

12.6

12.0

142.0 23.0

38.5 8.9

55.0 14.0

49.0

16.6

17.0

126.0 1 451.0

29.8 277.0

45.0 568.0

69 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

and major office, 2010–2011 (US$ million) (before currency adjustment) Europe Eastern Mediterranean Western Pacific Headquarters TOTAL

38.7 30.5

155.7 52.0

84.4 53.0

415.8 201.0

1 543.0 731.7

13.5

19.0

17.0

63.5

161.8

11.2

35.1

25.0

94.5

354.2

8.8

8.0

5.0

41.0

126.7

9.7

21.0

25.0

65.5

177.1

6.0

13.0

2.0

30.0

71.9

19.4

19.0

13.0

50.2

146.7

5.3

9.0

14.0

26.0

118.9

49.9 5.6

71.8 17.2

46.0 15.0

142.5 77.0

545.7 160.7

34.2

28.1

15.0

94.0

253.9

45.3 278.1

36.5 485.4

34.0 348.4

229.0 1 530.0

545.6 4 937.9

70 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 2. Proposed programme budget by strategic objective, organizational level and source of financing, 2010–2011 (US$ million) GRAND TOTAL Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual Voluntary contribution All financing 1 543.0 731.7 Regions Country All financing Regional All financing Headquarters All financing

Strategic objective

impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, genderresponsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

161.8

354.2

126.7

177.1

71.9

146.7

118.9

545.7 160.7

253.9

545.6 4 937.9

Includes miscellaneous income.

71 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) Africa Strategic objective Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Total Voluntary contribution All financing 605.0 242.0

Country All financing

Regional All financing

21.0

115.0

34.0

26.0

9.0

19.0

40.0

142.0 23.0

49.0

126.0 1 451.0

Includes miscellaneous income.

72 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) The Americas Strategic objective Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Total Voluntary contribution All financing 34.4 48.2

Country All financing

Regional All financing

11.8

27.4

15.9

13.9

6.9

12.1

12.6

38.5 8.9

16.6

29.8 277.0

Includes miscellaneous income.

73 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) South-East Asia Strategic objective Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Total Voluntary contribution All financing 209.0 105.0

Country All financing

Regional All financing

16.0

46.0

14.0

16.0

5.0

14.0

12.0

55.0 14.0

17.0

45.0 568.0

Includes miscellaneous income.

74 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) Europe Strategic objective Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Total Voluntary contribution All financing 38.7 30.5

Country All financing

Regional All financing

13.5

11.2

8.8

9.7

6.0

19.4

5.3

49.9 5.6

34.2

45.3 278.1

Includes miscellaneous income.

75 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) Eastern Mediterranean Total Country Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. Prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Strategic objective

Regional All financing

Voluntary contribution

All financing 155.7 52.0

All financing

19.0

35.1

8.0

21.0

13.0

19.0

9.0

71.8 17.2

28.1

36.5 485.4

Includes miscellaneous income.

76 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) Western Pacific Strategic objective Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals. 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Total Voluntary contribution All financing 84.4 53.0

Country All financing

Regional All financing

17.0

25.0

5.0

25.0

2.0

13.0

14.0

46.0 15.0

15.0

34.0 348.4

Includes miscellaneous income.

77 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 3. Proposed programme budget by strategic objective, major office and source of financing, 2010–2011 (US$ million) Headquarters Total Assessed contributiona 1. To reduce the health, social and economic burden of communicable diseases 2. To combat HIV/AIDS, malaria and tuberculosis 3. To prevent and reduce disease, disability and premature death from chronic noncommunicable conditions, mental disorders, violence and injuries and visual impairment 4. To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5. To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6. To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7. To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8. To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9. To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10. To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11. To ensure improved access, quality and use of medical products and technologies 12. To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work 13. To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL a

Strategic objective

Voluntary contribution

All financing 415.8 201.0

63.5

94.5

41.0

65.5

30.0

50.2

26.0

142.5 77.0

94.0

229.0 1 530.0

Includes miscellaneous income.

78 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 4. Individual partnerships and collaborative arrangements included in the Proposed programme budget by strategic objective, 2010–2011 (US$ million) Strategic objectives/partnerships and collaborative arrangements Total US$ million (before currency adjustments) 238.1 388.8 50.0 22.0 73.8 3.0 73.0 30.0 878.7

Strategic objective 1 Effective collaboration with partners in the GAVI Alliance in support of the accelerated introduction of vaccines against childhood diseases Global Polio Eradication Initiative Partnership for the control of neglected tropical diseases Effective collaboration with partners in the GAVI Alliance in support of integrated surveillance UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases Vaccine research partnerships Effective collaboration with partners in the GAVI Alliance in support of the accelerated introduction of vaccines against epidemic prone diseases WHO/FAO/OIE agreement on the management of avian influenza and other emerging diseases Total Strategic objective 2 WHO/UNAIDS HIV Vaccine Initiative (including the African AIDS Vaccine Programme) UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases Total Strategic objective 4 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Total Strategic objective 5 Health and Nutrition Tracking Service Total Strategic objective 6 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction WHO Centre for Health Development (Kobe) Total Strategic objective 8 Intergovernmental Forum on Chemical Safety Total Strategic objective 10 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction World Alliance for Patient Safety Total Grand total

3.0 2.0 73.0 78.0

40.5 40.5

3.0 3.0

2.0 11.0 13.0

1.2 1.2

1.0 34.5 35.5 1 049.9

79 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 FINANCIAL TABLES

Summary table 5. Partnership and collaborative arrangements – movements between 2008–2009 and 2010–2011 Name Partnerships and collaborative arrangements (US$ million) Approved Programme budget 2008–2009 Revised Programme budget 2008–2009 Revised Programme budget 2008–2009 net of partnerships and collaborative arrangements moved out for biennium 2010–2011 Proposed programme budget for partnerships and collaborative arrangements 2010–2011 (before currency adjustments)

Alliance for Health Policy and Systems Research Global Health Workforce Alliance Health and Nutrition Tracking Service Health Metrics Network Intergovernmental Forum on Chemical Safety Partnership for Maternal, Newborn and Child Health Roll Back Malaria Partnership UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Stop TB Partnership United Nations Standing Committee on Nutrition Water Supply and Sanitation Collaborative Council HIV Vaccine Initiative (including African AIDS Vaccine Programme) Global Polio Eradication Initiative World Alliance for Patient Safety Vaccine-Research Partnerships WHO/FAO/OIE agreement on the management of avian influenza and other emerging diseases WHO Centre for Health Development Effective collaboration with GAVI partners Partnership for the control of neglected tropical diseases Total

7.5 5.0 13.6

7.7 11.8 3.0 27.2 1.2 13.1 18.7

3.0 1.2 -

79.3

100.9

146.8

40.5 18.7 0.2 1.3 196.5 7.0 0.3

42.8 27.5 7.3 35.8 1.3 399.6 34.7 0.3

42.8 1.3 399.6 34.7 0.3

45.5 3.0 388.8 34.5 3.0

369.9

14.0 746.9

14.0 597.8

30.0 11.0 333.1 50.0 1 049.9

81 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

PARTNERSHIPS OUTSIDE THE PROGRAMME BUDGET 2010-2011 ENVELOPE

As the demand for international public health assistance has grown, so too has the donor community. Now, in addition to Member States financing international public health, national overseas development assistance programmes are playing a greater role, and contributions from other multilateral organizations, development institutions and private foundations are growing. As a result, the international health and development community increasingly works through partnerships. Often WHO has a key role in these partnerships, yet they have their own governance structure and WHO has no managerial control of their budgets or workplans. The relationship established between these partnerships and WHO reflects the synergies and coordination that are necessary to the achievement of the strategic objectives in the Medium-term strategic plan and the Proposed programme budget 2010–2011.

82 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

BIENNIAL BUDGETS OF PARTNERSHIPS OUTSIDE THE PROGRAMME BUDGET 2010–2011

Partnership

Strategic objective principally supported 10

Budget (in US$ thousand)

Alliance for Health Policy and Systems Research Global Health Workforce Alliance Health Metrics Network Partnership for Maternal, Newborn and Child Health Roll Back Malaria Partnership Secretariat of the Framework Convention on Tobacco Control Stop TB Partnership Global Drug Facility United Nations Standing Committee on Nutrition International Drug Purchase Facility, UNITAID Water Supply and Sanitation Collaborative Council

10 000

10 10 4 2

30 000 22 400 30 000 50 000

7000

2 2 9 2

32 500 86 250 7301 To be added in the version for EB124 61 410

TOTAL

83 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

ALLIANCE FOR HEALTH POLICY AND SYSTEMS RESEARCH Strategic objective to which the work of the partnership contributes 10: To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research Strategic approaches the partnership will focus on The Alliance for Health Policy and Systems Research focuses on the following strategic approaches, to support the achievement of strategic objective 10: (i) stimulating the generation and synthesis of policy-relevant health systems knowledge, encompassing evidence, tools and methods, (ii) promoting the dissemination and use of health policy and systems knowledge in order to improve the performance of health systems, and (iii) facilitating the development of capacity for the generation, dissemination and use of health policy and systems research knowledge among researchers, policy-makers and other stakeholders. Scope of the partnership’s work during the biennium 2010–2011 During the biennium 2010–2011, the Alliance will identify, and build consensus around, high-priority research questions in the health policy and systems field, and support both strategic, multicountry studies and the synthesis of existing knowledge. The Alliance will continue to invest in mechanisms at country and regional levels that promote the use of evidence in policy, and will evaluate the effectiveness of different innovative knowledge translation mechanisms. The Alliance will support the teaching of health policy and systems research as part of post-graduate courses, the strengthening and dissemination of health policy and systems research methodologies, and will implement and evaluate strategies to enhance policy-makers’ capacity to use evidence in policy-making. The strategies will be implemented primarily through calls for proposals and the competitive award of grants to developing country institutions. Coordinating with WHO The Alliance’s programme of work both benefits from WHO’s work on health systems and services (for example in terms of identifying research priorities) and contributes to that work (for example in terms of summarizing and synthesizing available evidence on health systems). The Alliance’s programme of work clearly links with WHO`s strategic objectives, yet the Alliance works primarily through developing country research institutions, thereby engaging a set of actors complementary to WHO’s member states. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 US$ 10 000 thousands

84 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

GLOBAL HEALTH WORKFORCE ALLIANCE Strategic objective to which the work of the partnership contributes 10: To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research Strategic approaches the partnership will focus on The Alliance will, through the coordinated actions of its members, support the development of evidence-based, comprehensive and coherent country-level approaches and significant scaling up of country, regional and global actions necessary to ensure universal access to motivated and skilled health workers. Scope of the partnership’s work during the biennium 2010–2011 The Alliance operates as a global focal point for workforce development, enhancing access to information, knowledge, best practices, and institution resources for all stakeholders. Its work will focus on the following three priorities: • accelerating country work and capacity development through promoting and facilitating partnerships within countries • harmonizing actors for workforce alignment to strengthen priority programmes and broader health systems • building knowledge and stimulating learning as a global public good. Coordinating with WHO The Alliance aims to stimulate work that brings extra value beyond the activities and productivity of current institutions, including WHO. Work that is prioritized must be catalytic, ensuring complete systems for health workforce development globally. The Alliance will collaborate with existing institutions and bodies, avoiding duplication or competition, supporting work that is consistent with the partners’ mandates, compatible with their capabilities, and linked to the transparency and accountability of their actions. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 US$ 30 000 thousands

85 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

HEALTH METRICS NETWORK Strategic objective to which the work of the partnership contributes 10: To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research Strategic approaches the partnership will focus on The Health Metrics Network has a single strategic goal: to increase the availability and use of timely and accurate health information by catalysing the joint funding and development of core country health information systems. Scope of the partnership’s work during the biennium 2010–2011 In support of strategic objective 10, the partnership will pursue its three interrelated objectives: • to create a harmonized framework for country health information systems, that describes standards for health information systems; • to strengthen country health information systems by providing technical and catalytic financial support to apply the framework; and • to ensure access to, and use of, information by local, regional and global constituencies. Coordinating with WHO The Health Metrics Network will continue to work closely with the WHO Secretariat in the area of health statistics and informatics in an effort to accelerate the work on standards development that will be crucial to the next version of the framework. The Network will continue to work with WHO regional offices and focal points at the country level to advance country activities to strengthen health information systems. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 US$ 22 400 thousands

86 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

PARTNERSHIP FOR MATERNAL, NEWBORN AND CHILD HEALTH Strategic objective to which the work of the Partnership contributes 4: To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals Strategic approaches the partnership will focus on The Partnership for Maternal, Newborn and Child Health focuses on the following work areas: global, regional and country-level political advocacy for maternal, newborn and child health; accelerating and facilitating country action; harmonizing relations with partners and increasing aid effectiveness; tracking progress both towards achieving Millennium Development Goals 4 and 5 and with regard to feeding. Core functions are also included in the annual work plan. These include regular Board meetings, supporting working groups and the WHO Secretariat. Scope of the Partnership’s work during the biennium 2010–2011 The Partnership will continue its advocacy work through the following activities: mapping advocacy messages and tools; developing common messaging platforms; implementing advocacy drives; increasing the Partnership’s media visibility; and tracking political commitments and media coverage. In support of countries the Partnership will: provide technical support for national planning and budgeting processes; improve access to useful models for integrated components for maternal, newborn and child health in national health plans; publish best practices; and develop in-country capacity. The Partnership will also exercise leadership in incorporating maternal, newborn and child health into new global health initiatives and in catalyzing effective national coordination mechanisms, as well as in building platforms for strengthening existing measurement mechanisms. The Partnership will also be active in assessing progress by holding stakeholders at all levels accountable in meeting their financial and policy commitments. Coordinating with WHO The Partnership for Maternal, Newborn and Child Health will coordinate its identification and analysis of specific countries’ constraints in order to avoid duplicating efforts that may be undertaken by WHO. Recognizing the additional resources the Partnership can bring to bear, it will supplement WHO’s work in the area of maternal, newborn and child health. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 US$ 30 000 thousands

87 DRAFT PROPOSED PROGRAMME BUDGET 2010–2011 ANNEX

ROLL BACK MALARIA PARTNERSHIP Strategic objective to which the work of the partnership contributes 2: To combat HIV/AIDS, tuberculosis and malaria Strategic approaches the partnership will focus on The Roll Back Malaria Partnership’s Global Malaria Business Plan and the annual Partnership-wide harmonized workplans serve to coordinate global actions for malaria control by all partners. The strategic objective is well aligned with both the Business Plan and the workplans. The following activities will also be critical to success: promoting universal access to essential interventions for prevention, treatment, care and support in order to halt disease transmission and reduce morbidity and mortality; ensuring sustained political commitment and more effective partnerships, including coherence and harmonization of operations with partners at all levels; and advocating for concerted efforts. Scope of the partnership’s work during the biennium 2010–2011 The work of the Roll Back Malaria Partnership focuses on supporting countries to (i) scale up rapidly in order to reach targets for rolling back malaria by the year 2010; (ii) sustain disease control through scaling up; and (iii) move towards transmission reduction and regional elimination. Coordinating with WHO The Partnership coordinates its activities through the Partnership-wide workplans, in which the WHO Secretariat is operationally involved across departments and at multiple levels. Accountability is ensured through the Roll Back Malaria Partnership Board. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010-2011 US$ 50 000 thousands (Proportion of estimated budget in direct support of the strategic objective is currently unknown. This figure is based on the 2008 harmonized workplan)

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SECRETARIAT OF THE FRAMEWORK CONVENTION ON TOBACCO CONTROL Strategic objective to which the work of the partnership contributes 6: To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex. Strategic approaches that the partnership will focus on • providing global leadership, coordination, communication, collaboration and advocacy for health promotion in order to improve health, reduce health inequalities, control major risk factors and contribute to national development objectives; • supporting the establishment of multisectoral partnerships and alliances within and among Member States, and building international collaboration for the generation and dissemination of research findings; and • providing direct technical assistance for the implementation of the WHO Framework Convention on Tobacco Control, including provision of support to strengthen the tobaccocontrol policies outlined in the MPOWER package.

Scope of the partnership’s work during the biennium 2010–2011 Based on the provisions of the WHO Framework Convention on Tobacco Control and the priorities and strategies identified by the Conference of the Parties, the work of the Conference and the Convention Secretariat will promote the development of internationally agreed instruments for the implementation of different articles of the Convention. The Convention Secretariat will also focus on raising awareness of and disseminating the different instruments, and on helping Parties in their use in the process of implementing the Convention. The work of the Convention Secretariat will include the provision of support to Parties in complying with their reporting obligations, as well as the preparation of annual summary reviews on progress made in implementing the Convention internationally. Coordination with relevant international and regional intergovernmental organizations, particularly those accredited as observers to the Conference of the Parties, engaging their expertise in support of the implementation of the Convention, will constitute another important area of work. Coordinating with WHO Ensuring synergy and complementarity with the work of WHO, particularly the Tobacco Free Initiative, is an important strategy of the Conference of the Parties and the Convention Secretariat. This work will focus on the following: treaty-specific issues; further development of treaty instruments; intergovernmental negotiations and processes; utilizing the legally binding character of the treaty for promoting whole-government commitment and action in the implementation of the treaty; and utilizing the opportunities provided by international obligations of the Parties to promote global and regional coordination and action. At the county level the principal activities will involve promoting access to internationally available resources; providing assistance in treaty-specific and legal matters; profiling and utilizing the political and intergovernmental dimension and potential of the treaty in supporting global and national action against tobacco; supporting Parties in their engagement in the work of the Conference of the Parties and its subsidiary bodies; and supporting the use of and utilizing the information provided through the reporting instrument for promoting the exchange of experiences and the use of best practices available in Parties. Every effort will be made to avoid duplication with the work of the Tobacco Free Initiative and other departments of the WHO Secretariat, which will continue to lead the technical work, advocacy, surveillance and capacity building in countries, and

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which will contribute to the work of the Conference of the Parties and the Convention Secretariat through the provision of their considerable technical expertise and knowledge. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011. The budget for the biennium 2010-2011 has not yet been drafted and discussed. However, the Convention Secretariat envisages that workplan components corresponding to nearly US$ 5000 thousands from voluntary assessed contributions and nearly US$ 2000 thousands from extrabudgetary contributions will directly contribute to the achievement of the strategic objective.

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STOP TB PARTNERSHIP Strategic objective to which the work of the partnership contributes 2: To combat HIV/AIDS, tuberculosis and malaria Strategic approaches the partnership will focus on The Stop TB Partnership will focus on the following approaches to realize its objectives: • expanding and strengthening the coalition of organizations involved in tuberculosis control and research by, for example, increasing community and private sector involvement; • broadening the agenda for tuberculosis control and research, increasing consensus thereon by means, inter alia, of the Global Plan to Stop TB 2006–2015, and the strengthening of guidance, for example, through the activities of the relevant working groups (the DOTS Expansion Working Group, the Multidrug-resistant Tuberculosis Working Group and the Green Light Committee); • expanding the reach and increasing the impact of global advocacy by, for example, conducting high-level missions to countries; • coordinating and supporting partner activities in key areas including technical assistance to countries, some of which have already benefited other functions and disease programmes in countries’ health systems; • improving tuberculosis control in countries, both directly, via, for example, the Global Drug Facility and the Green Light Committee, and indirectly through the Partnership’s other activities, such as advocacy. Scope of the partnership’s work during the biennium 2010–2011 During this period work will focus on: • expanding the network of partners further and directing their energy towards better tuberculosis control; • enhancing global communications; • targeted advocacy, communication and social mobilization efforts in order to build support for tuberculosis control at various levels; • building national partnerships; • supporting the work of civil society in generating support at the grass roots level for tuberculosis control; • monitoring the Global Plan to Stop TB 2006-2015; and • Stop TB Partnership’s Technical Assistance Mechanism in order to relieve bottlenecks in the implementation of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Coordinating with WHO The Stop TB Partnership will align its activities closely with the WHO Secretariat and will supplement the latter’s work. The Partnership will actively support WHO’s six-pronged Stop TB strategy, and will support the work of the three implementation working groups mentioned above, which are hosted in the WHO Secretariat. In this way, the duplication of efforts can be avoided, and the impact of different

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initiatives optimized. In undertaking its work the Partnership will follow all the rules and regulations of WHO. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010-2011 US$ 32 500 thousands

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GLOBAL DRUG FACILITY Strategic objective to which the work of the partnership contributes: 2: To Combat HIV/AIDS, tuberculosis and malaria Strategic approaches the partnership will focus on: • a grant service whereby first-line antituberculosis drugs are granted to eligible and approved countries that require donor support to meet their drug needs; • a direct procurement service for governments, donors and nongovernmental organizations to purchase drugs for use in programmes in countries that have sufficient finances but which lack adequate procurement capacity, including a robust quality assurance system; and • a technical support service whereby the grant and direct procurement services are combined with technical assistance for in-country drug management and monitoring. The Global Drug Facility supports global efforts to improve antituberculosis drug quality assurance, primarily through the WHO-managed prequalification programme for priority essential medicines. The Facility combines these core services with in-country monitoring of the management of the drugs it supplies. Monitoring teams, composed of tuberculosis and drug management experts, work with programmes to identify strategies that will strengthen drug management, and ensure rational drug use and effective distribution. The Global Drug Facility provides a comprehensive catalogue of the antituberculosis drugs and supplies needed to diagnose and treat adults and children, covering both patients infected with drug-sensitive tuberculosis and those with the drug-resistant form of the disease. Scope of the Global Drug Facility’s work during the biennium 2010 - 2011 During this period the Facility will: • maintain an effective grant service for tuberculosis drugs, including a transparent and rigorous applications review process; • ensure growth of the direct procurement service for countries or donors wishing to use their own resources to purchase tuberculosis drugs via the Facility; • supply approximately two million patient treatments via the grant and direct procurement services; • increase supply of diagnostic kits for smear microscopy via the direct procurement service; • maintain and improve the electronic order management system to (1) allow the Facility to electronically place order requests for countries, (2) enable countries to track and trace their tuberculosis drug consignments, and (3) permit the Facility to generate performance reports related to supply chain efficiency; • ensure that the Facility’s operations continue to be supported by a comprehensive unified internal quality management and information system that is ISO 9001:2000 certified; • maintain strategic rotating stockpiles of first- and second-line tuberculosis drugs; • provide the WHO-managed prequalification programme with technical and financial support in order to increase the number of tuberculosis drugs achieving prequalification; • provide, facilitate and broker technical assistance to all countries using the Facility (supported via both the grant and direct procurement services) in order to improve drug management; • maintain timely delivery of the drugs it grants, including rapid lead times for emergency procurements; and

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• contain average drug cost per additional patient cure and reduce prices for certain categories of product by pooling procurement to maintain optimal economies of scale for supply partners, and by coordinating effective forecasting initiatives and keeping abreast of market dynamics to successfully engage industry with respect to product price optimatization, assured product quality and sufficient capacity. Coordinating with WHO The Global Drug Facility will coordinate its activities relating to procurement and management of the aforementioned products with WHO country programmes, the DOTS Expansion Working Group, the Multidrug-resistant Tuberculosis Working Group, the Stop TB Partnership’s Technical Assistance Mechanism, the Green Light Committee and other key WHO partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the International Drug Purchase Facility (UNITAID) in order to avoid duplicating efforts and optimize investments in initiatives for drug (and diagnostics) management. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 The projected biennial budget is US$ 86 250 thousands. The bulk of this figure is for expenditures on procurement of drugs and diagnostics, with the remainder for operational costs including technical assistance, monitoring and evaluation and salaries.

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UNITED NATIONS SYSTEM STANDING COMMITTEE ON NUTRITION Strategic objective to which the work of the partnership contributes 9: To improve nutrition, food safety and food security, throughout the life-course and in support of public health and sustainable development. Strategic approaches the partnership will focus on The Standing Committee will focus on the following strategic approaches to support the achievement of the strategic objective: promoting, disseminating and monitoring coordinated international activities in food and nutrition. Scope of the partnership’s work during the biennium 2010–2011 The work of the Standing Committee in support of this strategic objective will focus on. • communication, advocacy and partnership-building campaigns aimed at reducing hunger and the double burden of malnutrition; • promoting coherent national food and nutrition policy and programme frameworks that are agreed to, integrated into national poverty reduction programmes, and scaled up; and • promoting monitoring and evaluation frameworks for reducing hunger and malnutrition. Coordinating with WHO The Standing Committee will coordinate its activities with WHO through the United Nations Standing Committee on Nutrition Steering Committee, of which several United Nations agencies are members (including FAO, WHO, UNICEF and WFP), as well as representatives of bilateral agencies and civil society. The work of the Steering Committee is to promote coordination across agencies and avoid the duplication of effort. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 US$ 7 301 thousands

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INTERNATIONAL DRUG PURCHASE FACILITY, UNITAID

Information to be added in the version for EB124

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WATER SUPPLY AND SANITATION COLLABORATIVE COUNCIL Strategic objectives to which the work of the partnership contributes 8: To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health. The Council’s work has implications for other strategic objectives since improved sanitation and hygiene reduce diarrhoeal diseases – major killers, especially of children. Sanitation services reduce the burden of communicable diseases (strategic objective 1), reduce morbidity and mortality of children (strategic objective 4) and improve nutrition (strategic objective 9). Advocacy and policy work on sanitation tackle the underlying social and economic determinants of health (strategic objective 7). Strategic approaches the partnership will focus on The Council’s organizational objective is to accelerate the provision of sustainable water, sanitation and waste management services to all people. During this planning period, the Council will continue to concentrate its energy on sanitation and hygiene, rather than on water. It will also pursue its three-part strategic approach, comprising: • networking and knowledge management • advocacy and communications • grants management (the Global Sanitation Fund) Scope of the partnership’s work during the biennium 2010–2011 The Council’s national coalitions (which are not hosted by WHO) will be active in approximately 40 countries, and the Council’s secretariat (which is hosted by WHO) will coordinate networking and knowledge management at the global level. The Council will carry out advocacy and communications work at national and global levels, and the Global Sanitation Fund will provide grants to organizations to carry out sanitation and hygiene services in approximately 20 countries. Coordinating with WHO Although planning and implementing their work independently, WHO and the Water Supply and Sanitation Collaborative Council intend their activities to be complementary and will pursue cooperation when the benefits achievable are significant. Collaborative work is expected to include joint publications, joint meetings, the exchange of professional views and knowledge, and committee work. WHO’s mainly normative, technical, evidence-based work and the Council’s mainly practical, outgoing, people-centred activities are mutually complementary. There is no duplication between the Council’s work and that of WHO. Partnership’s projected budget for contributing to the achievement of the strategic objective during the biennium 2010–2011 US$ 61 410 thousands _______________

Key facts

Organisation World Health Organization (WHO)

Document type Technical Documents

Adoption date December 31, 2008

Source World Health Organization