W O R L D H E A L T H O R G A N IZ A T IO N Reg io n a l O ffice fo r E uro pe C o pe n h a g e n REGIONAL COMMITTEE FOR EUROPE Forty-eighth session, Copenhagen, 1 4 - 1 8 September 1998 Provisional agenda item 3(b) EUR/RC48/8 Add. 1 26 August 1998 08628 ORIGINAL: ENGLISH A d d i t i o n a l R e g i o n a l P r o g r a m m e B u d g e t A l l o c a t i o n - A d d e n d u m t o t h e P r o p o s e d P r o g r a m m e B u d g e t f o r 2 0 0 0 - 2 0 0 1 In accordance with resolution WHA51.31, the Director-General has by memorandum o f 25 June 1998 increased the programme budget allocation to the European Region o f WHO by US $2 209 000 (from US $49 490 000 to US $51 699 000). This document should be read in conjunction with the European Region’s proposed programme budget for 2000-2001 (document EUR/RC48/8). It is an addendum to the programme budget, setting out alternatives for the use o f the additional funds. The Regional Committee is asked to decide on a model for budget allocation and selection o f beneficiary countries, and to endorse the principle o f identifying technical programme priorities. CONTENTS Page Policy basis for additional regional allocation...................................................................................................... 1 EUROHEALTH framework..................................................................................................................................... 1 Choice o f beneficiary countries................................................................................................................................1 Choice o f allocation form ula.................................................................................................................................... 2 Proposed programme priorities................................................................................................................................4 Conclusion................................................................................................................................................................... 5 Annex 1. Situation in the target countries............................................................................................................6 Annex 2. Overview of current and proposed additional allocations for 2000-2001, by country.............. 7 EUR/RC48/8 A dd.l page 1 1. By virtue o f solidarity between all WHO regions, the additional regional allocation became necessary because the traditionally low allocations to the African and European regions could no longer be maintained as equitable, needs-based and transparent. Thanks to efforts initially made by the WHO Regional Committee for Europe and European members o f the Executive Board, the World Health Assembly in May 1998 agreed on reallocations of regular budget funds over three biennia, starting with 2000-2001 (resolution WHA51.31). 2. The regional allocation for the European Region for 2000-2001 has accordingly been amended from US $49 490 000 to US $51 699 000, as confirmed by the Director-General in a memorandum dated 25 June 1998. To date (August 1998) no additional guidance has been received regarding the use o f the additional funds inside the Region. P o l ic y b a s is f o r a d d it io n a l r e g io n a l a l l o c a t i o n EUROHEALTH FRAMEWORK 3. At its forty-first session in 1991 the Regional Committee, responding to the great needs o f the countries o f central and eastern Europe and the newly independent states (CCEE/NIS), adopted the EUROHEALTH programme as the Regional Office’s framework for intensified cooperation with countries most in need. The programme’s activities have been extensively evaluated, and an updated EUROHEALTH programme was adopted by the Regional Committee at its forty-fifth session in 1995, which includes also aspirational targets for achievement by the year 2000 (resolution EUR/RC45/R6). Since the EUROHEALTH programme thus already aims at assisting the countries most in need, the entire additional regional allocation will be used within the EUROHEALTH framework and for its beneficiary countries and programme priorities. However, a further prioritization will be undertaken, in order to focus even more sharply on countries in greatest need and on the most crucial programme priorities. 4. The use made o f the additional funds will be evaluated on the basis o f the established criteria for internal and external evaluation, as endorsed by the Standing Committee o f the Regional Committee (document EUR/RC46/SC(3)/7). In addition, the evaluation will cover the degree o f “ intensified cooperation”, including a country’s ability to speed up key health programmes, to improve the capacity o f its structures to engage in collaboration, to mobilize additional national and international resources and projects, and to integrate more rapidly with the United Nations development assistance framework (UNDAF). C h o ic e o f b e n e f i c i a r y c o u n t r ie s 5. The first issue to be determined is which countries could benefit most from the additional regional allocation. At least three alternatives could be contemplated. Alternative A Countries classified as "low-income” countries according to the World Bank’s definition, i.e. those that have a gross national product (GNP) per head o f less than US $785. According to the World Bank Atlas 1998 (using 1996 data on GNP where available), six countries of the Region can be classified as “low-income”: Armenia (ARM), Azerbaijan (AZE), Bosnia and Herzegovina (BIH), Kyrgyzstan (KGZ), Republic o f Moldova (MDA) and Tajikistan (TJK). Alternative B The above-mentioned six plus any additional countries that satisfy the criteria for having a WHO country office beyond a liaison office. According to Executive Board document EB102/2 on WHO reform ( WHO country offices: criteria fo r classifying countries on the basis o f need), these are developing countries that have a population exceeding 50 million or else have a Human Development Index (HDI) below 0.7 and/or immunization coverage o f below 60%. It is acknowledged that the latter criteria can be sensitive to time period and estimation method. Based on estimates using the latest available data, eight o f the remaining 44 active Member States (50 minus the six low-income countries listed above) satisfy the criteria for a WHO country office: Albania (ALB), Georgia (GEO), Kazakhstan (KAZ), Russian Federation (RUS), Turkmenistan (TKM), Turkey (TUR), Ukraine (UKR) and Uzbekistan (UZB). Alternative B would thus cover 14 countries (the above eight plus the six low-income countries), i.e. ALB, ARM, AZE, BIH, GEO, KAZ, KGZ, MDA, RUS, TJK, TKM, TUR, UKR and UZB. Alternative C Turkey plus the 26 EUROHEALTH countries that already receive a regular budget allocation. C h o ic e o f a l l o c a t i o n f o r m u l a 6 . The Executive Board has advocated a considerable strengthening o f W HO’s country presence and discussed the possible criteria for establishing WHO country offices. At its 102nd session in May 1998, the Executive Board recommended that the type o f WHO representation in countries should be reviewed taking account of the HDI and immunization coverage, and modified as appropriate, and progress reported to the Board in January 2000 (decision EB 102(1)). However, in the European Region a full WHO country office would cost about US $550 000 per biennium, and the amount of the additional regional allocation is not sufficient to upgrade even the six countries listed in Alternative A. Even if only a few of them were to be upgraded, there would be insufficient regular budget funds for meaningful programme implementation. It is therefore proposed to rely largely on the current structure o f liaison offices and the Regional Office’s support to these offices through its Countiy Health department. 7. About US $0.2 million could be used to strengthen the capacity for programme development and cooperation in countries. This would encompass: • taking steps to streamline cooperation; • establishing some additional country or multi-country presence; • identifying cooperation and opportunities for resource mobilization; • strengthening national capacity for project formulation and the design o f practical strategies and policies; and • undertaking additional activities in the areas o f training and institution-building (but excluding supplies and equipment). 8 . The options for allocation o f the remaining US $2 million (about 91% of the total) to the beneficiary countries (see section 3 above) are set out below. Criterion 1 Even allocation. Criterion 1 is most appropriate for Alternative A, which covers countries o f roughly similar size and with considerable needs. Criterion 2 Preferential allocation, with countries most in need receiving a multiple (e.g. about 4 times) o f the allocation o f the others. Criterion 2 could apply to Alternative B. EUR/RC48/8 Add.l page 2 EUR/RC48/8 Add.l page 3 Criterion 3 Preferential allocation to countries according to the criteria used in resolution WHA51.31. Criterion 3 could be appropriate for Alternative C; its features have, moreover, already been used for the selection o f beneficiary countries in Alternatives A and B. 9. In financial terms, alternatives A, B and C (with criteria 1 ,2 and 3, respectively) would yield the following allocations (Table 1), in addition to the regular budget country allocations already foreseen in the proposed programme budget for 2 0 0 0 - 2 0 0 1 . Table 1. Financial implications of alternatives US$ % ALTERNATIVE A (with criterion 1) 330 000-335 000 each Low-income countries (6 countries) 2 000 000 90.5 Country programme development 209 000 9.5 Total 6 countries 2 209 000 100.0 ALTERNATIVE B (with criterion 2) 250 000 each Low-income countries (6 countries) 1 500 000 67.9 60 000-65 000 each Other countries in special need (8 countries) 500 000 22.6 Country programme development 209 000 9.5 Total 14 countries 2 209 000 100.0 ALTERNATIVE C (with criterion 3) 190 000 each 2 countries (RUS, UZB) 380 000 17.2 160 000 each 1 country (TUR) 160 000 7.2 110 000 each 1 country (BIH) 110 000 5.0 100 000 each 3 countries (KAZ, LVA1, UKR) 300 000 13.6 80 000 each 3 countries (AZE, GEO, KGZ) 240 000 10.8 70 000 each 4 countries (ARM, MDA, TJK, TKM) 280 000 12.7 50 000 each 9 countries (ALB, BLR, BUL, CRO, EST, LTU, POL, ROM, TFY)2 450 000 20.4 20 000 each 4 countries (CZH, HUN, SVK, SVN)3 80 000 3.6 Country programme development 209 000 9.5 Total 27 countries 2 209 000 100.0 10. As the additional regional allocation is rather small - US $2.2 million - the intention is not to spread the allocation too thinly among too many countries, in order to be able to make an impact. For the biennium 2000-2001, it is therefore proposed to retain Alternative A with criterion 1, which would mean distributing the additional funds evenly to the six “low-income” countries. For subsequent biennia, the Regional Committee may wish to return to this decision and review alternative models and criteria, as appropriate, in respect o f any further increases in the budget allocation. For ease o f reference, a table 1 Latvia. 2 Albania, Belarus, Bulgaria, Croatia, Estonia, Lithuania, Poland, Romania and The Former Yugoslav Republic of Macedonia. 3 Czech Republic, Hungary, Slovakia and Slovenia. showing the present situation in the target countries is attached as Annex 1, and a table showing the alternative additional allocations by country is attached as Annex 2. P r o p o s e d p r o g r a m m e p r io r it ie s 11. The six medium-term priorities for collaboration under the EUROHEALTH programme during 1995-2000, as agreed by the Regional Committee,4 are: infectious diseases, women’s and child health, health policy, health care reform, environmental health, and noncommunicable diseases and the promotion of better health. These priorities are broadly consistent with WHO’s global priorities for 2000-2001. For a breakdown o f the current country programme allocation, please refer to Table 2 in Chapter 1 of the Proposed programme budget 2000-2001 (see columns marked CP = country programme). 12. Especially in the six “ low-income” countries, a major effort is required to make progress towards the EUROHEALTH objectives. The purpose of the additional allocation is to improve technical cooperation in the most critical areas. For the preferred alternative, the allocations by priority area would be as set out in Table 2. EUR/RC48/8 Add.l page 4 Table 2. Allocations by priority area General Programme of Work Priority area Allocation % 3.1-3.4 Health care reform 500 000 22.6% 5.2 Infectious diseases 500 000 22.6% 4.1 Women’s and child health 400 000 18.1% 2.2-24 Health policy 300 000 13.6% 4.4 Environment and health 150 000 6.8% 5.3, 4.2 Noncommunicable diseases and promotion of better health 150 000 6.8% 2.3 Strengthening programme development and country presence 209 000 9.5% 2 209 000 100.0% 3. These priorities include a number o f areas o f special need: health care reform: evidence-based strategies, quality o f care, pharmaceutical strategies; infectious diseases: re-emerging diseases, malaria, sexually transmitted diseases, HIV/AIDS, tuberculosis, improved water supply and nutrition; women’s and child health: care surrounding pregnancy, school health, psychosocial aspects; health policy: formulation o f national HFA policy, national implementation plan (master plan of action, sectoral and local HFA strategies, HFA information); environment and health: national action plans and services; noncommunicable diseases and promotion o f better health: the CINDI5 programme, tobacco strategies and legislation; strengthening programme development and country presence: see paragraph 7 above. Resolution EUR/RC45/R6. Countrywide integrated noncommunicable diseases intervention. 14. At this stage, these allocations by programme priorities are suggested as average figures. It should be emphasized that detailed programme allocation would be negotiated with each country individually, taking account o f its particular circumstances and priority needs. C o n c l u s io n 15. The Regional Committee is asked to: (1) decide on the model for budget allocation and selection o f beneficiary countries; (2 ) endorse the principle o f identifying technical programme priorities. EUR/RC48/8 A dd.l page 5 EUR/RC48/8 Add.l page 6 Annex 1 S it u a t io n in t h e T a r g e t C o u n t r ie s Country GNP/head (US $) Immunization rate Human development index (HDI) Low-income countries Tajikistan 340 96 0.575 Azerbaijan 480 93 0.623 Kyrgyzstan 550 88 0.633 Republic of Moldova 590 93 0.610 Armenia 630 85 0.674 Bosnia and Herzegovina below 780 67 0.759 Countries with HDI <0.7 Albania 820 98 0.656 Georgia 850 89 0.633 Turkmenistan 940 90 0.660 Uzbekistan 1010 65 0.659 Ukraine 1200 95 0.665 Kazakhstan 1350 88 0.695 Other The Former Yugoslav Republic of Macedonia 990 91 0.749 Bulgaria 1190 97 0.789 Romania 1600 98 0.767 Belarus 2070 93 0.783 Lithuania 2280 90 0.750 Latvia 2300 66 0.704 Russian Federation 2410 80 0.769 Turkey 2830 77 0.782 Estonia 3080 84 0.758 Poland 3230 95 0.851 Slovakia 3410 98 0.875 Croatia 3800 89 0.759 Hungary 4340 100 0.857 Czech Republic 4740 97 0.884 Slovenia 9240 98 0.887 EUR/RC48/8 A dd.l page 7 Annex 2 O v e r v i e w o f C u r r e n t a n d P r o p o s e d A d d i t i o n a l A l l o c a t i o n s f o r 2000-2001, b y C o u n t r y Country Originally proposed, 2000-2001 Alternative A Alternative B Alternative C Albania 130 000 130 000 190 000 180 000 Andorra 0 0 0 0 Armenia 130 000 465 000 385 000 200 000 Austria 0 0 0 0 Azerbaijan 130 000 465 000 385 000 210 000 Belarus 130 000 130 000 130 000 180 000 Belgium 0 0 0 0 Bosnia and Herzegovina 130 000 460 000 380 000 240 000 Bulgaria 50 000 50 000 50 000 100 000 Croatia 130 000 130 000 130 000 180 000 Czech Republic 50 000 50 000 50 000 70 000 Denmark 0 0 0 0 Estonia 50 000 50 000 50 000 100 000 Finland 0 0 0 0 France 0 0 0 0 Georgia 130 000 130 000 190 000 210 000 Germany 0 0 0 0 Greece 0 0 0 0 Hungary 50 000 50 000 50 000 70 000 Iceland 0 0 0 0 Ireland 0 0 0 0 Israel 0 0 0 0 Italy 0 0 0 0 Kazakhstan 130 000 130 000 190 000 230 000 Kyrgyzstan 130 000 460 000 380 000 210 000 Latvia 50 000 50 000 50 000 150 000 Lithuania 50 000 50 000 50 000 100 000 Luxembourg 0 0 0 0 Malta 0 0 0 0 Monaco 0 0 0 0 Netherlands 0 0 0 0 Norway 0 0 0 0 Poland 50 000 50 000 50 000 100 000 Portugal 0 0 0 0 Republic of Moldova 130 000 465 000 385 000 200 000 Romania 50 000 50 000 50 000 100 000 Russian Federation 200 000 200 000 260 000 390 000 San Marino 0 0 0 0 Slovakia 50 000 50 000 50 000 70 000 Slovenia 50 000 50 000 50 000 70 000 Spain 0 0 0 0 Sweden 0 0 0 0 Switzerland 0 0 0 0 Tajikistan 130 000 465 000 385 000 200 000 EUR/RC48/8 Add.l page 8 Country Originally proposed, 2000-2001 Alternative A Alternative B Alternative C The Former Yugoslav Republic of Macedonia 130 000 130 000 130 000 180 000 Turkey 200 000 200 000 260 000 360 000 Turkmenistan 130 000 130 000 190 000 200 000 Ukraine 130 000 130 000 190 000 230 000 United Kingdom 0 0 0 0 Uzbekistan 130 000 130 000 190 000 320 000 Yugoslavia6 50 000 50 000 50 000 50 000 Total country allocations 2 900 000 4 900 000 4 900 000 4 900 000 Liaison offices 1 748 000 1 748 000 1 748 000 1 748 000 Country information support and programme development 172 000 381 000 381 000 381 000 Clearing house 265 000 265 000 265 000 265 000 Other support for HFA in countries 200 000 200 000 200 000 200 000 Total country support 2 385 000 2 594 000 2 594 000 2 594 000 COUNTRY PROGRAMME GRAND TOTAL 5 285 000 7 494 000 7 494 000 7 494 000 6 If the World Health Assembly in the meantime has agreed to normalization of official membership status.
|1948 ^ # 1 9 9 8 REGIONAL COMMITTEE FOR EUROPE Forty-eighth session, Copenhagen, 1 4 - 1 8 September 1998 WORLD HEALTH ORGANIZATION Regional Office for Europe Copenhagen Provisional agenda item 3(b) EUR/RC48/8 Add.l Corr.l 14 September 1998 10128 ORIGINAL: ENGLISH P r o p o s e d Pr o g r a m m e B u d g e t 2 0 0 0 -2 0 0 1 C o r r ig e n d u m For Read Page 3 Table 1, Alternative C, line 1. . .TFY FYM