WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA 26 th Session of WHO South-East Asia Advisory Committee on Health Research 17-20 April 2001, Thimphu, Bhutan SEA/ACHR/26/12 Agenda Item 3.7 5 April 2001 Promoting the use of collaborating centres as well as other networks of research institutions and national centres of expertise in the countries of the Region REVIEW OF WHO COLLABORATING CENTRES IN SOUTH-EAST ASIA REGION 1. BACKGROUND WHO Collaborating Centre (WHOCC) is a part of international inter- institutional collaborative network set up by World Health Organization. It represents a major instrument for effective and efficient planning, implementation and evaluation of WHO policies and programmes. It is an essential and cost-effective cooperation mechanism that enables the Organization to fulfil its mandated activities and to harness resources far exceeding its own. These Centres frequently foster linkages and access to national, regional and international centres of excellence worldwide and the institutional capacity to ensure the scientific validity of global health work. Use of national institutions for international health collaboration dates back to more than half-a-century. The World Health Assembly since its early inception had laid down the overall policy that the Organization should not consider the establishment, under its own auspices, of international research institutions, but use the existing national and international institutions as collaborating centres. It reaffirmed in many occasions that research in the field of health is best advanced by assisting, coordinating and making use of existing institutions. To date, nearly 1200 national and international institutions all over the world, which met the standard selection criteria as laid down by the World Health Assembly1, have been designated as WHO Collaborating Centres. This effort has undoubtedly enhanced national and international involvement in the activities of the Organization and its Members. In addition to the formally designated WHO Collaborating Centres, there are a wide range of national, regional and international institutions and networks that are continuously collaborating with the Organization in many health and health related development areas. Some of them are formally designated as “national institutions recognized by WHO”, while others are termed as “national centres of expertise”, where WHO makes use of them to tap their technical resources for its development work. The main contributions of WHO Collaborating Centres (WHOCCs) and national centres of expertise (NCE) are manifold. They can be logically grouped as: a) Standardization: WHOCCs and NCE are contributing to the work of WHO in various technical areas of work for the purpose of standardization of terminology and nomenclature, of diagnostic, therapeutic and prophylactic substances, of technologies, methods and procedures, etc. b) Information: WHOCCs and NCE usually involved and contributed in the synthesis and dissemination of information, such as the scientific and technical information and information of interest to the 1 WHO Basic Document, 1999: Regulations for study and scientific groups, collaborating institutions and other mechanisms of collaboration, p107-114 [Note: New rules have been updated based on Resolution EB105.R7. Revised guidelines for WHOCC is issued by WHO in early 2001.] 1 country’s national health development and/or in the implementation of its programme. c) Services: WHOCCs and NCE can provide services under two major areas: first the traditional services such as epidemiological surveillance, for identification of causal agent(s) and for the development of preventive measures and evaluation and testing new insecticides for vector biology and control; and second is the involvement in technical co-operation for national health development such as special programme of research, development and training. d) Research: The research function of WHOCCs and NCE has acquired a growing and rapidly predominant importance. It can be said that the large increase in the number of centres in the course of the last two decades has been due mainly to the development of the research component of WHO’s programme. e) Training: WHOCCs and NCE play an essential role in training and particularly in research training, with the emphasis on the strengthening of institutions, especially research institutions, in the developing countries. And, f) Coordination: Where WHOCCs and NCE of a given network participate in a collaborative scheme, it may be necessary to assign one or more of them, chosen in consideration of their quality and experience, the task of coordinating, promoting, supporting and harmonizing the work undertaken in common. 2. CURRENT SITUATION IN WHO SOUTH-EAST ASIA WHO Collaborating Centres (WHO CCs) and National Centres of Expertise (NCE) are the main institutions in building up the capacity of health research in generating knowledge in the Region. The review of the progress in WHO collaboration with its collaborating centres and the national centres of expertise has been on the agenda of WHO Governing Bodies periodically. The review usually focussed on the use of such WHO Collaborating Centres with a view to develop and sustain their capabilities and technical cooperation. In 1997, while reviewing the situation, WHO Governing Bodies2 urged the Member States to support and develop national centres of expertise so that they may meet the criteria to become a WHO collaborating centre. They also requested WHO to strengthen its collaboration with the centres in the specific WHO priority areas, and to encourage the emergence of a larger number of collaborating centres. They also encouraged the existing WHOCCs around the world to develop effective working relations with other centres and national institutions recognized by WHO, in particular, by setting up or joining collaborating networks with WHO support. An appropriate amendment of the 2 Resolutions WHA50.2, EB105.R7, SEA/RC50/R5 2 regulations for designating the centres has been adopted in extending the technical quality and fixing the period of successful collaboration. A series of national and regional consultative meetings of WHOCCs and NCE were organized by WHO in collaboration with Member States and other development partners. While new centres were identified for designation, existing centres that were overdue for a pre-specified designated period were evaluated for either termination or redesignation. Brief situation and major problems that are encountered during the last few years with respect to South-East Asia Region are: 1) Distribution of WHOCCs: According to the latest available record as of March 2001, there is a total of 83 WHO collaborating centres in the Region, representing 7% of the 1187 WHOCCs existing globally. (See Figure 1 on next page for detailed distribution of WHOCCs by WHO geographical regions and by technical areas.) • Within SEA Region, there are 27 centres that fall within the designation period. Out of this, Bangladesh has 2, India 16, Indonesia 2 and Thailand 6. These centres are designated for their collaborated work in health programmes, such as communicable diseases (CDS) (9 centres), non-communicable diseases and mental health (NMH) (6 centres), family and community health (FCH) (3), sustainable development and environment (SDE) (3 centres), health technology and pharmaceuticals (HTP) (4 centres) and evidence and information for policy (EIP) (1 centre). Out of 27 existing centres, only 9 (30%) are responsible for collaboration in the areas of work related the Organization-wide priorities. Figure 1. Regional Distribution of WHOCCs, April 2001 EUR 43% [524] AMR 24% [329] EMR 5% [55] AFR 3% [37] SEA 7% [83] WPR 18% [209] Global Total=1187 3 Figure 2. STATUS OF WHOCCs BY MAJOR AREA OF WORK IN SEA REGION, 2001 9 6 33 4 2 8 10 12 9 11 6 2 3 2 3 6 2 0 2 4 6 8 10 12 14 Communicable Diseases NCD & Mental Health Family and Community Health Sustainable Development and Environment Health Technology and Pharmaceuticals Evidence and Information for Policy Major Area of Work No. of WHOCCs Existing Overdue New • A total of 56 collaborating centres have completed their designation period, of which Bangladesh has 0, DPR Korea 2, India 26, Indonesia 7, Myanmar 1, Nepal 1, Sri Lanka 2 and Thailand has 17. The technical areas responsible by these overdue centres included: CDS (8), NMH (10), FCH (12), SDE (9), HTP (11), and EIP (6). The technical units are intensively reviewing other Centres for redesignation or otherwise termination. Here again, only 22 out of 61 centres fall within the area of work of WHO priorities. • As of April 2001, there are 17 national institutions and networks that have applied for designation as new WHOCCs. These institutions are: 4 from India, 4 from Indonesia, 3 from Nepal and 6 from Thailand. From the analysis, only 7 centres (43%) fall within WHO priority areas. 4 Figure 3. STATUS OF WHOCCs BY PRIORITY PROGRAMME AREA OF WORK 27 56 7 22 9 17 0 10 20 30 40 50 60 Existing Overdue New Nu mb er o f WHOCCs Priority Total • There are gaps and imbalances in the distribution of WHOCCs, both in terms of technical coverage and geographical distribution. Attempts have been made to strengthen capacity of the national institutions and networks, which fall within the WHO Organization-wide priority areas and selecting and designating these centres as WHOCCs. It requires a long-term investment in national capacity building. Most centres have been selected from institutions of high scientific and technical standing, and thus, the reasons help to explain the uneven distribution of centres among countries of the Region as well as different programme areas. 2) Utilization: While a few (around 10-15%) are being used effectively for norms and standard setting and references, most centres involved in information sharing, research, training and technical services. A very few centres served as a core centre for coordinating the others and usually forms as part of a wider network. 3) Networking: There is a need to improve the networking, linkages and joint planning among the centres within a country or the region. This is necessary not only for networking among themselves but also with WHO technical programmes. Nutrition Research-cum-action network, Asia- Pacific Network for National Health Accounts and Health Sector Reform, Asia-Pacific Health Economic Network (APHEN), Asia-Pacific Health Systems and Health Policy Research Network, FERCAP, ENHSR network, INCLEN and many other national, regional and international 5 networks display wide range of health development activities carried through institutions and expertise available in specific technical areas. 4) Support: Sustain political and financial support from the national authorities and international partners are required. WHO regional office and country offices have enormous opportunity to utilize these institutions, in some case using WHO funds, in the relevant of collaborative programme at least the high priority one. 3. ACTIONS FOR FURTHER PROMOTING USE OFWHOCCs The following actions are proposed for promoting effective management and use of WHO Collaborating Centres (WHO CCs) and National Centres of Expertise (NCE). The list is neither exhaustive nor exclusive as they are interconnected each other. 1) Increase awareness: National health authorities and WHO should identify appropriate national and international institutions which have potential for technical excellence and which have been closely collaborating with WHO for national and international health development, especially in relation to WHO priority areas. Candidate institutions may require technical assistance varying in scope. Capacity of such institutions should be strengthened to enable them to play a major role in national or international health development. The area of collaboration should link with either the global and regional priorities. Those national and regional or international institutions and networks should be given high priority for designation or redesignation as WHOCCs, so that they can provide technical expertise currently unavailable in the present network of WHOCCs. The initiation of collaboration programmes between the national institutions with WHO is open widely. While there is a general recognition on the important role of WHOCCs and NCE as partners in health development, there is a need to increase awareness toward the optimal use of these centres in the Region. There is a strong need to have good interactions between WHO and its network of collaborating centres. These require strong commitment from all parties concerned such as the institutions themselves, the national health authorities and WHO staff at all levels. WHOCCs could become effective instruments for promoting national and regional self-reliance, and they can have benefits from this interaction and mutual collaboration with WHO. By strengthening institutional capacities of WHOCCs through joint efforts, WHO technical programmes could have benefited as well. It should be highly aware that WHOCCs and NCE constitute a vast source of technical expertise available to be tapped by all parties. 6 2) Effective Programme Management: WHOCCs and NCE usually work within the framework of national health system. Any efforts to promote use of these centres could be part of WHO collaborative programme activities. The term of reference and expected results of each WHOCC should be contributed and reflected to the expected results of respective WHO collaborative programmes. Periodic monitoring and systematic evaluation of joint efforts of WHO and the collaborating centres have to be undertaken by the responsible technical units/staff at various level of the Organization. In some instances, external evaluation also helped to further promote and expand the work of collaboration, as well as increasing number of centres. These are frequently missing for various reasons. This has led to the decline, in some instances, in actual collaboration. It is important to note that WHOCCs themselves could play a distinct role in monitoring and evaluation, especially those centres that are acting as lead institutions. It is a longstanding issue but needs to pay more attention as clearly mentioned on earlier resolutions of WHO Governing Bodies. A minimum period of satisfactory collaboration for at least two years is needed for new designation. The main judgement of performance is the scientific standing and the capacity and potential to collaborate. Due care has to be taken to determine the basic conditions that an institution must be able to be shown with satisfaction for effective collaboration with WHO. A few institutions in this Region has the advancement in scientific and technological fields. The role of government and WHO representative to ensure the use of WHOCCs and NCE at country level may need to strengthen through decentralized monitoring system, periodical meeting and interactive discussion. An annual meeting of WHOCCs and NCE at the national level, especially for the countries with a considerable number of centres such as India, Indonesia and Thailand will help all parties to promote the effective use of collaborating centres and centres of expertise. 3) Improve Capacity and Capability: A high scientific standing and experience of national institutions and networks is a pre-requirement for a collaborating centre. However, the experience of the Region indicated that the capacity and capability of certain centres in some technical areas of work might need to be developed and strengthened. As analysed earlier, more concerted efforts are needed to select and designate more centres which are responsible for collaborating in WHO specific priority areas. The utilization of WHO collaborating centres and NCE depend on how best WHO can tap the technical infrastructure and human resources available there. It also depends on the kind and extent of support the centres are capable of giving to WHO collaborative programmes. In order to be mutually beneficial, both sides must know the policy and institutional framework, methods of 7 operation, nature of work, expected products and resource inputs. Joint plans and regular reviews have to be worked out within the agreed overall framework. WHO could also expand its collaborative programmes in a phased manner, bearing in mind the considerable resource constraints. Thus the principle of partnership must be applied in order to reap full benefit out of the collaborative activities. 4) Promote Use of Expertise: Most centres in the Region participated in various fields of scientific and technical development of WHO collaborative activities. Their functions were concentrating in serving as reference centres, training and research centres, clearing houses, etc. The vast reservoir of technical expertise available at these centres is a major source of technical support, which WHO and its Member States need in accomplishing their tasks. Many technical expertise available at these centres are also serving as members of WHO Expert Advisory Panels. Such expert involvement can enhance the quality of WHO collaborative activities at national, regional and global levels. It is therefore essential to find better ways to strengthen coordination among the individual and institutional elements of WHO system of expertise with the WHO collaborating centres. The involvement of WHO collaborating centres in planning, implementation and monitoring of WHO collaborative programmes at country level could be strengthened through involving staff of WHO collaborating centres as members in joint WHO/Government coordinating committees at country level. 5) Financial support: Shortage of funds to support collaborative activities to be carried out by the WHOCCs has been a chronic problem, especially in the least-developed countries. Usually, research and training activities conducted by the collaborating centres could be complemented with available internal and external financial support including WHO regular and extra-budgetary resources. WHO budgetary support may be used in support of important activities for national health development, to be implemented by WHOCCs. The extent of financial support, which WHO may accord to different collaborating centres, is usually small and nominal. An appreciable number of centres do not receive any financial support, even though they contribute significantly to the work of the Organization as well as national health development. WHO support to these centres is primarily catalytic to attract considerably greater amounts of financial support from national and other international sources. The Organization receives, in technical services, dividends greatly in excess of its small investments. Similarly, collaborating centres have often received technical support from WHO greatly in excess of any monetary value alone. Therefore, future catalytic support of WHO to WHOCCs should be in the form of supporting necessary impetus to objective-oriented collaborative activities. In this way, WHO would achieve a more specific and focussed use of its resources. 8 9 In essence, these efforts are aimed at making the best possible use of all skills and resources available at country and regional levels by an innovative networking of institutions, to better the health for all. 4. POINTS FOR ACHR’s CONSIDERATION WHO Collaborating Centres (WHO CCs) and National Centres of Expertise (NCE) are the main institutions in building up the capacity of health research in generating knowledge in the Region. ACHR members are requested to provide its comments and advise on the review of the progress in collaboration with the WHO collaborating centres and the national centres of expertise. ANEX 1 STATUS OF WHO COLLABORATING CENTRES IN SEA REGION, BY COUNTRY, 2001 0000 1 00 3 4 14 00 111 2 3 6 19 000 2 000 4 6 4 28 0 5 10 15 20 25 30 BHU MAV MMR NEP BAN SRL DPRK INO THA IND Number of WHOCCs Within period Overdue New Proposal 10 11 1 22 0 2 1 0000 11 0 4 3 000 33 1 9 0 1 3 0000 1 00 2 0 1 2 3 4 5 6 7 8 9 10 Malaria Tuberculosis NCD Cancer CVD Diabetes Tobacco Mental Health Maternal Health HIV/AIDS Health systems No. of WHOCCs Existing ANNEX 2 STATUS OF WHOCCs BY PRIORITY AREA OF WORK IN SEA REGION, 2001 Overdue New 12 Anexure 3 WHO COLLABORATING CENTRE IN SOUTH-EAST ASIA COUNTRIES (2 April 2001) Country Within period (a) Overdue (b) Total New Proposal (c) Bangladesh 1 1 2 - Bhutan - - - - DPR Korea - 3 3 - India 14 28 42 4 Indonesia 3 6 9 4 Maldives - - - - Myanmar - 1 1 - Nepal - 1 1 2 Sri Lanka - 2 2 - Thailand 4 19 23 6 Grand Total 22 61 83 16 Note: (a) WHOCCs that fall within designation period (b) WHOCCs that are overdue of designation period (c) National centres that are proposed for new designation 13 Annexure 4 DISTRIBUTION OF WHOCCS ACCORDING TO WHO’s AREA OF WORK (March 2001) Existing and New WHOCCs No Area of Work Within period Overdue Total New 1 Communicable disease surveillance 2 1 3 1 2 Communicable disease prevention, eradication and control 4 1 5 - 3 Research and product development for communicable diseases 1 4 5 - 4 Malaria 1 1 2 - 5 Tuberculosis 2 0 2 1 Communicable Diseases (CDS) 10 7 17 2 Surveillance, prevention and management of NCD 2 4 6 3 Cancer - 3 3 - Cardiovascular disease 2 - 2 - 6 Diabetes 1 - 1 - 7 Tobacco - - 9 Health promotion - 1 1 - 10 Disability/injury prevention and rehabilitation - - - - 11 Mental health and substance abuse - 3 3 1 N C D and Mental Health (NMH) 5 11 16 4 12 Child and Adolescent Health 0 2 2 2 13 Research and programme development reproductive health - 7 7 - 14 Making pregnancy safer (Maternal health) - 3 3 - 15 Women’s health - - - - 16 HIV/AIDS - 1 1 - Family and Comm. Health (FCH) - 13 13 2 17 Sustainable development - 3 3 1 18 Nutrition - 4 4 - 19 Health and environment 2 1 3 1 20 Food safety - - - - 21 Emergency preparedness &response - 2 2 1 Sustainable Development & Environmental Health (SDE) 2 10 12 3 22 Essential medicine: access, quality and rational use - 6 6 2 23 Immunization and vaccine develop - 1 1 1 24 Blood safety and clinical technology 4 4 8 - Health Technology & Pharmaceutical (HTP) 4 11 15 3 25 Evidence for health policy - - - - 26 Health Information management and dissemination - - - - 27 Research policy and promotion - - - - 28 Organization of health services (Health System) 1 9 10 2 Evidence & information for policy 1 9 10 2 Total 22 61 83 16
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA 26 th Session of WHO South-East Asia Advisory Committee on Health Research 17-20 April 2001, Thimphu, Bhutan SEA/ACHR/26/12 Agenda Item 3.7 5 April 2001 Promoting the use of collaborating centres as well as other networks of research institutions and national centres of expertise in the countries of the Region REVIEW OF WHO COLLABORATING CENTRES IN SOUTH-EAST ASIA REGION 1. BACKGROUND WHO Collaborating Centre (WHOCC) is a part of international inter- institutional collaborative network set up by World Health Organization. It represents a major instrument for effective and efficient planning, implementation and evaluation of WHO policies and programmes. It is an essential and cost-effective cooperation mechanism that enables the Organization to fulfil its mandated activities and to harness resources far exceeding its own. These Centres frequently foster linkages and access to national, regional and international centres of excellence worldwide and the institutional capacity to ensure the scientific validity of global health work. Use of national institutions for international health collaboration dates back to more than half-a-century. The World Health Assembly since its early inception had laid down the overall policy that the Organization should not consider the establishment, under its own auspices, of international research institutions, but use the existing national and international institutions as collaborating centres. It reaffirmed in many occasions that research in the field of health is best advanced by assisting, coordinating and making use of existing institutions. To date, nearly 1200 national and international institutions all over the world, which met the standard selection criteria as laid down by the World Health Assembly1, have been designated as WHO Collaborating Centres. This effort has undoubtedly enhanced national and international involvement in the activities of the Organization and its Members. In addition to the formally designated WHO Collaborating Centres, there are a wide range of national, regional and international institutions and networks that are continuously collaborating with the Organization in many health and health related development areas. Some of them are formally designated as “national institutions recognized by WHO”, while others are termed as “national centres of expertise”, where WHO makes use of them to tap their technical resources for its development work. The main contributions of WHO Collaborating Centres (WHOCCs) and national centres of expertise (NCE) are manifold. They can be logically grouped as: a) Standardization: WHOCCs and NCE are contributing to the work of WHO in various technical areas of work for the purpose of standardization of terminology and nomenclature, of diagnostic, therapeutic and prophylactic substances, of technologies, methods and procedures, etc. b) Information: WHOCCs and NCE usually involved and contributed in the synthesis and dissemination of information, such as the scientific and technical information and information of interest to the 1 WHO Basic Document, 1999: Regulations for study and scientific groups, collaborating institutions and other mechanisms of collaboration, p107-114 [Note: New rules have been updated based on Resolution EB105.R7. Revised guidelines for WHOCC is issued by WHO in early 2001.] 1 country’s national health development and/or in the implementation of its programme. c) Services: WHOCCs and NCE can provide services under two major areas: first the traditional services such as epidemiological surveillance, for identification of causal agent(s) and for the development of preventive measures and evaluation and testing new insecticides for vector biology and control; and second is the involvement in technical co-operation for national health development such as special programme of research, development and training. d) Research: The research function of WHOCCs and NCE has acquired a growing and rapidly predominant importance. It can be said that the large increase in the number of centres in the course of the last two decades has been due mainly to the development of the research component of WHO’s programme. e) Training: WHOCCs and NCE play an essential role in training and particularly in research training, with the emphasis on the strengthening of institutions, especially research institutions, in the developing countries. And, f) Coordination: Where WHOCCs and NCE of a given network participate in a collaborative scheme, it may be necessary to assign one or more of them, chosen in consideration of their quality and experience, the task of coordinating, promoting, supporting and harmonizing the work undertaken in common. 2. CURRENT SITUATION IN WHO SOUTH-EAST ASIA WHO Collaborating Centres (WHO CCs) and National Centres of Expertise (NCE) are the main institutions in building up the capacity of health research in generating knowledge in the Region. The review of the progress in WHO collaboration with its collaborating centres and the national centres of expertise has been on the agenda of WHO Governing Bodies periodically. The review usually focussed on the use of such WHO Collaborating Centres with a view to develop and sustain their capabilities and technical cooperation. In 1997, while reviewing the situation, WHO Governing Bodies2 urged the Member States to support and develop national centres of expertise so that they may meet the criteria to become a WHO collaborating centre. They also requested WHO to strengthen its collaboration with the centres in the specific WHO priority areas, and to encourage the emergence of a larger number of collaborating centres. They also encouraged the existing WHOCCs around the world to develop effective working relations with other centres and national institutions recognized by WHO, in particular, by setting up or joining collaborating networks with WHO support. An appropriate amendment of the 2 Resolutions WHA50.2, EB105.R7, SEA/RC50/R5 2 regulations for designating the centres has been adopted in extending the technical quality and fixing the period of successful collaboration. A series of national and regional consultative meetings of WHOCCs and NCE were organized by WHO in collaboration with Member States and other development partners. While new centres were identified for designation, existing centres that were overdue for a pre-specified designated period were evaluated for either termination or redesignation. Brief situation and major problems that are encountered during the last few years with respect to South-East Asia Region are: 1) Distribution of WHOCCs: According to the latest available record as of March 2001, there is a total of 83 WHO collaborating centres in the Region, representing 7% of the 1187 WHOCCs existing globally. (See Figure 1 on next page for detailed distribution of WHOCCs by WHO geographical regions and by technical areas.) • Within SEA Region, there are 27 centres that fall within the designation period. Out of this, Bangladesh has 2, India 16, Indonesia 2 and Thailand 6. These centres are designated for their collaborated work in health programmes, such as communicable diseases (CDS) (9 centres), non-communicable diseases and mental health (NMH) (6 centres), family and community health (FCH) (3), sustainable development and environment (SDE) (3 centres), health technology and pharmaceuticals (HTP) (4 centres) and evidence and information for policy (EIP) (1 centre). Out of 27 existing centres, only 9 (30%) are responsible for collaboration in the areas of work related the Organization-wide priorities. Figure 1. Regional Distribution of WHOCCs, April 2001 EUR 43% [524] AMR 24% [329] EMR 5% [55] AFR 3% [37] SEA 7% [83] WPR 18% [209] Global Total=1187 3 Figure 2. STATUS OF WHOCCs BY MAJOR AREA OF WORK IN SEA REGION, 2001 9 6 33 4 2 8 10 12 9 11 6 2 3 2 3 6 2 0 2 4 6 8 10 12 14 Communicable Diseases NCD & Mental Health Family and Community Health Sustainable Development and Environment Health Technology and Pharmaceuticals Evidence and Information for Policy Major Area of Work No. of WHOCCs Existing Overdue New • A total of 56 collaborating centres have completed their designation period, of which Bangladesh has 0, DPR Korea 2, India 26, Indonesia 7, Myanmar 1, Nepal 1, Sri Lanka 2 and Thailand has 17. The technical areas responsible by these overdue centres included: CDS (8), NMH (10), FCH (12), SDE (9), HTP (11), and EIP (6). The technical units are intensively reviewing other Centres for redesignation or otherwise termination. Here again, only 22 out of 61 centres fall within the area of work of WHO priorities. • As of April 2001, there are 17 national institutions and networks that have applied for designation as new WHOCCs. These institutions are: 4 from India, 4 from Indonesia, 3 from Nepal and 6 from Thailand. From the analysis, only 7 centres (43%) fall within WHO priority areas. 4 Figure 3. STATUS OF WHOCCs BY PRIORITY PROGRAMME AREA OF WORK 27 56 7 22 9 17 0 10 20 30 40 50 60 Existing Overdue New Nu mb er o f WHOCCs Priority Total • There are gaps and imbalances in the distribution of WHOCCs, both in terms of technical coverage and geographical distribution. Attempts have been made to strengthen capacity of the national institutions and networks, which fall within the WHO Organization-wide priority areas and selecting and designating these centres as WHOCCs. It requires a long-term investment in national capacity building. Most centres have been selected from institutions of high scientific and technical standing, and thus, the reasons help to explain the uneven distribution of centres among countries of the Region as well as different programme areas. 2) Utilization: While a few (around 10-15%) are being used effectively for norms and standard setting and references, most centres involved in information sharing, research, training and technical services. A very few centres served as a core centre for coordinating the others and usually forms as part of a wider network. 3) Networking: There is a need to improve the networking, linkages and joint planning among the centres within a country or the region. This is necessary not only for networking among themselves but also with WHO technical programmes. Nutrition Research-cum-action network, Asia- Pacific Network for National Health Accounts and Health Sector Reform, Asia-Pacific Health Economic Network (APHEN), Asia-Pacific Health Systems and Health Policy Research Network, FERCAP, ENHSR network, INCLEN and many other national, regional and international 5 networks display wide range of health development activities carried through institutions and expertise available in specific technical areas. 4) Support: Sustain political and financial support from the national authorities and international partners are required. WHO regional office and country offices have enormous opportunity to utilize these institutions, in some case using WHO funds, in the relevant of collaborative programme at least the high priority one. 3. ACTIONS FOR FURTHER PROMOTING USE OFWHOCCs The following actions are proposed for promoting effective management and use of WHO Collaborating Centres (WHO CCs) and National Centres of Expertise (NCE). The list is neither exhaustive nor exclusive as they are interconnected each other. 1) Increase awareness: National health authorities and WHO should identify appropriate national and international institutions which have potential for technical excellence and which have been closely collaborating with WHO for national and international health development, especially in relation to WHO priority areas. Candidate institutions may require technical assistance varying in scope. Capacity of such institutions should be strengthened to enable them to play a major role in national or international health development. The area of collaboration should link with either the global and regional priorities. Those national and regional or international institutions and networks should be given high priority for designation or redesignation as WHOCCs, so that they can provide technical expertise currently unavailable in the present network of WHOCCs. The initiation of collaboration programmes between the national institutions with WHO is open widely. While there is a general recognition on the important role of WHOCCs and NCE as partners in health development, there is a need to increase awareness toward the optimal use of these centres in the Region. There is a strong need to have good interactions between WHO and its network of collaborating centres. These require strong commitment from all parties concerned such as the institutions themselves, the national health authorities and WHO staff at all levels. WHOCCs could become effective instruments for promoting national and regional self-reliance, and they can have benefits from this interaction and mutual collaboration with WHO. By strengthening institutional capacities of WHOCCs through joint efforts, WHO technical programmes could have benefited as well. It should be highly aware that WHOCCs and NCE constitute a vast source of technical expertise available to be tapped by all parties. 6 2) Effective Programme Management: WHOCCs and NCE usually work within the framework of national health system. Any efforts to promote use of these centres could be part of WHO collaborative programme activities. The term of reference and expected results of each WHOCC should be contributed and reflected to the expected results of respective WHO collaborative programmes. Periodic monitoring and systematic evaluation of joint efforts of WHO and the collaborating centres have to be undertaken by the responsible technical units/staff at various level of the Organization. In some instances, external evaluation also helped to further promote and expand the work of collaboration, as well as increasing number of centres. These are frequently missing for various reasons. This has led to the decline, in some instances, in actual collaboration. It is important to note that WHOCCs themselves could play a distinct role in monitoring and evaluation, especially those centres that are acting as lead institutions. It is a longstanding issue but needs to pay more attention as clearly mentioned on earlier resolutions of WHO Governing Bodies. A minimum period of satisfactory collaboration for at least two years is needed for new designation. The main judgement of performance is the scientific standing and the capacity and potential to collaborate. Due care has to be taken to determine the basic conditions that an institution must be able to be shown with satisfaction for effective collaboration with WHO. A few institutions in this Region has the advancement in scientific and technological fields. The role of government and WHO representative to ensure the use of WHOCCs and NCE at country level may need to strengthen through decentralized monitoring system, periodical meeting and interactive discussion. An annual meeting of WHOCCs and NCE at the national level, especially for the countries with a considerable number of centres such as India, Indonesia and Thailand will help all parties to promote the effective use of collaborating centres and centres of expertise. 3) Improve Capacity and Capability: A high scientific standing and experience of national institutions and networks is a pre-requirement for a collaborating centre. However, the experience of the Region indicated that the capacity and capability of certain centres in some technical areas of work might need to be developed and strengthened. As analysed earlier, more concerted efforts are needed to select and designate more centres which are responsible for collaborating in WHO specific priority areas. The utilization of WHO collaborating centres and NCE depend on how best WHO can tap the technical infrastructure and human resources available there. It also depends on the kind and extent of support the centres are capable of giving to WHO collaborative programmes. In order to be mutually beneficial, both sides must know the policy and institutional framework, methods of 7 operation, nature of work, expected products and resource inputs. Joint plans and regular reviews have to be worked out within the agreed overall framework. WHO could also expand its collaborative programmes in a phased manner, bearing in mind the considerable resource constraints. Thus the principle of partnership must be applied in order to reap full benefit out of the collaborative activities. 4) Promote Use of Expertise: Most centres in the Region participated in various fields of scientific and technical development of WHO collaborative activities. Their functions were concentrating in serving as reference centres, training and research centres, clearing houses, etc. The vast reservoir of technical expertise available at these centres is a major source of technical support, which WHO and its Member States need in accomplishing their tasks. Many technical expertise available at these centres are also serving as members of WHO Expert Advisory Panels. Such expert involvement can enhance the quality of WHO collaborative activities at national, regional and global levels. It is therefore essential to find better ways to strengthen coordination among the individual and institutional elements of WHO system of expertise with the WHO collaborating centres. The involvement of WHO collaborating centres in planning, implementation and monitoring of WHO collaborative programmes at country level could be strengthened through involving staff of WHO collaborating centres as members in joint WHO/Government coordinating committees at country level. 5) Financial support: Shortage of funds to support collaborative activities to be carried out by the WHOCCs has been a chronic problem, especially in the least-developed countries. Usually, research and training activities conducted by the collaborating centres could be complemented with available internal and external financial support including WHO regular and extra-budgetary resources. WHO budgetary support may be used in support of important activities for national health development, to be implemented by WHOCCs. The extent of financial support, which WHO may accord to different collaborating centres, is usually small and nominal. An appreciable number of centres do not receive any financial support, even though they contribute significantly to the work of the Organization as well as national health development. WHO support to these centres is primarily catalytic to attract considerably greater amounts of financial support from national and other international sources. The Organization receives, in technical services, dividends greatly in excess of its small investments. Similarly, collaborating centres have often received technical support from WHO greatly in excess of any monetary value alone. Therefore, future catalytic support of WHO to WHOCCs should be in the form of supporting necessary impetus to objective-oriented collaborative activities. In this way, WHO would achieve a more specific and focussed use of its resources. 8 9 In essence, these efforts are aimed at making the best possible use of all skills and resources available at country and regional levels by an innovative networking of institutions, to better the health for all. 4. POINTS FOR ACHR’s CONSIDERATION WHO Collaborating Centres (WHO CCs) and National Centres of Expertise (NCE) are the main institutions in building up the capacity of health research in generating knowledge in the Region. ACHR members are requested to provide its comments and advise on the review of the progress in collaboration with the WHO collaborating centres and the national centres of expertise. ANEX 1 STATUS OF WHO COLLABORATING CENTRES IN SEA REGION, BY COUNTRY, 2001 0000 1 00 3 4 14 00 111 2 3 6 19 000 2 000 4 6 4 28 0 5 10 15 20 25 30 BHU MAV MMR NEP BAN SRL DPRK INO THA IND Number of WHOCCs Within period Overdue New Proposal 10 11 1 22 0 2 1 0000 11 0 4 3 000 33 1 9 0 1 3 0000 1 00 2 0 1 2 3 4 5 6 7 8 9 10 Malaria Tuberculosis NCD Cancer CVD Diabetes Tobacco Mental Health Maternal Health HIV/AIDS Health systems No. of WHOCCs Existing ANNEX 2 STATUS OF WHOCCs BY PRIORITY AREA OF WORK IN SEA REGION, 2001 Overdue New 12 Anexure 3 WHO COLLABORATING CENTRE IN SOUTH-EAST ASIA COUNTRIES (2 April 2001) Country Within period (a) Overdue (b) Total New Proposal (c) Bangladesh 1 1 2 - Bhutan - - - - DPR Korea - 3 3 - India 14 28 42 4 Indonesia 3 6 9 4 Maldives - - - - Myanmar - 1 1 - Nepal - 1 1 2 Sri Lanka - 2 2 - Thailand 4 19 23 6 Grand Total 22 61 83 16 Note: (a) WHOCCs that fall within designation period (b) WHOCCs that are overdue of designation period (c) National centres that are proposed for new designation 13 Annexure 4 DISTRIBUTION OF WHOCCS ACCORDING TO WHO’s AREA OF WORK (March 2001) Existing and New WHOCCs No Area of Work Within period Overdue Total New 1 Communicable disease surveillance 2 1 3 1 2 Communicable disease prevention, eradication and control 4 1 5 - 3 Research and product development for communicable diseases 1 4 5 - 4 Malaria 1 1 2 - 5 Tuberculosis 2 0 2 1 Communicable Diseases (CDS) 10 7 17 2 Surveillance, prevention and management of NCD 2 4 6 3 Cancer - 3 3 - Cardiovascular disease 2 - 2 - 6 Diabetes 1 - 1 - 7 Tobacco - - 9 Health promotion - 1 1 - 10 Disability/injury prevention and rehabilitation - - - - 11 Mental health and substance abuse - 3 3 1 N C D and Mental Health (NMH) 5 11 16 4 12 Child and Adolescent Health 0 2 2 2 13 Research and programme development reproductive health - 7 7 - 14 Making pregnancy safer (Maternal health) - 3 3 - 15 Women’s health - - - - 16 HIV/AIDS - 1 1 - Family and Comm. Health (FCH) - 13 13 2 17 Sustainable development - 3 3 1 18 Nutrition - 4 4 - 19 Health and environment 2 1 3 1 20 Food safety - - - - 21 Emergency preparedness &response - 2 2 1 Sustainable Development & Environmental Health (SDE) 2 10 12 3 22 Essential medicine: access, quality and rational use - 6 6 2 23 Immunization and vaccine develop - 1 1 1 24 Blood safety and clinical technology 4 4 8 - Health Technology & Pharmaceutical (HTP) 4 11 15 3 25 Evidence for health policy - - - - 26 Health Information management and dissemination - - - - 27 Research policy and promotion - - - - 28 Organization of health services (Health System) 1 9 10 2 Evidence & information for policy 1 9 10 2 Total 22 61 83 16