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SEA/RC57/7 - Review of proposed programme budget 2006-2007

August 6, 2004 World Health Organization

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REGIONAL COMMITTEE Fifty-seventh Session Kurumba, Maldives 7-9 September 2004

Provisional Agenda item 7 SEA/RC57/7

6 August 2004

REVIEW OF PROPOSED PROGRAMME BUDGET 2006-2007

The Proposed Programme Budget 2006-2007 is the fourth successive biennial budget whose formulation revolved around a set of objectives, strategies and Organization-wide expected results, within the framework of 36 Areas of Work, emphasizing Organization-wide expected results and indicators within each such area of work. The lessons learnt in implementing the previous biennial programme have formed a crucial input in the process. The Proposed Programme Budget builds upon achievements and lessons learnt. It sets out current and emerging priorities, and devotes greater attention to the challenges faced by global public health, which have led to increased demands on, and expectations from, WHO. It has been organized around the Areas of Work which represent WHO’s main orientations, with well-defined scopes and contents. Draft Regional Areas of Work, attached to the Proposed Programme Budget document, outline the regional situation in terms of issues, challenges, goals, objectives and strategic approaches. The Proposed Programme Budget also reflects the Director-General’s proposal to increase the overall level of the budget by 12.8% as compared with the previous biennium. The Proposed Programme Budget is an important step in the consultative process and is a key instrument in WHO’s ongoing work. The document was discussed at length by the CCPDM, at its forty-first meeting in July 2004 as agenda item 3.3, and its observations and recommendations have been highlighted in its report (Section 7, doc. SEA/PDM/Meet.41/11). The CCPDM recommended that the Proposed Programme Budget 2006-2007 be endorsed by the Regional Committee. It also recommended that the Regional Committee adopt a resolution on the subject. Comments from the representatives as well as guidance of the Regional Committee will be a vital input in the process of refining the document before the final budget is submitted to the Executive Board for review at its 115th session in January 2005, and then to the Fifty-eighth World Health Assembly in May 2005.

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR SOUTH-EAST ASIA

Forty-first Meeting of the Consultative Committee for Programme Development and Management, W HO/SEARO, New Delh i, 19-21 July 2004

Agenda item 3.3

SEA/PDM/Meet.41/6.1 15 July 2004

PROPOSED PROGRAMME BUDGET 2006-2007 The Programme Budget for the biennium is a key instrument in WHO’s ongoing work, and the Proposed Programme Budget 2006-2007 is the fourth successive biennial budget based on an Organization-wide results-based approach. Prepared jointly by the countries, the regional offices and WHO headquarters through a participatory and iterative process, the Proposed Programme Budget formulation revolved around a set of objectives, strategies and Organization-wide expected results, emphasizing Organization-wide expected results and indicators within the framework of each area of work. For the first time, lessons learnt in implementing the previous biennial programme, as summed up in the draft performance assessment report for the 2002-2003 biennium, have formed a crucial input in the process. Clearly continuing WHO’s work during the last biennium, the Proposed Programme Budget (Draft PPB/2006-2007) builds upon achievements and lessons learnt and sets out current and emerging priorities. It devotes greater attention to the challenges faced by global public health, which have led to increased demands on, and expectations from, WHO. It recognizes the interrelationship between health and development and the importance of focusing on the achievement of the Millennium Development Goals, which imply, more importantly, that the Organization must expand its resource base in order to fulfil its mandate and fully meet the expectations of its Member States. The Proposed Programme Budget is organized around the Areas of Work which represent WHO’s main orientations, with well-defined scopes and contents. A separate attachment contains the Draft Regional Areas of Work Statements which outline the regional situation in terms of issues, challenges, goals, objectives and strategic approaches. These are complementary and mutually supportive with clear linkages to the Organization-wide programme budget. In order to fully deliver the Organization’s programme and achieve the expected results, the Proposed Programme Budget also reflects the Director-General’s proposal to increase the overall level of the budget by 12.8% as compared with the previous biennium. This proposed increase is based on a conservative and careful strategic planning through the Organization, set within the established results-based framework. The Proposed Programme Budget 2006-2007 will be presented to the Fifty-seventh session of the Regional Committee in September 2004, as an important step in the consultative process. Comments from Member States at the Regional Committees will help to refine the document in the light of regional perspectives, before submitting the final budget to the Executive Board for review at its 115th session, and then to the Fifty-eighth World Health Assembly in May 2005. In the light of the Regional Committee’s decision at its Fifty-first session, the Proposed Programme Budget and the Regional Area of Work Statements are submitted to CCPDM for its review. The Regional Director will consider the CCPDM’s comments, observations and recommendations, before presenting them to the fifty-seventh session of the Regional Committee.

DRAFT PPB/2006-2007 ORIGINAL: ENGLISH

WORLD HEALTH ORGANIZATION

P R O P O S E D PROGRAMME B U D G E T 2006–2007

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.

CONTENTS Foreword [will contain the Director-General’s introduction, to be prepared after the meetings of the regional committees. ] I. Introduction Strategic direction 1 Areas of work – the building blocks of the Proposed programme budget 3 Overall level of the budget 4 Financing the Proposed programme budget 6 Implementing the Proposed programme budget 7 II. Orientations 2006-2007 by area of work Communicable disease prevention and control 10 Communicable disease research 13 Epidemic alert and response 16 Malaria 19 Tuberculosis 22 HIV/AIDS 26 Surveillance, prevention and management of chronic, noncommunicable diseases 29 Health promotion 33 Mental health and substance abuse 36 Tobacco 39 Nutrition 42 Health and environment 45 Food safety 48 Violence, injuries and disabilities 51 Reproductive health 54 Making pregnancy safer 57 Gender equality, women and health 60 Child and adolescent health 63 Immunization and vaccine development 66 Essential medicines 69 Essential health technologies 72 Policy-making for health in development 76 Health system policies and service delivery 80 Human resources for health 83 Health financing and social protection 86 Health information, evidence and research policy 90 Emergency preparedness and response 94 WHO’s core presence in countries 96 Knowledge management and information technology 99 Planning, resource coordination and oversight 103 Human resources management in WHO 106 Budget and financial management 109 Infrastructure and logistics 112 Governing bodies 114 External relations 116 Direction 119 III. Statistical annexes Detailed allocation by area of work and office (assessed contribution and estimate for total voluntary contribution), by region, 2006-2007 122 Allocation by area of work and office (assessed contribution and estimate for total voluntary contribution), all levels, 2006-2007 134

iii

PROPOSED PROGRAMME BUDGET 2006-2007

INTRODUCTION

1. WHO’s Proposed programme budget 2006-2007 is the fourth successive biennial budget that follows an Organization-wide results-based approach. The programme formulation revolves around a set of objectives, strategies, and Organization-wide expected results. These expected results – outcomes to which the WHO Secretariat collectively (country offices, regional offices, and headquarters) – is committed over the biennium, form the basis for costing and estimating resource requirements. They also justify resource allocation. Actual achievements in implementing the programme budget are measured through performance indicators. 2. The Proposed programme budget was drawn up through a participatory and iterative process, involving dialogue between countries, regional offices and headquarters. An internal peer review of a preliminary draft, involving all levels of the Organization, took place in March 2004. For the first time, lessons learnt in implementing the previous biennial programme, as captured in the performance assessment report for the biennium 2002-2003, constituted an important input in the process.1 3. Submission of the draft Proposed programme budget to the regional committees is an important step in the consultative process. Comments from Member States at the regional committees will help to refine the document in the light of regional perspectives. The Director-General will submit it to the Executive Board for review at its 115th session, and then to the Fifty-eighth World Health Assembly.

Strategic direction 4. The Proposed programme budget 2006-2007 both clearly continues WHO’s work during the last biennium, building on achievements and lessons learnt, and sets out current and emerging priorities, reflected in resolutions of recent Health Assemblies. Greater attention given internationally to the challenges faced by global public health have substantially increased demands on, and expectations from, WHO. Global health security has been recently threatened by outbreaks of SARS and avian influenza, raising the spectre of global pandemics on a scale not witnessed for nearly a century. New mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and crucial developmental processes such as Poverty Reduction Strategy Papers require WHO’s full commitment. The interrelationship between health and development is now clearly recognized and the importance of focusing on achievement of Millennium Development Goals well accepted. These developments are all encouraging and positive, but they also imply that WHO must expand its resource base in order to fulfill its mandate and fully meet the expectations of Member States. 5. It is proposed to intensify WHO’s activities in the following directions: • enhancing global health security: maintaining a comprehensive outbreak alert and response mechanism (resolutions WHA56.29 and WHA54.14), supported by the international health regulations (resolution WHA56.28); responding rapidly and effectively in crisis situations (resolutions WHA57.3 and WHA55.13); • accelerating progress towards achieving the Millennium Development Goals: reducing maternal mortality (resolution WHA57.12), improving child survival (resolutions WHA56.20 and WHA56.21); addressing the global pandemics of HIV/AIDS, tuberculosis and malaria (resolutions WHA57.14, and WHA53.1); promoting healthy environments (resolutions WHA57.9 and WHA57.10); increasing access to essential medicines (resolutions WHA56.27 and WHA55.14); • responding to the increasing burden of noncommunicable disease: reducing tobacco use (resolution WHA56.1), promoting healthy diets and physical activity (resolution WHA57.17), enhancing healthpromotion activities (resolution WHA57.16);

Programme budget 2002-2003. Performance assessment report. Document WHO/PRP/04.1 (draft).

PROPOSED PROGRAMME BUDGET 2006-2007

• promoting equity in health: strengthening health systems to reach poor and disadvantaged people (resolutions WHA57.19 and WHA56.25); • ensuring accountability: improving organizational effectiveness, transparency and accountability. 6. In order to achieve significantly enhanced results in the above directions, priority will be given to the corresponding areas of work, identified below. Epidemic alert and response. The outbreaks of SARS and avian influenza clearly show the importance of global surveillance and the crucial role WHO is playing in collecting information, coordinating international response, setting international standards and providing support to countries for surveillance and effective response to the threat of disease. WHO is now expected to expand its role and its ability to respond. Making pregnancy safer. Reducing maternal deaths is one of the key Millennium Development Goals: little progress has been achieved in this area over past decades. Half a million women die each year from pregnancy-related complications; they die not from disease, but from lack of skilled attendants and insufficient emergency obstetric care. Safe motherhood is not only a health issue but also a social and moral one. WHO will lay emphasis on strengthening health systems and activities at country level that will contribute to reducing maternal deaths. Child and adolescent health. Every year about 11 million children still die from the effects of disease and inadequate nutrition. Seven out of 10 child deaths in developing countries are attributable to five preventable communicable diseases, compounded by malnutrition. The interventions needed to save millions of children’s lives are known; WHO will give priority to scaling up its response in order to improve child health in countries. Surveillance, prevention and management of chronic, noncommunicable diseases and control of tobacco. Noncommunicable diseases represent a growing challenge to health systems, and coupled with communicable diseases constitute a double burden of disease in many developing countries. According to current estimates, chronic, noncommunicable diseases constitute about 40% of deaths in developing countries and almost 75% in developed countries. WHO will lay more emphasis on building systems that can cope with this challenge. Planning, resource coordination and oversight. A major effort will focus on further improving planning, resource coordination, performance monitoring, assessment, evaluation and oversight in order to improve transparency and programmatic, as well as financial, accountability. 7. Further, in pursuing the work of previous bienniums, the Proposed programme budget 2006-2007 recognizes that health-for-all commitments and the principles and practices of primary health care remain valid goals for the Organization. WHO stands committed to the goal of assuring access to the highest attainable standards of health for all. It seeks better health and access to health care for poor and disadvantaged people, especially women and children. Efforts to tackle HIV/AIDS, particularly through access to treatment as expressed by the “3 by 5” initiative, and to strengthen work in the areas of malaria and tuberculosis, which are top priorities for the biennium 2004-2005, will continue. Emphasis is also laid on maintaining WHO’s work and role in strengthening national health systems, recognizing that a well functioning, effective health system is essential for the delivery of health care. 8. In some areas, however, efforts are being scaled down. For example, success in eradicating poliomyelitis, expected in 2005, will reduce resources required for this activity, although coverage will continue to be expanded for other vaccine-preventable diseases. Thus, activities in the area of Immunization and vaccine development will be maintained, but at a slightly lower level.

PROPOSED PROGRAMME BUDGET 2006-2007

9. Some of the priorities of the Proposed programme budget are cross-cutting and Organization-wide. For example, through its focus on decentralization and results in countries, the Organization is committed to working more intensively with national health partners in order to meet their priority goals and to move appropriate human, and adequate financial, resources to country level. 10. In order to achieve the commitments and results expected from increased organizational efficiency that started in the biennium 2004-2005, further investments will be made in better management of both human and financial resources. The new Global Management System will be launched in 2006.

Areas of work – the building blocks of the Proposed programme budget 11. The Proposed programme budget is organized around the areas of work set out in Section II, which represent WHO’s main orientations. They have been revised through consultation at all levels of the Organization in order to reflect more accurately the work of WHO in countries and to incorporate the strategic directions determined by the Director-General. With well-defined scope and contents, the areas of work are complementary and mutually supportive. The linkages between them are outlined in Figure 1 overleaf. 12. In order to provide greater transparency and accountability, the areas of work contain additional information compared to the previous bienniums. A baseline and targets are provided for each Organization-wide expected result, in addition to resource requirements. Figure 1. Linkage between areas of work

Health outcomesa

Determinants of healthb

Enabling the Organization effectively to deliver its technical supportd WHO 04.89

Related areas of work HIV/AIDS; Child and adolescent health; Communicable disease prevention and control; Surveillance, prevention and management of chronic, noncommunicable diseases; Making pregnancy safer; Malaria; Mental health and substance abuse; Reproductive health; Tuberculosis; Emergency preparedness and response; Epidemic alert and response; Immunization and vaccine development Food safety; Gender equality, women and health; Health and environment; Health promotion; Nutrition; Tobacco; Violence, injuries and disabilities; Communicable disease research c b a

Health financing and social protection; Health information, evidence and research policy; Essential health technolgies; Health systems policies and service delivery; Human resources for health; Policy making for health in development; Essential medicines

Planning, resource coordination and oversight; Knowledge management and information technology; Budget and financial management; Human resources management in WHO; Infrastructure and logistics; WHO’s core presence in countries; Direction; External relations; Governing bodies

Health policies and systemsc

PROPOSED PROGRAMME BUDGET 2006-2007

Overall level of the budget 13. The increase in the overall level of the budget stems from growing demands made on the Organization. Progress made in achieving results expected in the biennium 2002-2003 is being reported on to Member States in terms not only of financial, but also of programmatic, results.1 Actual achievements for each area of work during the past biennium provided a sound basis for assessing future requirements. This exercise helped to determine results expected in the biennium 2006-2007, which respond to increased requirements and thus need a higher level of financial resources in order to meet the expectations of Member States and partners. At the same time, opportunities have been seized to use the financial resources of the Organization more efficiently, thus contributing to cost-effective results. 14. In order fully to deliver the Organization’s programme and achieve the results expected, the DirectorGeneral is proposing an increase in the budget of US$ 361 million for 2006-2007, i.e. a growth of 12.8% compared with the previous biennium. This proposed increase is based on conservative and careful strategic planning throughout the Organization, set within the established results-based framework. 15. Referring to Figure 1, resources required in the areas of work supporting “Health outcomes” are approximately 51% of the total. Comparable figures for “Determinants of health” are 11%; “Health policies and systems”, 13%; and “Enabling the Organization effectively to deliver its technical support to Member States”, 22%. A further 2% is allocated to exchange rate hedging, and to the information technology, real estate, and security funds. 16. The proposed increase will enable the Organization significantly to improve results expected in regions and countries in the five areas of work identified for intensified action (increases of 40% to 60% compared with the biennium 2004-2005), and contribute towards offsetting the effect of inflation. Most importantly, it will allow the Organization to respond to higher expectations in countries in respect of responding to epidemic alerts, achieving the Millennium Development Goals, working with countries on Poverty Reduction Strategy Papers, and building up partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria, and others. 17. Figure 2 below provides a breakdown of all the sources of financing between the regions and headquarters for the periods 2004-2005 and 2006-2007. The figures for the regional level combine the proposed amounts for the country and regional budget of the respective region. These figures do not include individual funds and special programmes. The allocations suggested are based on Organization-wide results-based budgeting. The allocation of resources between levels of the Organization is 73.9% in regional and country offices and 26.1% in headquarters. Across the regions allocation is designed to achieve a more equitable distribution of resources and to reach countries in most need.

Document WHO/PRP/04.1 (draft).

PROPOSED PROGRAMME BUDGET 2006-2007

Figure 2. Proposed programme budget 2006-2007 compared with programme budget 2004-2005 (resolution WHA56.32), all sources of financing Summary by regional office (US$ thousand and percentage)

2006-2007 Western Pacific 229 331 7.8% Eastern Mediterranean 345 782 11.8% Headquarters 762 900 26.1%

Europe 196 745 6.7%

South-East Asia 329 215 11.3% Africa 868 115 29.7%

The Americas 192 295 6.6%

2004-2005 Western Pacific 191 930 7.5% Eastern Mediterranean 281 792 10.9%

Headquarters 768 105 29.9%

Europe 154 681 6.0%

South-East Asia 280 642 10.9%

The Americas 161 634 6.3%

Africa 733 051 28.5%

WHO 04.90

PROPOSED PROGRAMME BUDGET 2006-2007

Financing the Proposed programme budget 18. Setting clear priorities, strengthening the work of WHO in countries, regions and globally, and increasing organizational efficiency brings the Organization close to its objectives. Securing the volume of resources that adequately reflect the work of the Organization, its core functions and priorities ensures that it fully meets them. 19. WHO’s budget is financed from two principle sources: assessed contributions and Miscellaneous Income, which finance the regular budget, and voluntary contributions (formerly known as extrabudgetary resources). The relationship between these sources has changed significantly over the past few bienniums. The level of the regular budget has increased minimally over the past 10 years, whereas the volume of voluntary contributions has risen substantially. Voluntary contributions now represent some 70% of the total financial resources of the Organization. 20. During this period of growth of voluntary contributions, the overall approach to the budget did not fully reflect an integrated managerial and planning framework as is currently in use in the Organization. As the use of a significant proportion of voluntary contributions is specified, the priorities established by the Health Assembly in the Programme budget can be distorted if some areas of work receive additional finance during the biennium, and others receive less than estimated to meet the expected results. This may lead to questions of coherence and governance. 21. Presentation of a total, integrated proposed budget that includes targets for voluntary contributions strengthens the overall governance and priority-setting of the Health Assembly. An increase in the assessed contributions that is closer to the overall increase in the budget is proposed in order to achieve a better balance between the two sources of funding. It breaks down into 9% in assessed contributions and 14.9% in voluntary contributions, as shown below. Programme budget – all sources of financing (US$ thousand) Source of financing Assessed contributions Miscellaneous Income (excluding adjustment mechanism) Voluntary contributions Total all sources of financing 2004-2005 858 475 21 636 1 944 000 2 824 111 2006-2007 935 738 15 345 2 234 021 3 185 104 % change 9.0 -29.0 14.9 12.8

Assessed contributions and Miscellaneous Income 22. The amount of Miscellaneous Income estimated for the biennium 2006-2007 reflects a conservative approach that aims to reduce the risk of a shortfall in the amount actually realized. As provided for in the Financial Regulations, in the event of a shortfall in the level of Miscellaneous Income the Director-General is required to reduce implementation of the budget, an outcome that should be avoided. 23. In the biennium 2004-2005 the total amount of Miscellaneous Income forecast was US$ 34 million. It was decided in resolution WHA56.32 to use an amount of US$ 12 million to finance the adjustment mechanism which compensates Member States that would experience an increase in their rates of assessment for 2004-2005 compared with 2000-2001. The net amount of Miscellaneous Income in 2004-2005 applied in financing the regular budget was therefore US$ 22 million. In accordance with resolution WHA56.34, it is expected that the adjustment mechanism will be maintained in 2006-2007; an amount of US$ 8.6 million is envisaged for appropriation from Miscellaneous Income by the Fifty-eighth World Health Assembly. The Miscellaneous Income forecast for 2006-2007 of US$ 24 million has been adjusted accordingly, giving a total of US$ 15 million. 6

PROPOSED PROGRAMME BUDGET 2006-2007

24. The level of the budget 2006-2007 to be financed by assessed contributions and Miscellaneous Income is proposed at US$ 951 million. The net amount to be paid as assessed contributions by Member States is US$ 935 million. This level represents an increase of US$ 71 million or 9% compared with assessed contributions for 2004-2005. 25. In accordance with Financial Regulation VII, it is proposed that the Working Capital Fund which, together with internal borrowing, is used to finance cash-flow deficits that arise from late payment of assessed contributions, should be maintained at US$ 31 million.

Voluntary contributions 26. Voluntary contributions include funds provided by Member States and other partners that are used for that portion of the integrated budget which is not financed by assessed contributions. The level of voluntary contributions required for the biennium 2006-2007 is US$ 2234 million. This represents an increase of US$ 290 million or 14.9% compared with 2004-2005. 27. The increase in voluntary contributions will be realized through strategic partnerships and a focused resource-mobilization strategy that reflects the priorities of the Organization. These efforts will be an integral part of a resource-allocation strategy that directly aligns the use of resources with achievement of expected results. 28. A portion of these contributions, known as programme support costs, is used to finance the administrative support services that underpin effective achievement of the results expected in all areas of work. In keeping with the authority given to the Director-General in both the Financial Regulations and Health Assembly resolutions, 13% of this income will be used to meet costs in the following areas of work: Knowledge management and information technology, Planning, resource coordination and oversight, Human resources management in WHO, Budget and financial management, Infrastructure and logistics, Governing bodies, External relations, and Direction.

Management of exchange-rate risk 29. As in previous bienniums it is necessary to protect the budget so that the expected results may be achieved irrespective of the effect of fluctuations of currencies compared with the United States dollar, the base currency of the Organization. The resources required to meet the results expected for 2006-2007 have been determined on the basis of a historic exchange rate.1 This rate of exchange will be protected through a foreign-exchange risk strategy drawn up in the light of market conditions in mid-2005. At the time of writing, it is envisaged that an amount of US$ 15 million will be made available to protect, to the extent possible, the assessed contribution portion of the budget from the impact of exchange rate fluctuations. It is expected that a further amount of US$ 5 million will be set aside in respect of the portion of the budget financed by programme support costs. The level of those parts of the budget that are thus protected will be adjusted during the biennium in order to reflect the effect of changing exchange rates.

Implementing the Proposed programme budget 30. The Proposed programme budget is WHO’s strategic plan for the biennium 2006-2007, providing common objectives for WHO’s work. It is implemented through operational plans prepared by country and regional offices and headquarters (see Figure 3).

These requirements will be recosted at the exchange rate prevailing at the time of submission of the Proposed programme budget to the Fifty-eighth Health Assembly.

PROPOSED PROGRAMME BUDGET 2006-2007

Figure 3. Implementing the Proposed programme budget Set out in Programme budget Timeframe Goal Over many years

Strategic planning

Programme budget Programme budget

Evaluation Monitoring

WHO objectives

More than one biennium

Operational planning

Organization-wide expected result Office-specific expected result

One biennium

Workplans Products and services

Within one biennium WHO 04.92

31. Country and regional offices and headquarters define the results to be achieved at the end of the biennium (office-specific expected results), and draw up their work plan on the basis of products needed to achieve those results. The office-specific expected results are country focused. While meeting the specific needs of countries, the results are derived from, and support, achievement of the Organization-wide expected results set out in the Proposed programme budget. Through its integrated approach to financing of the budget, the Organization will use the resource requirements estimated for each expected result as the basis for mobilizing, prioritizing, and allocating funds across areas of work and by Organizational level. Gaps between resources required to execute the Proposed programme budget and availability of resources for implementation of areas of work by countries, regions and headquarters will be continuously monitored. To the extent possible, the actual allocation of resources across areas of work will be adjusted and the necessary shifting of resources undertaken throughout the biennium in an attempt to close the gaps, ensuring that the resources are available to achieve results in the right place and at the right time.

PROPOSED PROGRAMME BUDGET 2006-2007

II.

ORIENTATIONS 2006-2007 BY AREA OF WORK COMMUNICABLE DISEASE PREVENTION AND CONTROL

ISSUES AND CHALLENGES

Diseases covered by this area of work for intensified control include Buruli ulcer, dengue/dengue haemorrhagic fever, intestinal parasitoses, leishmaniasis, schistosomiasis, trachoma, trypanosomiasis, zoonoses, and epidemic enteric diseases. Dracunculiasis is targeted for eradication. The goal for leprosy, lymphatic filariasis, onchocerciasis and Chagas disease is elimination at global or regional level. These diseases affect almost exclusively poor and powerless people living in rural parts of low-income countries. They cause immense suffering and often life-long disabilities, but rarely kill, and therefore remain low on countries’ public-health agendas and do not receive the level of attention afforded to high-mortality diseases. For most of these diseases, effective, safe and economical interventions are available. In the absence of a demand by disease-endemic countries for greater attention to be paid to these diseases, however, global resources remain scarce and progress toward their control, prevention and eradication or elimination is unacceptably slow. A major challenge is to increase access to drugs and interventions for targeted diseases while reinforcing health systems through innovative approaches within the framework of countries’ priorities and strategic plans. Such approaches could include, for instance, use of the school system. A particular challenge is to develop new tools, including drugs, vaccines and diagnostic tests, and cost-effective strategies for those communicable diseases for which such instruments are still lacking, especially in countries facing complex emergencies. Further alliances of partners should be facilitated in order to work in synergy at global, regional and national levels to deal with neglected diseases; the strong link with poverty and human rights needs to be highlighted and advantage taken of lessons learnt through the implementation of concrete actions against neglected diseases. Lastly, intense advocacy is needed to increase both commitment and resources from the international community, and political commitment within affected countries in order to extend interventions for the intensified control of neglected diseases.

GOAL

To reduce the negative impact of communicable diseases on health and on the social and economic wellbeing of all people worldwide. To reduce morbidity, mortality and disability through the prevention, control and, where appropriate, eradication or elimination of selected communicable diseases using, where possible, a synergetic approach. Indicators

WHO OBJECTIVES

• Number of countries with active national programmes targeting neglected communicable diseases • Number of countries progressing towards targets set by specific Health Assembly resolutions for the targeted diseases

STRATEGIC APPROACHES

Formulation and implementation of evidence-based strategies; provision of technical support to countries; capacity building; and involvement of relevant partners for implementation, including in countries facing complex emergencies; formulation of integrated disease-control strategies, including integrated case management, vector control and interventions through schools.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Comprehensive guidance formulated and available for development of policies and strategies for the prevention, control and elimination of neglected communicable diseases that will be effective in reaching populations at risk. 2. Effective approaches to the prevention, case management, surveillance and control of neglected communicable diseases in low-resource settings validated and promoted in priority countries.

INDICATORS • Number of national and subnational strategic plans developed or revised on the basis of WHO guidelines for the prevention, control and elimination of selected communicable diseases affecting populations at risk

BASELINES

TARGETS

100

• Number of low-resource countries where guidelines and training materials on integrated management of adolescent and adult illness for first-level facilities and district hospitals are adapted for country use Number of countries adapting and implementing integrated school-health interventions Number of countries where effective approaches for the surveillance, prevention and control of emerging enteric diseases have been established

• •

105

3. Innovative partnerships and coordination mechanism mobilized to strengthen effectively the capacity and role of health ministries for the control of targeted communicable diseases.

• Number of countries that have built effective partnerships, including with nongovernmental organizations, private providers, civil society and international organizations, for control of targeted communicable diseases with WHO’s support Number of countries where intersectoral collaboration for zoonotic and food-borne diseases have been effectively put in place with WHO’s support

105

•

100

4. Priority countries adequately supported to adopt and implement policies and strategies, including countries facing complex emergencies.

• Number of countries facing complex emergencies provided with effective support for applying appropriate components of prevention and control of communicable diseases Number of targeted countries implementing synergetic intensified control of neglected diseases with WHO’s support

•

5. Innovative and cost-effective interventions, techniques and tools devised and validated for implementation of prevention, control and elimination of communicable diseases in lowresource settings, including in complex emergencies.

• Number of new integrated case-management • strategies for control of neglected communicable diseases Number of new techniques and tools developed and tested for the surveillance, prevention and control of zoonotic, and waterand food-borne diseases

6. Adequate support provided to countries for strengthening capacity for achieving substantial progress in the intensified control or elimination of targeted communicable diseases.

• Number of countries that have completed • disease mapping and started mass drug administration for lymphatic filariasis Number of countries that have updated national programmes for the prevention and control for major zoonoses or food-borne disease with WHO’s support

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

154 056

Includes Miscellaneous Income.

Communicable disease prevention and control is

also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

COMMUNICABLE DISEASE RESEARCH ISSUES AND CHALLENGES

Despite the continued resources and efforts put into their prevention, infectious diseases persist and contribute a major part of the disease burden in developing countries. They continue to impede social and economic development and disproportionately to affect poor and marginalized populations; they will therefore be major hindrances to attaining the health-related Millennium Development Goals. Effective tools have long been lacking for the control of some diseases. For others, tools, methods and strategies once considered sufficient for successful prevention and control are now failing: microorganisms have developed resistance to drugs; insect vectors have developed resistance to pesticides; ecological and social conditions change; or ensuring their sustainable implementation becomes difficult. Absence of commercial incentive and lack of appropriately directed research resources limit the engagement of both the private and the public sectors. As a result, there is no innovation or inadequate evaluation and implementation of new tools; many potentially valuable tools and methodologies have yet to be properly evaluated. Experience shows, however, that the public and private sectors and networks of researchers can, through appropriate mechanisms, cooperate efficiently to overcome many of these obstacles: the experience of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases is a case in point. Numerous challenges remain. The biosocial, economic and political determinants of the persistence of the burden of communicable diseases need to be better understood. New knowledge being generated through modern science, such as genomics, has to be translated into development of new products (drugs, vaccines and diagnostic tools) that are acceptable, affordable and applicable to the circumstances that prevail in developing countries. Appropriate evidence needs to be generated in order to facilitate the work of countries in defining how best to use these products and new methodologies and to evaluate their use for assessment of implications for policy. A further challenge is to identify mechanisms for expanding those methodologies that are worthy of inclusion in policy. Capacity needs to be built and appropriately used in developing countries so that advances in knowledge and technology can be assimilated and applied in a sustainable manner. Finally, awareness needs to be raised among resource contributors and development partners of the need for and role of health research to achieve healthrelated Millennium Development Goals and to mobilize the resources required. Success in all these endeavours requires building broad partnerships for research and product development, involving health systems, control programmes, industry, researchers and donors from both developing and developed countries.

GOAL

To foster research activities, to generate knowledge, and to create essential tools for preventing and controlling neglected infectious diseases. To improve and develop tools and approaches which are applicable by developing countries for preventing, diagnosing, treating and controlling neglected infectious diseases, and to strengthen the capacity of disease-endemic countries to undertake the research required for developing and implementing new and improved disease-control approaches. Indicators

WHO OBJECTIVES

• Accessibility to new and/or improved approaches for preventing, diagnosing, treating and controlling neglected infectious diseases in developing countries where they are endemic • Extent of input of disease-endemic countries to communicable-disease research

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Strategic research directions based on sound and validated analysis and prioritization of the most critical areas of research on specific diseases and, where appropriate, multiple diseases; balancing of a portfolio between long-term, high-risk projects and shorter-term, low-risk projects, and the basis of innovation; organization, funding and management of research activities, combining functional areas of expertise with a disease focus and control needs; activities with defined milestones and criteria for success, and based on focused research questions, issues and objectives, that are undertaken in partnership (with academic scientists, pharmaceutical companies and disease-control experts); knowledge management, partnership building, and networking with disease-control and research communities in disease-endemic countries for strengthening research capacity, setting priorities and identifying solutions; particular emphasis on extending research so that it better links to, and integrates with, disease control and can aid programme and policy implementation.

ORGANIZATION-WIDE EXPECTED RESULTS 1. New basic knowledge about determinants (biomedical, social, economic, health systems, behavioural and gender) and other factors of importance for prevention and control of infectious diseases, generated and accessible. 2. New and improved tools, including drugs, vaccines and diagnostic tools, devised for prevention and control of infectious diseases.

INDICATORS • Number of new, significant and relevant scientific advances in the biomedical, social, economic and public-health sciences

BASELINES

TARGETS

250

• Number of new and improved tools, such as drugs and vaccines, receiving regulatory approval and/or label extensions or, in the case of diagnostic tools, being recommended for use in controlling neglected tropical diseases Number of new and improved epidemiological and environmental tools recommended for use in controlling neglected tropical diseases

•

3. New and improved intervention methods for applying existing and new tools at clinical and population levels developed and validated.

• Number of new and improved intervention methods validated for prevention, diagnosis, treatment or rehabilitation, for populations exposed to or affected by infectious diseases

4. New and improved public-health policies for full-scale implementation of existing and new strategies for prevention and control framed and validated; guidance for application in national control settings accessible. 5. Partnerships established and adequate support provided for strengthening capacity for research, product development and application in disease-endemic countries.

• Number of new and improved policies and strategies for enhanced access to proven public health interventions formulated, validated and recommended for use

• Number of research institutions in low• income disease-endemic countries strengthened Proportion of new and significant scientific advances produced by scientists from diseaseendemic countries

56%

60%

6. Technical information and research guidelines accessible to partners and users.

• Number of research instruments and • guidelines for infectious diseases developed and published Number of global research priority-setting reports for neglected infectious diseases published

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

109 672

Includes Miscellaneous Income.

Communicable disease research is also supported

by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

EPIDEMIC ALERT AND RESPONSE ISSUES AND CHALLENGES

Global health security (as referred to in resolution WHA54.14) is repeatedly threatened by the emergence of new or newly recognized pathogens, their possible deliberate or accidental release, and the resurgence of known epidemic threats. Although biological weapons represent the most visible threat to security, emerging or epidemic-prone communicable diseases (such as influenza, meningitis, severe acute respiratory syndrome, cholera or Ebola virus haemorrhagic fever) also threaten global health security because they frequently and unexpectedly challenge national health services and disrupt routine control programmes, diverting attention and funds. Most outbreaks and epidemics are caused by known pathogens, but new infectious diseases continue to emerge, many of which appear to originate as zoonoses. Outbreaks and epidemics do not recognize national boundaries and, if not contained, can rapidly spread internationally. Unverified and inaccurate information on disease outbreaks often elicits excessive reactions from the media and authorities, leading to panic and inappropriate responses, which in turn may result in significant interruptions of trade, travel and tourism, thereby placing further economic burden on affected countries. Reliable and rapid laboratory diagnostic support is a prerequisite for effective and prompt response. At present many outbreaks remain undiagnosed. Inability to diagnose infections during the early phase of disease outbreaks leads to greater morbidity and mortality, which could have been averted. Preparedness is crucial for improving global health security. National surveillance and response systems should provide ongoing surveillance of major diseases, and also function effectively to provide information for alert and response to outbreaks (whether natural, deliberate or accidental). To be sustainable, such systems should be integrated into national communicable disease surveillance, within the health information system. The revised International Health Regulations provide a powerful tool for harmonizing public health action among Member States and a framework for notification, identification and response to publichealth emergencies of international concern. Despite considerable progress recently, major challenges for the biennium include the need for strengthened global partnership, advocacy and improved international cooperation to deal with epidemics and emerging-disease threats. Further, it is vital to update and implement national, regional and global surveillance and containment strategies for known epidemic diseases and to exploit new tools and knowledge. Mechanisms need to be reinforced to detect, verify and respond rapidly and effectively to unexpected outbreaks and epidemics at local, national, regional and international levels. National plans of action for epidemic alert and response need to be developed, implemented and evaluated within national communicable disease surveillance systems, and, as far as possible, using a multidisease approach. Finally, the revised International Health Regulations need to be implemented in order to provide a regulatory framework for global health security.

GOAL

To ensure global health security and foster action to reduce the impact of communicable diseases epidemics on health and the social and economic well-being of all people worldwide. To detect, identify and respond rapidly to threats to national, regional and global health security arising from epidemic-prone and emerging infectious diseases of known or unknown etiology, and to integrate these activities with the strengthening of communicable disease surveillance and response systems, national health information systems, and public health programmes and services. Indicator

WHO OBJECTIVES

• Timely detection of and response to epidemics and emerging-disease threats of national and international concern

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Sustaining of national and international interest and commitment for epidemic alert and response; support for policy and strategy formulation at regional and national levels for epidemic alert and response in accordance with the global strategy; reinforcing of WHO’s unique role in leadership and coordination by refining the Global Outbreak Alert and Response Network; strengthening of national early warning, surveillance and response systems through improved laboratory capacity (including training), operational research and training in field epidemiology; setting up of appropriate mechanisms to implement the revised International Health Regulations.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Effective partnerships formed at national, regional and global levels, national interest and commitment raised and adequate resources mobilized to support epidemic alert and response.

INDICATORS • Number of new partnership initiatives at regional and global levels providing financial, political or technical support to epidemic alert and response, or involving new sectors (e.g. animal health, agriculture and security), or both

BASELINES 0

TARGETS 5 new global partners in financial support; 3 regional initiatives on epidemic alert and response; 3 global partnerships in new sectors 6 (1 per region)

2. Strategy for detecting and responding to epidemics and guidance on best ways to provide support to countries updated in close collaboration with WHO collaborating centres and international partners.

• Number of new or updated plans for implementation of updated strategy and delivery of supporting materials for epidemic readiness and intervention available in official and other relevant languages Proportion of low- and middleincome countries implementing WHO strategies for strengthening surveillance of targeted major epidemic-prone diseases and enhancing readiness for response

•

40%

60%

3. Appropriate alert and response to public health emergencies of international concern coordinated through collaboration between all Member States, WHO collaborating centres, and partners in the Global Outbreak Alert and Response Network.

• Proportion of reported outbreaks that were verified

70%

80%

• Proportion of requests for assistance • to which response was provided Number of new technical areas (e.g. anthropology, infection control) for which WHO has established cooperation with institutions for outbreak control

95% 0

100% 3

4. Adequate support provided to Member States for strengthening national communicable disease surveillance and response systems, including the capability for early detection, investigation of, and response to, epidemics and emerging infectious disease threats, according to guidelines of the International Health Regulations.

• Proportion of low- and middleincome countries supported in their implementation of national surveillance plans, including preparedness plans, early warning, communications, laboratory capacity, field epidemiology and public health mapping

40%

60%

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 5. Procedures established for the administration of the revised International Health Regulations and Member States supported for the implementation of the revised Regulations.

INDICATORS • Proportion of countries starting to assure required core capacities needed to comply with the International Health Regulations

BASELINES 0

TARGETS 80%

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

130 944

Includes Miscellaneous Income.

Epidemic alert and response is also supported by

results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

MALARIA ISSUES AND CHALLENGES

Malaria causes annually about 300 million cases of acute illness, of which more than a million are fatal, and contributes to the gap in prosperity between disease-endemic countries and the malaria-free world. Some 90% of the burden falls on tropical Africa, where the disease is a major cause of mortality and morbidity in children under five years of age. Almost 60% of all malarial deaths are concentrated in the poorest 20% of the world’s population, the highest association of any disease with poverty. Resistance to formerly effective treatment is increasing and has contributed to increasing mortality. Other parts of the world also have significant prevalence of malaria and need continued support from WHO. Current malaria-control strategies are based on early and effective treatment (combination treatment, preferably artemisinin-based, for resistant falciparum malaria); prevention by vector control (in Africa, especially use of insecticide-treated nets); intermittent preventive treatment in pregnancy in areas where the epidemiological situation of malaria is stable; and prevention and control of epidemics. The Roll Back Malaria project, initiated in 1998 with the goal of halving the number of malaria cases by 2010, led to the establishment of the Roll Back Malaria partnership and clarification of roles and responsibilities of WHO and the partnership in malaria control. The Millennium Development Goals include combating malaria as one of the global targets for 2015, and 2001-2010 has been declared the Decade to Roll Back Malaria in Developing Countries, particularly in Africa. The year 2005 was the deadline for the commitment in the Abuja Declaration on Roll Back Malaria in Africa to achieve at least 60% coverage with the main malaria-control interventions; over the past few years progress towards these targets has been rapid. The Global Fund to Fight AIDS, Tuberculosis and Malaria allocated more than US$ 942 million to malaria control on a five-year basis in its first three rounds of grant-making. This increased funding has provided a major opportunity for WHO and the Roll Back Malaria partnership to strengthen support for capacity development, implementation, monitoring and evaluation.

GOAL

To halve the burden of malaria by 2010 compared to 2000 and to reduce it further by 2015. (Millennium Development Goal: By 2015 “halt and begin to reverse the incidence of malaria...”.) To facilitate access of populations at risk to effective treatment of malaria; to promote the application of preventive measures against malaria for populations at risk; to build capacity for malaria control; to strengthen malaria-surveillance systems, and the monitoring and evaluation of control. Indicators

WHO OBJECTIVES

• • • •

Death rates due to malaria and all causes among target groups Incidence of severe and uncomplicated cases of malaria among target groups Proportion of households having at least one insecticide-treated bednet Percentage of patients with uncomplicated malaria receiving correct treatment within 24 hours of onset of symptoms

STRATEGIC APPROACHES

Support for health ministries in essential public-health functions related to malaria control; promotion of synergies with related health programmes, especially those for immunization, child and maternal health, pharmaceuticals and environmental health; promotion of the participation of communities and civil society; engagement of the private sector in delivery of prevention and treatment; identification of best practices and financing mechanisms for extending interventions; preparation of tools and support measures for district-level management; expansion of WHO capacity at country level, together with HIV/AIDS and tuberculosis programmes.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Access of populations at risk to effective treatment of malaria promoted and facilitated through guidance on treatment policy and implementation.

INDICATORS • Proportion of malaria-endemic countries • implementing policies on artemisinin-based combination therapy for falciparum malaria Number of malaria-endemic countries in Africa implementing home-treatment programmes for uncomplicated malaria nationwide

BASELINES

TARGETS

40/100

50/100

18/44

35/44

2. Application of effective preventive measures against malaria for populations at risk promoted in disease-endemic countries.

• Proportion of malaria-endemic countries with • • insecticide-treated net strategy, through which at least 60% of target population is protected Number of countries in Africa implementing the WHO recommended strategy on malaria in pregnancy Number of malaria-prone countries that use weekly malaria-surveillance data in >80% of epidemic-prone districts

30%

50%

11/44

35/44

25/25 in Africa

3. Adequate support provided for capacity building in malaria control in countries.

• Number of countries where national • institutions involved in malaria-control activities have been adequately strengthened Number of countries using WHO human resource development guidelines to support malaria control

4. Malaria-surveillance systems and monitoring and evaluation of control programmes functioning at country, regional and global levels.

• Number of global reports on malaria • Proportion of malaria-endemic countries producing comprehensive annual reports and using effectively this information

1 To be determined

2 100%

5. Effective partnerships established and maintained for implementing the global Roll Back Malaria work plan to maximize countries’ malaria-control performance.

• Number of malaria-endemic countries • operating optimally to achieve 50% reduction in morbidity and mortality due to malaria Percentage increase in resources channelled to malaria

25%

75%

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

137 934

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Malaria is also supported by results expected to be

achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

TUBERCULOSIS ISSUES AND CHALLENGES

Although the impact of intensified control efforts is being felt in some regions, the tuberculosis epidemic continues to be a major public health problem globally, with currently 8.8 million new cases a year and about two million deaths worldwide. Some 80% of this morbidity and mortality falls on 22 “highburden” countries. The internationally recommended tuberculosis-control strategy that includes directly observed treatment, short-course (DOTS)1 is widely proven and highly cost effective. By 2002, 180 countries had introduced DOTS, but only 37% of all tuberculosis patients were cared for under this approach. Many small- to medium-sized countries are close to, or have achieved, the global control targets (namely, detection of 70% of infectious cases and 85% treatment success by 2005), but most populous countries with heavy case-loads of tuberculosis are falling short: either they adopted the strategy only recently or they have been slow to expand it, commonly because of lack of political commitment and of financial and human resources. In addition, weak primary health-care systems and failure to involve all care providers, both governmental and nongovernmental, in tuberculosis-control activities have seriously hindered the application of DOTS at all levels. Furthermore, the HIV/AIDS epidemic, economic and social disruption in many poor countries, and the emergence of multidrug resistance have undermined tuberculosis control. In countries with a high prevalence of HIV infection, the number of tuberculosis cases has quadrupled in the past 15 years. Drug resistance is a serious problem in several countries, with the prevalence of multidrug-resistant tuberculosis reaching 10% or more in countries of the former Soviet Union in eastern Europe and Central Asia and in parts of China. The global movement to stop tuberculosis currently has more than 280 partners, including organizations in countries with a high burden of disease, bilateral and multilateral bodies, nongovernmental organizations, academic institutions and the private sector. The Washington Commitment to Stop TB (2001) supported the massive expansion of DOTS in order to reach the global targets by the end of 2005. Millennium Development Goal 6 includes rates of case detection, cure, prevalence and mortality as indicators of progress. The Global Plan to Stop TB, launched in 2001, sets out the actions to be undertaken to reach these goals, including expansion of DOTS coverage, extending new strategies to deal with HIV-associated tuberculosis and multidrug-resistant tuberculosis, and research and development for new diagnostic tools, drugs and vaccines. Finances and collaboration have increased in each of these areas, but not fast enough. By 2004, the Global TB Drug Facility had already provided drugs to 49 countries for use in expanding DOTS, reaching nearly two million patients. The Green Light Committee that provides access to second-line drugs for the effective treatment of multidrug-resistant tuberculosis had enabled DOTS-Plus projects for its management to be initiated in 14 countries by 2003. New strategies are needed to tackle the epidemic of tuberculosis, starting with engagement of all governmental services providing care and expanding to involve communities, nongovernmental organizations and private practitioners in national control programmes. In addition, broader obstacles to tuberculosis control (such as insufficient social mobilization, weak primary care services, and the crisis in human resources) are to be faced.2 The Global Fund to Fight AIDS, Tuberculosis and Malaria has made grants on an unprecedented scale to countries to tackle tuberculosis; the World Bank and some bilateral donors have also increased support. WHO and these partners will continue to work closely with countries to ensure effective use of these new resources.

GOAL

All countries to reach the global control targets of 70% detection and 85% treatment success rates and to sustain this achievement in order to halve the prevalence and death rates associated with tuberculosis by 2015.

1 See Global tuberculosis control: surveillance, planning, financing: WHO Report 2004. Geneva, World Health Organization, 2004. 2

Document WHO/HTM/STB/2004.28.

PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

To expand implementation of the DOTS strategy and strengthen tuberculosis control, by means including strategies and policies on tuberculosis/HIV coinfection and multidrug-resistant tuberculosis, and of increased involvement of communities, all health-care providers, nongovernmental organizations and corporate partners, through increased country support and by nurturing the Stop TB partnership; to strengthen surveillance, monitoring and evaluation; and to promote and facilitate research on new diagnostic tools, drugs and vaccines. Indicators

• • • •

DOTS coverage Case-detection and treatment-success rates Tuberculosis prevalence, incidence and mortality rates Level of implementation of new approaches targeting, for example, tuberculosis/HIV coinfection, multidrug-resistant tuberculosis and communities • Financial resources available for tuberculosis control

STRATEGIC APPROACHES

Existence of coordinated plans for DOTS expansion in the high-burden countries and in other countries with high tuberculosis prevalence rates; innovative means of involving all health-care providers and communities; provision of high-quality drugs through the Global TB Drug Facility; global advocacy and social mobilization to increase political commitment and engage communities; resource mobilization through the Global Stop TB partnership; rational use of second-line antituberculosis drugs; enhanced surveillance and monitoring, including of drug resistance.

ORGANIZATION-WIDE EXPECTED RESULTS 1. A global plan for DOTS expansion, geared to reaching Millennium Development Goal 6, implemented.

INDICATORS • Proportion of countries having long• • • • • term plans to achieve Millennium Development Goal 6 Global case detection rates Global treatment-success rates Global prevalence rate (per 100 000) Global incidence rate (per 100 000) Global mortality rate (per 100 000)

BASELINES 5/22

TARGETS 15/22

50% 84% 148 222 27 26/87

70% 85% ≤148 ≤222 ≤27 43/87

2. Implementation of longterm national plans for DOTS expansion and sustained tuberculosis control supported through functional national partnerships. 3. Global TB Drug Facility and the Green Light Committee maintained and supporting expanded access to treatment and cure.

• Proportion of the 22 heavy-burden and other targeted countries with functional national partnerships against tuberculosis

• Number of patients treated each year • with support from the Global TB Drug Facility Number of countries receiving adequate support from the Green Light Committee

4 million additional patients 40

4 million additional patients 60

4. Political commitment sustained and mobilization of adequate resources ensured through nurturing of the Stop TB partnership and effective communication of the concept, strategy and progress of the Global Plan to Stop TB.

• Number of targeted countries with internal and/or external financial resources sufficient to close the funding gap

30/87

40/87

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 5. Surveillance and evaluation systems at national, regional and global levels maintained and expanded to monitor progress towards targets, resource allocations for tuberculosis control, and impact of control efforts.

INDICATORS • Proportion of Member States submitting accurate annual surveillance, monitoring and financial reports for inclusion in the annual global report on tuberculosis control Proportion of high-burden countries having assessed or measured impact of tuberculosis control on disease burden

BASELINES 185/192 for monitoring; 123 for financial reporting

TARGETS 192 for monitoring; 150 for financial reporting

•

5/22

10/22

6. Adequate guidance and support provided to countries to tackle multidrug-resistant tuberculosis and to improve tuberculosis-control strategies in countries with high HIV prevalence.

• Proportion of targeted countries implementing DOTS-Plus projects to manage multidrug-resistant tuberculosis Proportion of countries with up-todate data from drug-resistance surveillance Number of countries with heavy disease burden due to tuberculosis and HIV infection implementing joint activities that involve collaboration between tuberculosis and HIV programmes

40%

50%

• •

136/210 (65%) 15

147/210 (70%) 30

7. Better tuberculosis casedetection and cure rates promoted and supported through all public and private providers and communitybased services, and integrated respiratory care implemented at primary level.

• Proportion of targeted countries expanding tuberculosis care through diversified care networks, using public-private entities and community interventions Proportion of targeted Member States that have implemented guidelines to mobilize societies for tuberculosis cure and control Number of countries with satisfactory tuberculosis-control services implementing integrated respiratory care at primary level

20/87

40/87

•

5/22

15/22

•

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

134 865

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Tuberculosis is also supported by results expected

to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HIV/AIDS ISSUES AND CHALLENGES

Tackling the HIV/AIDS epidemic remains among the greatest challenges in international public health. HIV/AIDS is now the leading cause of death in sub-Saharan Africa and the fourth worldwide. At the end of 2003, an estimated 40 million people were living with HIV/AIDS, 95% of them in developing countries, and more than 20 million people had died. In many developing countries, new infections occur mainly in young adults, especially young women. About one third of those currently living with HIV/AIDS are aged 15-24 years; most do not know they are infected. The impact of HIV/AIDS on development continues to be underestimated. The epidemic is destroying families and communities and sapping the economic vitality of the worst affected countries. Core government functions and national security are threatened by the toll of the disease among civil servants, teachers and health-care workers. In severely affected regions, it is undermining economic, social and political gains and crushing hopes for a better future. Globally, about 8000 people die of AIDS-related conditions daily, notwithstanding the ability of antiretroviral therapy to delay disease progression and improve quality of life significantly. Although numerous projects have proven the feasibility of providing such therapy in developing countries, only 400 000 of the five to six million people in the advanced stages of the disease had access to that therapy in developing countries at the end of 2003. In Africa, where 70% of people with HIV/AIDS live, antiretroviral therapy was available to only 100 000 people – a mere 2% of those in need. Responding to this crisis in late 2003, WHO and UNAIDS declared the gap in treatment between high- and low-income countries as an international public health emergency, in response to which they initiated a plan to deliver treatment to at least half those in developing countries who needed it – 3 million people – by the end of 2005. The “3 by 5” target was an interim step toward the ultimate goal of universal access to antiretroviral therapy. Sustained commitment to expanding interventions to prevent infection and disease is essential, but extending access to treatment will ensure that national responses to HIV/AIDS are comprehensive. It will also enable synergies between treatment and prevention to be exploited more effectively, for example, by stimulating demand for HIV testing, incorporating prevention into the care provided to people living with HIV/AIDS, and using opportunities created during outreach in prevention programmes to bring marginalized people into care. Above all, the introduction of antiretroviral therapy must contribute to overall improvements in health systems, for example, through the strengthening of existing infrastructures and referral mechanisms and greater use of entry points, including services for antenatal care, sexually transmitted infections, harm reduction and drug substitution, and community- or home-based care and tuberculosis-control programmes. In developing countries where antiretroviral therapy is available, the reduced demand for inpatient services has contributed to overall cost savings in the health system. Simplified approaches to treatment and clinical monitoring also contribute to cost-savings and the long-term sustainability of antiretroviral therapeutic programmes. Such programmes also bring social benefits beyond the health sector through heightened awareness about HIV/AIDS, increased condom use, reduced stigmatization and discrimination, and regained productivity in the workforce. More concerted efforts are required to ensure that the most vulnerable populations, including women, poor people in rural areas and injecting drug users, have access to HIV/AIDS services and to reduce stigmatization and discrimination, especially where they inhibit access to health services. Emerging priorities also include operational research and the development and application of new products such as clinical diagnostic tools, vaccines and microbicides. Countries require continuing technical support in consolidating their HIV/AIDS programmes and surveillance mechanisms (including antiretroviral drug resistance), creating and managing strategic partnerships, strengthening procurement of drugs and diagnostics, mobilizing and absorbing new funds, assuring sustainable human resources within the health sector, and ensuring that the response to HIV/AIDS is further integrated within, and benefits, health systems as a whole.

GOAL

Effectively to control HIV/AIDS and mitigate its socioeconomic impact by accelerating prevention and by providing universal access to antiretroviral therapy.

PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

Rapidly to expand access to treatment and care while accelerating prevention and strengthening health systems to make the health-sector response to HIV/AIDS more effective and comprehensive. Indicators

• Number of developing and countries in transition providing comprehensive HIV prevention and care programmes

• Percentage of people with advanced HIV infection receiving antiretroviral therapy • Number of health-care facilities that have the capacity and conditions to provide HIV testing and counselling, HIV/AIDS care and antiretroviral treatment

STRATEGIC APPROACHES

Continued advocacy for universal access to antiretroviral therapy as a human right; brokering of new, and support for existing, partnerships as part of the comprehensive response to the epidemic; capacity building for strengthening health systems in order to facilitate countries’ expansion of HIV/AIDS responses; formulation and updating of high-quality guidelines, tools and training packages; continuous documentation of lessons learnt and best practices and their dissemination for application.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Support provided to countries to build national capabilities and technical expertise for improving health-system responses to HIV/AIDS, sexually transmitted infections and related conditions, including planning, resource mobilization, training and service delivery. 2. Involvement of affected communities in global, national and local health-sector responses to the HIV/AIDS epidemic increased. 3. Support provided to countries to ensure uninterrupted supply of HIV-related supplies and equipment.

INDICATORS • Number of countries receiving support to build health-sector competencies in HIV/AIDS, sexually transmitted infections and related conditions using WHO normative tools and resources

BASELINES

TARGETS

100

• Number of countries that involve affected communities in planning, implementation and delivery of HIV/AIDS health services

100

• Number of countries using AIDS medicines and diagnostics service to support procurement and distribution of HIV-related supplies and equipment

100

4. Appropriate set of evidence-based technical tools developed and provided to countries to enhance essential health-sector interventions and services for treatment, care, prevention and support of people with HIV and related conditions. 5. Application of operational research and knowledge management processes by local and national-level implementers.

• Number of countries using or adapting WHO tools and resources on prevention and management of HIV/AIDS and related conditions including tuberculosis and sexually transmitted infections

100

• Number of countries with operational research and knowledge management programmes receiving support from WHO

100

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

261 013

Includes Miscellaneous Income.

HIV/AIDS is also supported by results expected to

be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

SURVEILLANCE, PREVENTION AND MANAGEMENT OF CHRONIC, NONCOMMUNICABLE DISEASES ISSUES AND CHALLENGES

The growing burden of chronic, noncommunicable diseases is a consequence of global trends, including urbanization, population ageing and behavioural change, and the failure of disease prevention, diagnosis and management. Common, preventable biological risk factors (such as high blood pressure, high concentrations of total cholesterol and overweight) and related behavioural risks (unhealthy diet, physical inactivity and tobacco use) lead to four major conditions: cardiovascular disease, cancers, chronic obstructive pulmonary disease and type 2 diabetes. Preventable visual and hearing impairment is estimated to affect more than 180 million and 250 million people, respectively. Mortality, morbidity and disability attributable to chronic, noncommunicable diseases caused 60% of all deaths – most (79%) in the developing countries –and 47% of the global burden of disease in 2001. Without action being taken, these figures are expected to rise by 2020 to 73% of all deaths and 60% of the global burden of disease. Effective interventions are available for the prevention and management of chronic, noncommunicable diseases, but are not used widely or equitably. Much of the cost of diagnosis and management will fall on developing countries, many still suffering from the burden of under-controlled communicable diseases, and the expected overall costs for countries suffering this double burden of disease are high. In total, chronic illness accounts for almost 70% of all medical spending, much of this in direct payment by patients, so contributing to family poverty. Meeting these challenges requires global commitment and comprehensive national responses combining surveillance, prevention and management. For surveillance to be effective, standardized, comparable data need to be collected regularly and used for implementing appropriate health policies. WHO’s STEPwise approach to surveillance supports lowand middle-income countries in developing sustainable surveillance systems for chronic, noncommunicable diseases, and encourages countries to collect information on major risk factors with standardized methods. It is being applied in four WHO regions. Additional work is needed to include other countries and to compile this information in the global and regional databases for analysis and dissemination. A new challenge is to translate all the data being collected into information that leads to beneficial changes in national health policies. National programmes are being established within the framework of the global strategy for prevention and control of noncommunicable diseases, as urged by the Health Assembly in 2000.1 These programmes are linked by regional and global networks which facilitate the implementation of initiatives in countries and share available regional experience. WHO’s recently endorsed Global Strategy on Diet, Physical Activity and Health2 now needs to be implemented at national, regional and global levels, with the support of established and new regional networks. Successful prevention of chronic, noncommunicable diseases is based on a life-course approach and needs appropriate interventions, including health promotion, starting in childhood and adolescence and continuing throughout the lifespan, resulting in healthy ageing. For disease-specific and generic interventions to be implemented, primary and secondary prevention need to be integrated into health services. Countries need policies, practical tools and instruments in order to adapt or strengthen the ability of health systems to deal with the increasing burden of chronic, noncommunicable conditions. A challenge is to foster relevant partnerships within countries in order to facilitate the changes in health-service delivery that will be necessary to implement effective diseasespecific interventions.

GOAL

To reduce the burden of premature mortality and morbidity related to chronic, noncommunicable diseases.

1 2

Resolution WHA53.17. Resolution WHA57.17.

PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

To build surveillance systems; to reduce exposure to the major risk factors; and to help health systems respond appropriately to the rising burden of chronic, noncommunicable diseases. Indicators

• Regional burden of chronic, noncommunicable diseases • Disability-adjusted life years related to avoidable blindness and deafness STRATEGIC APPROACHES

Comprehensive integrated and collaborative response by countries and WHO through surveillance, prevention and management of the main chronic, noncommunicable diseases and their common risk factors; availability of comprehensive, country-level data on chronic, noncommunicable diseases and their risk factors to all Member States through WHO regional offices; support to all Member States for incorporating evidence-based information on integrated prevention and control of chronic, noncommunicable diseases into the health policy; networks in all WHO regions to support the implementation of programmes based on integrated prevention and control policies for chronic, noncommunicable diseases; promotion of community participation in prevention and management.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Effective guidance and support, including standardized methods and materials, provided for implementation of WHO’s surveillance framework for chronic, noncommunicable diseases and their risk factors in low- and middle-income countries.

INDICATORS • Number of countries that collect and analyse data on chronic, noncommunicable diseases and their risk factors and make results available to policy-makers Proportion of low- and middle-income countries out of those with initial surveillance data collections that regularly collect surveillance data on chronic, noncommunicable diseases

BASELINES 35 countries

TARGETS 80 countries

•

10% of countries

2. International standards for collection, analysis and dissemination of data on chronic, noncommunicable diseases and their major modifiable risk factors established, in order to improve the quality, availability and comparability of such data.

• Availability of comparable data on risk factors for chronic, noncommunicable diseases in WHO’s global database and in the report on surveillance of risk factors

No existing comparable data available for Member States in Surveillance of Risk Factors Report 1 No standard risk-factor definitions available

• Existence of standards for data on risk factors for chronic, noncommunicable diseases

• Comprehensive availability of specific information on chronic, noncommunicable diseases and their risk factors in the global databases

Specific information on stroke and diabetes included in the global database

• Number of WHO regions that have dedicated, up-to-date databases on noncommunicable diseases

1 region with a dedicated database

Comparable risk factor data for all Member States, with projections of future prevalence in Surveillance of Risk Factors Report 2 Standardized definitions for all modifiable risk factors for chronic, noncommunicable diseases Specific information on stroke, diabetes, cardiovascular diseases, oral health, respiratory diseases, genetic diseases, blindness and deafness included in the global database All 6 regions with dedicated databases

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 3. Evidence-based public health information produced and adequate support provided to countries for use in informing policies and strategies for prevention and management of chronic, noncommunicable diseases at national level, including integration of primary and secondary prevention into health systems. 4. Multisectoral strategies that can be translated into plans of action on diet and physical activity validated and adequate support provided to priority countries. 5. Strengthened ability of targeted countries to progress towards the elimination of avoidable visual and hearing impairment as a public health problem.

INDICATORS • Number of targeted countries using evaluated and revised WHO guidelines for the prevention, management and control of chronic, noncommunicable diseases

BASELINES Number of targeted countries using current WHO guidelines for prevention, management and control of chronic, noncommunicable diseases Global report on chronic, noncommunicable diseases Proportion of Member States with multisectoral strategies and plans on diet and physical activity

TARGETS Number of targeted countries using revised WHO guidelines for prevention, management and control of chronic, noncommunicable diseases Follow-up report on chronic, noncommunicable diseases Proportion of Member States with multisectoral strategies and plans on diet and physical activity

• Provision of information on the status of chronic, noncommunicable diseases, their prevention, management and control

• Proportion of targeted regions and countries with multisectoral strategies and plans on diet and physical activity

• Number of countries setting up national plans to eliminate avoidable visual and hearing impairment as a public health problem

Monitoring report on avoidable visual and hearing impairment

120 countries setting up national plans to eliminate avoidable visual and hearing impairment

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

56 300

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Surveillance, prevention and management of chronic, noncommunicable diseases is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HEALTH PROMOTION ISSUES AND CHALLENGES

Most countries are experiencing unprecedented societal transformation as a result of population growth and urbanization together with environmental and other changes. This process is often accelerated by globalization in trade and communication, and complex emergencies. New approaches are required in the light of these changes in order to address the broader determinants of health. Within the context of primary health care, health promotion is critical to improving outcomes in the prevention and control of both chronic and communicable diseases, and in meeting the health-related Millennium Development Goals, particularly among poor and marginalized groups. In order to accomplish these aims, WHO applies health promotion techniques to health and related social systems, and to a variety of risk factors, diseases and health issues, including oral health. Carrying out health promotion in settings where people live, work, learn and play is a creative and effective way of improving health and quality of life. Health promotion has a crucial role to play in fostering healthy public policies and health-supportive environments, enhancing positive social conditions and personal skills, and promoting healthy lifestyles. The capacity and infrastructure for the planning and implementation of multisectoral health promotion policies and programmes need to be strengthened in most regions. Most countries lack the policies and the human or financial resources necessary for sustainable, effective health promotion to counter risks and their underlying determinants. For this reason, there is an urgent need to orient health systems more towards health promotion and to build their capacity to promote health (e.g., by developing new and innovative ways for securing sustainable funding and accurate and updated health promotion profiles, strengthening education and training, and expanding the evidence base for health promotion). Advocacy and social mobilization for policy in support of health promotion are also vital. Effective policies need to be multisectoral; they must draw upon a broad range of partners, including the wider community, for their development and implementation. Governments must play a stronger role in developing healthy public policies; health ministries need to take the lead by advocating for the development and adoption of these policies. In accordance with resolution WHA51.12 requesting that health promotion should be given top priority within WHO, and in line with the global conferences held in Ottawa (1986), Adelaide, Australia (1988), Sundsvall, Sweden (1991), Jakarta (1997) and Mexico City (2000), health promotion needs to be strengthened in all areas of work in order to support Member States more effectively.

GOAL

To improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health. To develop and implement multisectoral public policies for health, integrated gender- and age-sensitive approaches that facilitate community empowerment together with action for health promotion, self-care and health protection throughout the life course in cooperation with the relevant national and international partners. Indicators

WHO OBJECTIVES

• Degree of integration of health promotion into national health strategies and services and appropriate settings • Sustainability of financing of health promotion interventions in countries

STRATEGIC APPROACHES

Advocating for policy support and investment in the development of health systems and services that support health promotion and risk prevention; fostering health-supportive environments and integrated approaches to public health services; strengthening the sustainable financing and evidence base required for health promotion; increasing the knowledge base for tackling the broad determinants of health.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Increased guidance for integrating health promotion, including ageing and oral health, into health systems. 2. Capacity for governance, stewardship, planning and implementation of multisectoral health promotion policies and programmes strengthened at country and regional levels, based on gender-sensitive approaches to promoting health and wellbeing throughout the life course. 3. Evidence validated and disseminated of the effectiveness of health promotion strategies and interventions to tackle communicable and noncommunicable diseases. 4. New and innovative approaches applied to sustainable financing of health promotion interventions and capacity building at national, local and community levels. 5. Increased capacity of ministries of health and education to plan, implement and evaluate school health programmes for the reduction of risks associated with leading causes of death, disease and disability. 6. Increased guidance to curtail social, economic and political policies and practices that undermine the effects of health promotion programmes and that glorify and encourage risk-taking behaviour, particularly among young people.

INDICATORS • Number of countries that have integrated strategies for health promotion throughout the life course into national health plans

BASELINES

TARGETS

• Number of countries that have • accurate and updated country profiles on health promotion and risk factors Number of university public health/health promotion degree programmes, at national or provincial level in low- and middle-income countries, with strengthened capacity Number of countries that have health impact assessment in place for new public policies

•

• Number of intervention studies demonstrating the effectiveness of health promotion in low- and middleincome countries published in professional journals

• Number of health promotion foundations, or other means for financing health promotion, established in countries

• Number of countries that have implemented the Global Schoolbased Student Health Survey, or the survey on Health Behaviour in School-aged Children

• Availability of WHO guidelines for fostering and encouraging healthy behaviours, and for curtailing policies and practices that undermine young people’s health

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a b

Voluntary contribution

All financing

Percentage by level

48 400b

Includes Miscellaneous Income. Including US$12 000 for the Kobe Centre.

Health promotion is also supported by results

expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES AND CHALLENGES

The proportion of the global burden of disease attributable to mental and neurological disorders and those related to substance use is expected to rise from 12.3% in 2000 to 16.4% by 2020. Alcohol consumption alone is responsible for 4%. More than 150 million people suffer from depression at any point in time and nearly one million commit suicide every year. There are some 10 million injecting drug users worldwide and 4% to 12% of all HIV cases are transmitted through injecting drug use. The impact of mental and neurological disorders and those related to substance use will become particularly severe in developing countries, primarily because of the projected increase in the number of individuals entering the age of risk for the onset of such disorders. Most affected are vulnerable groups, such as people living in absolute and relative poverty, those coping with chronic diseases and those exposed to emergencies. As a result of resolutions adopted on strengthening of mental health,1 governments are now more aware of the negative impact of mental and neurological disorders and those related to substance use on families, communities, and individuals. Nevertheless, governments need to give higher priority to mental health. Worldwide, a huge gap still exists between needs and the implementation of the cost-effective treatments that are available for most of those disorders. Reducing this gap and improving treatment rates will reduce the burden of disease and disability and health-care costs while increasing economic and social productivity. Cases of depression could be halved and a quarter of suicides could be prevented, for instance, if appropriate care were given. To bridge the gap, it is essential that innovative mental-health policies and legislation should be designed and integrated into health systems. Promoting mental health, preventing mental disorders, incorporating cost-effective interventions into the mainstream of primary health care, and engaging local communities are key components of these policies.

GOAL

To reduce the burden associated with mental and neurological disorders and those related to substance abuse, and to promote mental health worldwide. To ensure that mental health and the consequences of substance abuse are taken fully into account in considerations of health and development, to formulate and implement cost-effective responses to the burden of mental and neurological disorders and those related to substance use, and to promote mental health. Indicators

WHO OBJECTIVES

• Proportion of countries that have strengthened policies and services for reducing the burden of

mental and neurological disorders and those related to substance use, and for promoting mental health • Proportion of countries that have taken specific measures to protect the rights of people with mental and neurological disorders and those related to substance use • Proportion of countries that have implemented evidence-based cost-effective intervention strategies for mental-health promotion, prevention and management of mental and neurological disorders and those related to substance use

STRATEGIC APPROACHES

Dissemination of information on the magnitude, burden, determinants and cost-effective services for the prevention and treatment of mental and neurological disorders and those related to substance use; provision of support to countries for formulating and implementing coherent and comprehensive policies, legislation and services for prevention and treatment of mental and neurological disorders and those related to substance use, for fighting against discrimination and abuse of the rights of people with such disorders, and for the development of human resources for mental health, including research capability, with emphasis on developing countries.

Resolutions EB109.R8 and WHA55.10.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Support provided to priority countries and countries facing complex emergencies for institutional capacity strengthening in order to develop and implement policies and plans on mental health and substance abuse.

INDICATORS • Number of countries receiving WHO support that have developed policies and plans for mental health (including alcohol and illicit drugs) with achievable targets Number of targeted countries that have received WHO support to deal with the mental-health consequences of emergencies

BASELINES

TARGETS

•

2. Support provided for capacity building in countries in order to develop mentalhealth legislation, to protect rights of people with mental and neurological disorders and those related to substance use, and to reduce stigmatization and discrimination. 3. Services, research capacity and information systems on mental health and substance abuse within Member States strengthened and supported.

• Number of countries receiving WHO support that have effectively reviewed or updated mental-health legislation and/or initiated projects to monitor observation of human rights

• Number of countries in which performance of mental-health systems and services has been monitored within WHO’s framework of reference Number of global databases revised and updated on the basis of inputs from countries with gender-disaggregated data

•

4. Support provided to improve countries’ capability to develop evidence-based strategies, programmes and interventions for prevention and management of mental and neurological disorders, including suicidal behaviours. 5. Guidance and support provided to countries for development of evidence-based strategies, programmes and interventions for prevention and management of disorders related to substance use and reducing the adverse health and social consequences of use of alcohol and other psychoactive substances.

• Percentage of people with epilepsy in selected countries that are untreated

• Number of countries receiving WHO support that have developed effective gender-specific interventions for prevention of suicidal behaviours and/or management of mental and neurological disorders

• Number of countries receiving WHO support that have trained staff and developed appropriate programmes for prevention and management of disorders related to substance use and integrated them within primary health care Number of countries receiving WHO support that have improved the coverage and quality of drugdependence treatment directed towards HIV prevention and care for injecting drug users

•

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

29 855

Includes Miscellaneous Income.

Mental health and substance abuse is also

supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

TOBACCO ISSUES AND CHALLENGES

Currently, 1300 million people use tobacco, and that number is expected to rise. Tobacco continues to be the second major cause of death in the world. Half today’s tobacco users will eventually be killed by tobacco – most of them in developing countries. Tobacco also contributes to the continuing poverty of low-income households and countries because money is spent on tobacco rather than on food, education and health care. With globalization, the tobacco industry has continued to expand its search for new markets in developing countries. In response to the consequent spread of tobacco use, the Health Assembly unanimously adopted WHO’s first global treaty, the WHO Framework Convention on Tobacco Control, in May 2003.1 The treaty will enter into force once it has been ratified by 40 Member States. As the interim secretariat for the Convention, WHO provides technical support to Member States and will convene the first session of the Conference of the Parties when the treaty enters into force. Building human and institutional capacity remains a major challenge for tobacco control worldwide. Few countries have the infrastructure that will enable them to implement the comprehensive measures needed to reduce tobacco use significantly. Many countries are still wary of the potential impact of tobacco-control measures on their national economies. Nevertheless, there exist many feasible and costeffective interventions that dramatically cut tobacco consumption rates without harming economies. WHO’s major task in 2006-2007 will be to recommend policies, promote interventions and develop and implement varied approaches to build capacity in those countries that are Parties to the Framework Convention, those that have signed but not ratified the treaty, and those that have not yet signed it. WHO will also work to counter the activities of the tobacco industry, which continues to use its considerable influence to undermine tobacco-control policies and programmes in many countries. Tobacco-product regulation will also need to be given attention, as tobacco products have so far enjoyed an unprecedented degree of freedom from the regulations that apply to other consumer products. Coordination will be needed to ensure that tobacco control is integrated into other relevant technical areas of work such as Tuberculosis, Child and adolescent health, Health promotion and Management of noncommunicable diseases. Lastly, WHO will continue to keep issues related to tobacco use in the public gaze by working with local, national and international nongovernmental and health professional organizations and by sponsoring awareness-raising and World No Tobacco Day campaigns. The work of the United Nations Ad Hoc Inter-Agency Task Force on Tobacco Control will also continue to be important in addressing the multisectoral aspects of tobacco control.

GOAL

To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. To reduce continuously and substantially both tobacco use and exposure to tobacco smoke, by putting in place effective tobacco-control measures and providing support to Member States in implementing the WHO Framework Convention on Tobacco Control. Indicators

WHO OBJECTIVES

• Number of countries that are Parties to the Framework Convention • Number of countries with effective tobacco-control policies and plans that take account of the provisions of the Convention

Resolution WHA56.1.

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Maximizing of the number of Member States becoming Parties to and implementing the Convention; provision of secretariat service to the Convention; maintenance of countries’ awareness of tobaccoindustry activities nationally and internationally; highlighting of the links between tobacco use and poverty; provision of support for research on economic interventions and promotion of behavioural change for tobacco control; collaboration with health professional organizations; reinforcement of countries’ ability to implement strong, gender-sensitive tobacco-control measures through national capacity building in the areas of surveillance, research, legislation, economics, health education, tobacco-use cessation, advocacy, tobacco-product regulation and monitoring and assessment systems, recognizing the special needs of young people and indigenous communities and their members.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Number of Member States with tobaccocontrol policies and plans of action reflecting the provisions of the Framework Convention increased; best practices in tobacco control collected and disseminated as a supporting measure.

INDICATORS • Number of countries that have adopted legislation or its equivalent in relation to the following settings and articles: health-care and educational facilities (ban on smoking), national media (ban on direct advertising of tobacco products), tobacco products that meet the criteria set forth in the Framework Convention (health warnings) Number of tobacco-control success stories, and lessons learnt, published and disseminated by WHO

BASELINES

TARGETS

•

2. Multisectoral collaboration on tobacco control increased.

• Number of new projects initiated under the • umbrella of the United Nations Ad Hoc InterAgency Task Force on Tobacco Control Worldwide membership of GLOBALink

4 500 40 80 12

5 500 80 192 20

3. Capacity for surveillance and research in support of tobacco control increased in the areas of health, economics, legislation, environment and behaviour.

• Number of countries that have completed the • • Global Youth Tobacco Survey at least twice Number of countries covered by a global information system on tobacco control Number of economic and intervention-based research studies supported by WHO

4. Public awareness of the dangers of tobacco raised through strong media coverage and comprehensive information on web site. 5. Regulation and public awareness of tobaccoindustry activities increased. 6. Knowledge of testing methods for effective tobacco-product regulation improved.

• Number of countries that celebrate World No • Tobacco Day Average number of web site hits per month

60 40 000 20

80 45 000 25

• Number of published results of countryspecific research on tobacco industry activities

• Number of recommendations published by the WHO Study Group on Tobacco Product Regulation

7. Number of Member States that ratify, accept, approve, formally confirm or accede to the Framework Convention increased.

• Number of Member States that are Parties to the Framework Convention

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

29 282

Includes Miscellaneous Income.

Tobacco is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

NUTRITION ISSUES AND CHALLENGES

Hunger and malnutrition are intricately bound up with ill-health, poverty and underdevelopment. Food insecurity threatens 800 million people. Freedom from hunger and malnutrition is a basic human right, and their alleviation is a fundamental prerequisite for human and national development. The past decade has seen some measurable success in reducing the global burden of malnutrition. Nevertheless, nutritional deficiencies still remain responsible for massive mortality and morbidity, especially in pregnant women and young children, worldwide. Some 21 million babies are born every year with low birth weight. Fully 60% of the 10.9 million deaths among children aged under-five each year in developing countries are associated with underweight due to malnutrition, and 161 million preschool children suffer chronic malnutrition. One third of the world’s population is affected by vitamin and mineral deficiencies and therefore subject to infection, birth defects and impaired physical and psycho-intellectual development. In countries facing emergencies, malnutrition affects nearly 40 million people and is one of the major causes of death and disability. The 40 million people living with HIV/AIDS are exposed to an increased risk of food insecurity and malnutrition, especially in poor settings, which may combine to aggravate their condition. At the same time, both industrialized and rapidly industrializing countries are seeing the large-scale emergence of overweight and obesity as a result of unhealthy diets and sedentary lifestyles. Some 1000 million adults and 20 million children are estimated to be overweight. More than half the world’s population is affected by some form of diet- and nutrition-related chronic disease, which is increasing death rates and lost years of healthy life from cardiovascular diseases, type 2 diabetes and some cancers A number of countries face the dual burden of both over- and under-nutrition in their populations, which places increased strain on health systems, reduces economic performance and impacts on social and economic development. WHO’s fundamental role in tackling these challenges, and therefore contributing to the achievement of the health-related Millennium Development Goals, is to strengthen the ability of Member States to identify and reduce all forms of malnutrition, and to promote healthy nutrition and diet. In that respect, WHO has a unique strength through its work on setting norms and standards at global level and developing strategies to counter malnutrition, and through its close relations with national health authorities by means of its regional and country offices.

GOAL WHO OBJECTIVES

To eliminate malnutrition in all its forms. To reduce malnutrition through the promotion of healthy nutrition and diet, and strengthening of national nutrition policies and programmes. Indicators

• Number of countries with effective policies and programmes to control malnutrition • Number of countries that have made progress towards the Millennium Development Goals related to nutrition

STRATEGIC APPROACHES

Evidence-based actions to tackle all forms of malnutrition throughout the life-course, and promotion of national nutrition policies and programmes by setting up norms and standards; providing technical support and guidance to countries; strengthening national nutrition-surveillance systems; promoting public advocacy and mobilization of public health authorities; and collaborating with organizations of the United Nations system, public- and private-sector bodies, and civil society.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Ability of countries to develop and implement national nutrition policies strengthened, including for tackling the nutrition transition, emergency situations and populations with HIV/AIDS. 2. Adequate guidance and support provided for implementation of WHO’s global strategy on infant and young child feeding.

INDICATORS • Number of countries with an effective national nutrition policy in place

BASELINES 146 countries

TARGETS 15 additional countries

• Number of countries with an effective • strategy on infant and young child feeding in place Number of WHO regions with locally adapted guidelines on implementation of WHO’s global strategy on infant and young child feeding

No data available

50 countries

No data available

All six WHO regions

3. Global, regional and national nutrition-surveillance systems strengthened through the maintenance and updating of WHO databases on nutrition. 4. Adequate guidance and support provided for implementation of the new WHO growth standards for assessment of child malnutrition, growth and development. 5. Provision of support to countries for effective implementation of WHO’s guidance on management of severe childhood malnutrition and evaluation of its impact on child mortality. 6. Provision of support to countries for effective implementation of a strategy for fetal development and control of maternal and fetal malnutrition, including low birth weight. 7. Provision of support to countries for effective implementation of policy on control of micronutrient malnutrition in the most susceptible groups, focusing on iodine, vitamin A, iron, zinc and folic acid deficiencies.

• Number of countries with nationally representative data on major forms of malnutrition in WHO databases

92-187 countries (depending on databases)

120-190 countries (depending on databases)

• Number of targeted countries receiving WHO technical support in implementing WHO’s new growth standards

No data available

50 countries

• Number of countries receiving WHO technical support in implementing and evaluating WHO’s guidelines on management of severe childhood malnutrition

30 countries

50 countries

• Number of countries that have implemented an effective strategy for prevention and control of maternal and fetal malnutrition

No data available

40 countries

• Number of countries with national programmes on micronutrientdeficiency control which will be assessed

4 countries

10 countries

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 8. Provision of support for effective implementation of WHO’s guidance on control of obesity and on promotion of healthy diet and lifestyles. 9. Ability to manage nutrition disorders in populations in emergency situations and in populations with HIV/AIDS.

INDICATORS • Availability of WHO guidelines on the control of obesity and the promotion of healthy diet and lifestyles

BASELINES Guidelines produced in 2 regions

TARGETS Guidelines available in 4 regions

• Number of WHO regions with locally adapted WHO guidelines on the management of nutrition disorders in emergency situations and in populations with HIV/AIDS

1 strategy document and 8 guidelines

Guidelines adapted for each of the 6 regions

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

24 183

Includes Miscellaneous Income.

Nutrition is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HEALTH AND ENVIRONMENT ISSUES AND CHALLENGES

Environmental conditions, whether affected by global change or within a local setting, are a major direct and indirect determinant of human health. In developing societies, exposure to modern forms of urban, industrial and agrochemical pollution aggravates the burden of disease stemming from traditional health risks within the household and community. Breaking the vicious cycle that links poverty, environmental degradation and ill-health, and redressing the continuing inequities related to gender and economic development, remain a major challenge. Use of biomass fuel and coal for cooking and heating is estimated to be responsible for more than 1.6 million lives lost every year; almost 60% of the dead are children under five years of age. Safe and sufficient drinking-water is still not accessible to 1100 million people, and 2400 million lack adequate sanitation. Reduced availability and degraded quality of water, related to population growth and exploitation of natural resources, lead to 3.4 million deaths a year, mostly among the poor and children. Chaotic urban growth has its price in terms of environmental health: lack of clean forms of energy, safe water, sanitation, and disposal of municipal and hazardous waste remains a problem in many regions. Occupational diseases and injuries, which are grossly underreported, are responsible for more than one million deaths annually. Increased use of chemicals, their mismanagement and inappropriate disposal – particularly of pesticides in developing countries – lead to a significant burden of injury, ill-health and mortality. Climate change and increased levels of ultraviolet radiation contribute to increasing the burden of disease. Impacts include a growth in health hazards, from greater intensity and number of extreme weather events such as heat waves, floods or droughts, to changing patterns in vector-borne diseases. Accidental releases or the deliberate use of biological and chemical agents or radioactive material that affect health require effective prevention, surveillance and response systems to contain or mitigate harmful outcomes. Essential health services and basic sanitary installations are often disrupted or devastated as a consequence of conflict or environmental disasters. Political, legislative and institutional barriers to improving environmental conditions are numerous. The public-health impact of different policy options needs to be properly assessed and cost to the health system of diseases attributable to environmental exposures, estimated. Human resources adequately specialized in risk assessment and management, and public participation on those processes, are still lacking in many countries. National and local health authorities are thus often unable to collaborate with other socioeconomic sectors where health-protective measures need to be taken. Agenda 21, adopted at the United Nations Conference on Environment and Development (Rio de Janeiro, Brazil, 1992), the Plan of Implementation of the World Summit on Sustainable Development (Johannesburg, South Africa, 2002), together with the Millennium Development Goals and such regional initiatives as the series of ministerial conferences on environment and health, provide the necessary international policy framework for action.

GOAL

To achieve safe sustainable and health-enhancing human environments, protected from biological, chemical and physical hazards, and secure from the effects of global and local environmental threats. To ensure effective incorporation of health dimensions into national policies and action for environment and health, including legal and regulatory frameworks governing management of the human environment, and into regional and global policies affecting health and environment. Indicator

WHO OBJECTIVES

• Level of commitment to protection of environmental health reflected in policy declarations and development programmes, at national, regional and international levels

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Contribution to reducing the burden of excess mortality and disability by reducing risk factors to human health that arise from environmental causes; promotion, through the health sector, of interventions for health protection in the environment and other socioeconomic sectors; coordination of action across programmes within WHO, on the basis of proven strategies such as the “healthy settings” approach.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Evidence-based normative and good practice guidance developed or updated and promoted that effectively provide support for countries in assessing health impacts and in decision-making across sectors, in key environmental-health areas including water, sanitation and hygiene, air quality, workplace hazards, chemical safety, radiation protection, and environmental change. 2. Countries adequately supported in building capacity to manage environmental health information, and to implement intersectoral policies and interventions for protecting health from immediate and longer-term environmental threats. 3. Environmental health concerns of vulnerable and high-risk population groups (particularly children, workers and the urban poor) addressed by global, regional and country-level initiatives that are implemented through effective partnerships, alliances and networks of centres of excellence.

INDICATORS • Number of countries using WHO guidance for risk assessment and management

BASELINES

TARGETS

• Number of countries implementing environmental and health action plans with WHO’s support

• Number of projects implemented in partnerships at national, regional and global levels

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

90 800

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Health and environment is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

FOOD SAFETY ISSUES AND CHALLENGES

Globally, unsafe food results in disease for at least one person in three every year, and in some regions the situation is considerably worse. Many cases result in long-term complications or death, and unsafe food, in addition to unsafe water, cause diarrhoeal diseases that kill an estimated 1.8 million people annually. These diseases also interact in a vicious circle with malnutrition, resulting in an even greater indirect burden of disease. In addition, foodborne chemical hazards still cause significant public-health problems, although their extent is difficult to estimate. There are clear indications that the incidence of foodborne disease is increasing. In addition, both the number and international importance of severe episodes of food contamination seem to be rising. These trends have substantial political implications, considerable changes to old food-safety systems are being contemplated throughout the world. Although food-safety issues have in the past been accorded low priority in many health systems, it is now recognized that serious health-sector involvement in food safety is necessary in order to guide interventions aimed at lowering disease incidence. Future food-safety systems and interventions need to be based on risk, that is start and end in relation to health. Food-safety issues influence growth in international food trade because of their public health significance: food trade increases the potential to disseminate foodborne hazards. The need for international precaution in trade is evident. Such precaution requires a regulatory system based on objective and transparent criteria. In recent years several countries have lost significant export earnings from restrictions on food trade, yet no international system exists to tackle such challenges, or even to exchange information on food-related emergencies. Similarly, issues related to new technologies, such as food biotechnology, need to be recognized and resolved at international level. In many countries the legislation and policies to guide food safety are either non-existent or outdated. Responsibility may be divided between a number of ministries with poor coordination; activities may not be based on risk nor with WHO/FAO guidance; there may be no surveillance of foodborne disease and education and training for food handlers and consumers in food safety is poorly developed.

GOAL

To reduce the health effect of food contamination and to reform and strengthen existing food-safety systems to reduce the burden of foodborne disease. To enable the health sector, in cooperation with other sectors and partners, effectively and promptly to assess, communicate and manage foodborne risks. Indicator

WHO OBJECTIVES

• The increase in the number of countries providing data on foodborne diseases and food hazards, which demonstrates that they are developing a risk-based approach to food safety assessment, management and communication

STRATEGIC APPROACHES

Building of capacity nationally and internationally to obtain, use and share reliable data on foodborne diseases and food contamination; promotion of risk assessments and risk-based decisions; formulation of international food safety standards and guidelines; furtherance of effective participation of more countries in the work of the Codex Alimentarius Commission; promotion of concept of food safety as an intersectoral responsibility at both technical and policy levels; building of risk-communication capability in Member States; advocacy of a coordinated approach at international, regional and country levels in order to handle more effectively the shared responsibility for food safety from production to consumption.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Foodborne disease surveillance and food-hazard monitoring and response programmes strengthened and international networks established.

INDICATORS • Percentage of WHO Member States • participating in networks Percentage of Member States providing surveillance data to WHO on one or more foodborne diseases, or reporting data from monitoring of microbiological or chemical hazards

BASELINES 60% Percentage of Member States reporting data at the end of 2005

TARGETS 100% At least 50% in each region

2. Timely provision of scientific advice and guidance to developing countries in order to increase their capability to assess risk, and to enable them to participate actively in international risk assessment. 3. Adequate technical guidance provided to countries to assess and manage the risks and benefits associated with products of new food technologies. 4. Effective support provided to countries for the organization and implementation of multisectoral food-safety systems, focusing on health and participation in international standard-setting.

• Number of international risk assessments (microbiological and chemical) finalized by WHO and FAO Number of participants from developing countries in WHO/FAO expert advisory bodies

•

Estimated 69 international risk assessments conducted in 2004-2005 Number recorded in 2004-2005

Double the number of risk assessments

25% increase

• Number of risk assessments, or tools, for risk assessment or management, validated and disseminated by WHO

4 risk assessments of genetically modified foodstuff in developing countries

2 consultations held on risk assessment; one set of guidelines issued

• Percentage of countries in each region participating actively in international standard-setting (Codex Alimentarius Commission)

• Number of countries that, with WHO support, have established or amended policies, plans of action, legislation or enforcement strategies for food safety

Percentage of countries in each region participating in standard-setting meetings in 2004-2005 3 countries per region in 2004-2005

At least 60% of countries in all regions participating in standard-setting meetings Additional 5 countries per region

5. Adequate support provided to high-priority countries for improving food-safety education, effectively communicating risk, and managing public-private partnerships.

• Number of countries that have used and evaluated food-safety material based upon WHO’s guidelines for safer food

2 countries per region in 2004-2005

Additional 5 countries per region

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

23 800

Includes Miscellaneous Income.

Food safety is also supported by results expected

to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

VIOLENCE, INJURIES AND DISABILITIES ISSUES AND CHALLENGES

Violence and injuries account for 9% of global mortality. Seven of the 15 leading causes of death for people between the ages of 15 to 44 years are injury-related. Children and young adolescents are also vulnerable. Injury rates vary by sex: for most types of injuries, death rates are higher for males, whereas females are at higher risk for burns, non-fatal sexual violence, or injury from an intimate partner. The burden imposed by violence and injury is particularly heavy on low-income families. The traditional view of injuries as “accidents”, suggesting that they are random, unavoidable events, has resulted in their historical neglect. Research has shown that injuries are preventable; innovative, cost-effective interventions are being introduced at work, at home or on roads. About 600 million people in the world are disabled; most of them live in poverty. The population with disabilities is increasing because of injuries from road crashes, landmines or other causes, HIV/AIDS, malnutrition, chronic conditions, substance use, population growth, or medical advances that preserve and prolong life. Less than 10% of those in need have access to appropriate rehabilitation services. The Health Assembly recognized the need for WHO to provide support in such areas as prevention of road-traffic accidents, disabilities and rehabilitation, prevention of violence, and use of anti-personnel mines.1 Similar resolve is expressed in such international instruments as the United Nations Millennium Declaration, the Programme of Action of the United Nations Conference on the Illicit Trade of Small Arms and Light Weapons in All its Aspects (2001), and the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities. The basis for WHO’s activities is the World report on violence and health.2 World Health Day 2004 on road safety and the World report on road traffic injury prevention have served as platforms to strengthen WHO’s activities on road safety.3 Both reports are starting points for tackling some of the challenges involved, but it is often unclear where responsibility lies for problems and for devising and implementing the solutions. Further, political will may be lacking because of ignorance of the magnitude of the problem or the potential for prevention. In some countries there are no focal points for injury prevention, no pertinent public-health policies or appropriate training programmes, hence insufficient resources dedicated to finding solutions. Information systems and research are needed in order to understand better the magnitude of violence, injury and disability and their causes, together with national prevention policies and programmes, training for public health personnel, establishment of networks for advocacy and exchange of information, and better services for victims.

GOAL

To prevent violence and unintentional injuries, promote safety and enhance the quality of life for people with disabilities. To formulate and implement cost-effective, age- and gender-specific strategies to prevent and mitigate the consequences of violence and unintentional injuries, and disabilities, and to promote and strengthen rehabilitation services. Indicators

WHO OBJECTIVES

• Number of countries that formulated policies and prevention programmes on violence and injuries • Number of countries that formulated policies on disabilities and implemented plans for strengthening rehabilitation services

1 2 3

Resolutions WHA27.59, WHA45.10, WHA49.25, WHA56.24 and WHA51.8, respectively. World report on violence and health. Geneva, World Health Organization, 2002. World report on traffic injury prevention. Geneva, World Health Organization, 2004.

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Compilation and analysis of information on the magnitude and determinants of violence, injuries and disability; support for research and gathering of evidence on effective prevention strategies in developing countries, support for training and implementation of policies and strengthening of services for victims; advocacy for increased attention and a stronger focus on primary prevention; support for network development and capacity building.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Adequate support provided to high-priority countries for implementation and evaluation of information systems for the major determinants, causes and outcomes of violence, unintentional injuries and disabilities. 2. Multisectoral interventions to prevent violence and unintentional injuries validated and effectively promoted in countries. 3. Guidance and effective support provided for strengthening of prehospital and hospital care for persons affected by violence and injuries. 4. Effective support provided for strengthening of country capacity for integrating rehabilitation services into primary health care, and for early detection and management of disabilities. 5. Improved capacity in selected countries for framing policy on prevention of violence and injury or on managing disabilities.

INDICATORS • Number of targeted countries that implement functional information systems on the determinants, causes and outcomes of violence, unintentional injuries or disabilities

BASELINES

TARGETS

20 countries

44 countries

• Number of targeted countries that implement multisectoral interventions to prevent violence and unintentional injuries

19 countries

32 countries

• Number of targeted countries that strengthen the response of their health-care system to violence and unintentional injuries

14 countries

26 countries

• Number of targeted countries that implement strategies for integrating rehabilitation services into primary health care

4 countries

8 countries

• Number of targeted countries that have national plans and implementation mechanisms to prevent violence and unintentional injuries Number of targeted countries that have policies on management of disabilities

16 countries

37 countries

• 6. Strengthened training capacity in priority countries for prevention of violence and injury and for rehabilitation services.

90 countries 13 countries

105 countries 34 countries

• Number of targeted countries that have schools of public health with training programmes on prevention and management of violence and unintentional injuries, and on rehabilitation

7. Functional global, regional and national networks that effectively strengthen collaboration between health and other sectors, involving organizations of the United Nations system, Member States and nongovernmental organizations, including those of people with disabilities.

• Number of global, regional and national multisectoral networks for prevention of violence and injury and for disability in place with WHO support

8 networks

11 networks

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

17 582

Includes Miscellaneous Income.

Violence, injuries and disabilities is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

REPRODUCTIVE HEALTH ISSUES AND CHALLENGES

Reproductive and sexual health is essential for individuals, couples and families, and fundamental to the social and economic development of communities and nations. However, good reproductive and sexual health continues to elude millions of men and women in all regions of the world. Pregnancy-related complications continue to claim the lives of more than half a million women each year. Neonatal mortality (the death of a baby during the first week of life), which is closely related to women’s health and care during pregnancy, has not declined over the past two decades despite the progress made in reducing infant and child mortality. Access to, and use of, contraceptives are often quoted as examples of successes in the past few decades, yet more than 120 million couples in developing countries and countries in transition still have an unmet need for safe and effective contraception. This lack results each year in 80 million unintended pregnancies, some 45 million of which are terminated – 19 million in unsafe conditions. Forty per cent of these unsafe abortions involve young women, aged 15-24 years. Complications resulting from unsafe abortions account for 13% of all maternal deaths. Maternal and perinatal mortality and morbidity, cancers, sexually transmitted infections and HIV/AIDS account for nearly 20% of the global burden of ill-health for women, and 14% for men. In addition to the five million new cases of HIV infection and countless numbers of other incurable viral sexually transmitted infections, an estimated 340 million new cases of curable non-viral sexually transmitted infections are contracted annually. More than one million women and men die from cancers of the reproductive system, including 240 000 women, most in developing countries, from cervical cancer. In addition, there are some 2.7 million stillbirths a year, and the substantial but underestimated consequences for reproductive and sexual ill-health of sexual violence, harmful practices such as female genital mutilation, menstrual abnormalities, infertility and other gynaecological morbidities. WHO’s work on these issues is grounded in the agreements adopted at the International Conference on Population and Development (Cairo, 1994) and the Fourth World Conference on Women (Beijing, 1995) and in the commitments made in the United Nations Millennium Declaration in 2000, as confirmed by the Health Assembly.1 It is further underpinned by internationally agreed human rights instruments and other global consensus declarations, including the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so; the right of women to have control over and decide freely and responsibly on matters related to their sexuality, including reproductive and sexual health, free of coercion, discrimination and violence; the right of access to relevant health information; and the right of everyone to enjoy the benefits of scientific progress and its applications. The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction is the focal point in the United Nations system for research in reproductive and sexual health.

GOAL WHO OBJECTIVES

The attainment by all peoples of the highest possible level of reproductive and sexual health. To ensure that by 2015 the widest achievable range of safe and effective reproductive and sexual health services is being provided across the health system and integrated into primary health care. Indicators • Number of countries that make reproductive and sexual health an integral part of national planning and budgeting • Number of countries reporting at least one of the proxy indicators for use of reproductive and sexual health services

Resolutions WHA48.10, WHA55.19 and WHA57.12.

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Strengthening of the quality of care by ensuring that up-to-date practices are implemented throughout the health system; provision of evidence on causes, determinants, prevention and management of morbidity and mortality related to reproductive and sexual ill-health; identification and overcoming of obstacles to access to, and use of, reproductive and sexual health services; contribution to the empowerment of individuals, families and communities in order to increase their control over their reproductive and sexual health; creation of supportive regulatory frameworks at national and local levels; and creation of a dynamic environment of strong international, national and local support for rights-based reproductive and sexual health initiatives in order to overcome inertia, mobilize resources, and establish high standards and mechanisms for performance accountability.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Adequate guidance and support provided to improve sexual and reproductive health care in countries through dissemination of evidencebased standards and related policy, and technical and managerial guidelines. 2. New evidence, products and technologies of global and/or national relevance available to improve reproductive and sexual health, and research capacity strengthened as necessary.

INDICATORS • Number of new or updated guidance documents to support national efforts to improve reproductive and sexual health validated and disseminated in countries

BASELINES

TARGETS

None

• Number of completed studies of priority issues • • in reproductive and sexual health Number of new or updated systematic reviews on best practices, policies and standards of care Number of new research centres strengthened through grants

None None

40 15

None

3. Policy and technical support effectively provided to countries for the design and implementation of comprehensive plans for increasing access to, and availability of, highquality sexual and reproductive health care, strengthening human resources, and building capacity for monitoring and evaluation.

• Number of targeted countries with new or updated strategies and plans for strengthening access to, and availability of, high-quality sexual and reproductive health care. Number of countries completing operational research studies to evaluate approaches to provision of high-quality sexual and reproductive health care

•

None

4. Adequate technical support provided to countries for better reproductive and sexual health through individual, family and community actions. 5. Ability of countries to identify regulatory obstacles to provision of high-quality sexual and reproductive health care strengthened.

• Number of targeted countries developing new or improved interventions to foster action at individual, family and community levels for better reproductive and sexual health

None

• Number of targeted countries having reviewed their existing national laws, regulations and policies relating to reproductive and sexual health and rights

None

6. International efforts for achieving international development goals in reproductive health, including global monitoring, mobilized and coordinated.

• Global report on progress towards achievement of international development goals in reproductive health submitted to the Health Assembly

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

66 435

Includes Miscellaneous Income.

Reproductive health is also supported by results

expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

MAKING PREGNANCY SAFER ISSUES AND CHALLENGES

Reducing the number of women dying in pregnancy and childbirth by three quarters between 1990 and 2015 is one of the targets of the Millennium Development Goals. Actions to achieve this target will also contribute substantially to reducing newborn mortality, which in turn will play an important part in the achievement of the Millennium Development Goal of reducing child deaths. Complications of pregnancy and childbirth account for the deaths of 529 000 women a year and are the second most common cause of mortality in women of reproductive age after HIV/AIDS. This burden is unevenly distributed: while the greatest numbers of maternal deaths are found in large countries with high fertility rates, the highest maternal mortality ratios are found mainly in Africa. In these areas of high maternal mortality, women run more than 140 times the risk of dying from a pregnancy-related cause than in Europe. Since the launch of the Safe Motherhood initiative in 1987, the international community has been trying to solve this problem. A few countries have managed to reduce maternal and neonatal deaths, but mortality ratios have remained virtually unchanged in the worst affected countries. Nevertheless, important lessons have been learnt: for example, strengthening emergency care for women with complications is important but not sufficient; and training traditional birth attendants has not yielded the results expected. The WHO Making Pregnancy Safer initiative provides a set of strategy directions that build on the lessons learnt. These directions concern the establishment of an effective continuum of care for all pregnant women and their newborn infants. The continuum of care runs through all the levels of the health-care system, starting with the care provided by women, their families and communities. Critically, this requires a functioning referral system to be in place with the necessary linkages between the different levels of care, to ensure that complications, especially life-threatening emergencies, are managed quickly and efficiently. WHO’s work to make pregnancy safer aims at strengthening the capacities of 72 priority countries to build this continuum of care. Evidence of reduction in maternal and neonatal mortality, including that from case studies in Malaysia and Sri Lanka, has shown that, although poverty is an important determinant of maternal and neonatal ill-health, its effects can be overcome by improving access to, and quality of, care. In order to make these improvements, strong social and political commitment is needed. This is particularly true for actions in two areas, namely, improving the availability and utilization of skilled attendants for care throughout pregnancy, birth and the postnatal period, and providing improved health-care facilities for the management of obstetric and neonatal complications. Specific interventions and strategies for working with women, their partners and other family members and their communities have been identified in order to improve access to and use of skilled care and also to contribute to the empowerment of women and the community. Finally, strengthening health systems to ensure the continuum of care will also provide a crucial opportunity to make linkages between maternal and neonatal services and other primary health-care services such as those for HIV/AIDS, sexually transmitted infections, malaria control, family planning and child health. This area of work focuses primarily on strengthening support for countries, with related research and normative work being included in the reproductive health area of work.

GOAL

To achieve the Millennium Development Goal for maternal health by reducing maternal mortality by 75% from 1990 levels by the year 2015; and to contribute to lowering the infant mortality rate to below 35 per 100 000 live births in all countries by 2015, through a reduction in perinatal mortality. To strengthen national efforts to implement cost-effective interventions so that health systems provide all women and newborn infants with a continuum of care throughout pregnancy, childbirth and the postnatal period. Indicators

WHO OBJECTIVES

• Proportion of women seen by a skilled attendant at least once during the antenatal period • Proportion of women assisted by a skilled attendant at childbirth

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Fostering of political and social commitment and effective partnerships; development and adaptation of evidence-based standards and guidelines for effective maternal and neonatal care, and provision of support to countries for dissemination and implementation; monitoring and evaluation of progress towards strategic goals and improved maternal and neonatal health; production of evidence for effective maternal and neonatal health programming; and provision of technical support to address the key interlinked elements required to build the continuum of care, namely: human resource development in maternal and neonatal health care; provision of accessible, high-quality maternal and neonatal healthcare services; empowerment of individuals, families and communities to increase their control over maternal and neonatal health; and integration of other primary health-care programmes with maternal and neonatal health services.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Political and financial commitment increased through advocacy and effective partnerships promoted to provide support to countries in strengthening their maternal and neonatal health care. 2. Technical support provided to priority countries to make the continuum of care more effective, including: developing a skilled workforce to provide maternal and neonatal health care; improving quality and coverage of maternal and neonatal health, family planning and related services; working in partnership with individuals, families and communities to increase their control over maternal and neonatal health; and integrating maternal and neonatal health service delivery and programmes for HIV/AIDS, malaria, sexually transmitted infections and family planning. 3. Evidence-based standards and guidelines for effective maternal and neonatal health care adopted by priority countries for implementation at local level. 4. Monitoring, surveillance and evaluation systems for maternal and neonatal health programmes strengthened in priority countries and their progress towards the Millennium Development Goals monitored. 5. Capacity for conducting operational research in countries strengthened to ensure effective maternal and neonatal health outcomes.

INDICATORS • Number of recently-established joint action plans between WHO and other stakeholders at country, regional or global level

BASELINES

TARGETS

None

• Number of priority countries that establish plans within the biennium to improve the proportion of births attended by skilled health personnel Number of priority countries that have established new mechanisms for involving individuals and communities in maternal and neonatal health programming Number of priority countries where maternal and neonatal health services have initiated new collaborations with other key public health programmes

None

•

None

•

None

• Number of priority countries that have recently adopted WHO standards and guidelines for maternal and neonatal health care

None

• Number of priority countries that have established a system for maternal and neonatal health monitoring and evaluation during the biennium, and for yearly reporting on key indicators

None

• Number of operational research studies conducted to evaluate approaches to provision of services

None

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

64 150

Includes Miscellaneous Income.

Making pregnancy safer is also supported by

results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

GENDER EQUALITY, WOMEN AND HEALTH ISSUES AND CHALLENGES

Differences and inequalities in socially attributed roles and responsibilities of women and men and gender-based disparities in access to resources, information and power have different consequences for women’s and men’s health. These factors, in interaction with other social inequalities and biological characteristics, are reflected in women’s and men’s exposure to health risks, access to, and use of, preventive and curative measures, health status and social consequences of ill-health. The Platform for Action adopted at the Fourth World Conference on Women (Beijing, 1995) identified “women and health” as a crucial theme and recommended “gender mainstreaming” as the strategy for implementing actions in all critical areas of concern, including health. United Nations General Assembly resolutions and the Millennium Development Goal 3 also call for the consideration of gender to be integrated into the policies and programmes of bodies of the United Nations system and for acceleration of efforts to achieve equality between women and men. WHO’s policy seeks to integrate a gender perspective into its programmes and health-sector policies and strategies. Efforts to date have focused on building up evidence about the way gender inequality affects health; gender-based violence; gender and HIV/AIDS; and the integration of gender considerations into health research, policies and programmes. However, more work is needed to ensure that this approach becomes a core component of all public-health work. Raising awareness and fostering partnerships between WHO, other organizations of the United Nations system, governmental bodies and nongovernmental organizations are essential. Good practices in reducing gender inequality in health systems need to be developed and documented. Capacity needs to be built in both national health systems and WHO to bring gender perspectives into the mainstream of all policies, and that integration needs to be monitored. As gender is a cross-cutting issue, political will, commitment from senior management and accountability are essential to ensuring that it is considered in all WHO’s work.

GOAL

To achieve better health for girls and women, boys and men, through the promotion of gender equality between men and women, women’s empowerment and the promotion of health research, policies, and programmes that adequately address gender issues. To develop and provide support for the use of tools, strategies and interventions for the effective integration of gender considerations into health research, policies and programmes, in order to redress gender inequality and mitigate its impact on health. Indicator

WHO OBJECTIVES

• Proportion of targeted Member States and other health partners that are using one or more WHO tools for integration of gender and women’s health in the development of health policies, strategies and programmes

STRATEGIC APPROACHES

Provision of support for data collection, research, reviews and policy analysis to improve knowledge on the impact of gender inequality and roles on health and health care, and formulation of appropriate strategies; formulation, piloting and evaluation of indicators, tools and standards for the integration of gender perspectives into public-health policies, programmes and research, and for application in activities related to gender and women’s health; development of skills and expansion of capacities at all levels of national health systems and within WHO to generate sex-disaggregated data, analyse them from a gender perspective and use the results to bring gender into the mainstream of health policy and programme development; advocacy and fostering of partnerships between WHO and other organizations of the United Nations system, nongovernmental organizations and other entities in order to raise awareness of, and disseminate information on, equality between men and women and health equity, with creation of intersectoral networks in countries to support this process.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION WIDE EXPECTED RESULTS 1. Awareness increased and information disseminated relating to gender equality and health equity, with Organization-wide support. 2. Information disseminated about good practices in reducing gender inequality in health and specific genderbased health risks, and provision of support to targeted countries for its use in advocacy and policy. 3. Gender and women’s health considerations incorporated into workplans of selected WHO activities. 4. Effective monitoring tools and standards, with supporting training materials, developed and used by countries in capacity building and in design and implementation of gendersensitive programmes and policies.

INDICATORS • Number of networks established

BASELINES Number of programmes or projects advancing gender issues in health

TARGETS 5

• Proportion of targeted countries using information about good practices in reducing gender inequality in health for advocacy, policy change or development of interventions

Number of reviews and documents available

• Number of targeted WHO programmes that systematically incorporate gender considerations in their strategies and guidelines

• Number of tools, standards, training • and other materials developed Number of targeted countries requesting technical support for using and testing training materials and standards

None Current number of targeted countries requesting support

6 3-5 countries in each of 3 regions requesting support

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

17 800

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Gender equality, women and health is also

supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

CHILD AND ADOLESCENT HEALTH ISSUES AND CHALLENGES

Newborn infants, children and adolescents make up almost 40% of the world’s population; their healthrelated problems, and potential solutions to them, have been well documented. Nearly 11 million children under five years of age die every year – most in developing countries. The major killers remain unchanged; pneumonia, diarrhoea, malaria, measles, and HIV/AIDS cause half the deaths, with malnutrition underlying more than 50% of mortality for this group. There is a growing recognition of the particular vulnerability of newborn infants: deaths in the first month of life represent 60% of infant mortality and 40% of under-five mortality. Cost-effective interventions are available and, when implemented on an adequate scale, they reduce child mortality significantly and improve child growth and development. Some interventions rely on properly functioning and well-supplied health services; others can be promoted through the community and civil society. However, the reach of these successful interventions is not currently sufficient to benefit those in greatest need, and should be increased. During the coming decade, the number of adolescents in the world will rise to a record level. This group is exposed to multiple risks and multiple opportunities. Up to 70% of premature adult mortality has its roots in the adolescent period. An estimated 1.4 million adolescents lose their lives annually, mostly through injuries caused unintentionally, suicide and violence; pregnancy-related complications claim 70 000 adolescent lives a year. In addition, young people aged between 15 and 24 continue to have the highest rates of sexually transmitted infections (accounting for nearly 50% of all new HIV infections in 2002). A set of positive factors that limit adolescents’ risky behaviour has been identified. In addition to supporting the social environment of adolescents, key interventions include increasing access to ageappropriate information, skills and health services. WHO has a particular responsibility to strengthen the health sector’s response to adolescent needs. WHO has developed a number of interrelated strategies to respond to the health and development needs of children up to the age of 19 years. The strategic directions for child and adolescent health and development were endorsed by the Health Assembly; resolution WHA56.21 requests a report to be made to the Health Assembly in 2006 on WHO’s contribution to implementation of the strategic directions, with particular emphasis on actions related to poverty reduction and the attainment of internationally agreed goals on child and adolescent health and development, such as the Millennium Development Goals. Integrated management of childhood illness (endorsed by the Health Assembly in resolution WHA48.12) is a cost-effective health sector and community-based strategy that supports and complements other global initiatives to promote child survival, growth and development. The global strategy for infant and young child feeding (endorsed by the Health Assembly in resolution WHA55.25) supports interventions to improve feeding practices, reduce malnutrition, and improve growth and development. WHO’s strategy for HIV and young people aims to strengthen and accelerate country-level health sector action by developing capacity, providing technical support, facilitating partnerships and mobilizing resources. WHO continues to support strong collaboration among areas of work whose technical or population focus converges with child and adolescent health (e.g. reproductive health, making pregnancy safer, malaria, nutrition, essential medicines, and immunization). The Organization will maintain its strong partnerships with other organizations of the United Nations system, bilateral agencies, nongovernmental organizations, governments, the private sector and communities; and it will continue to guide international and national policies by means of its support to instruments such as the Convention on the Rights of the Child.

GOAL

To reduce by two thirds the rate of infant and child mortality by the year 2015 from the 1990 rate; and to reduce by 25% globally HIV prevalence among young people aged 15 to 24 years by the year 2010.

PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

To enable countries to pursue evidence-based strategies in order to reduce health risks, morbidity and mortality along the life course, promote the health and development of newborn infants, children and adolescents, and create mechanisms to measure the impact of those strategies. Indicators

• Number of countries implementing WHO-recommended policies and programmes on neonatal and child health and development health and development

• Number of countries implementing WHO-recommended policies and programmes on adolescent

STRATEGIC APPROACHES

Elaboration of cost-effective mechanisms and guidelines to deal with diseases and conditions that represent the greatest health burden to populations; implementation of such tools in countries with feedback for further research; efforts to meet international health outcome goals by extending interventions, ensuring quality of care, and strengthening national child health programmes, particularly in countries with high under-five mortality rates; provision of support for adolescent health programming and the promotion of protective factors; prioritizing human resources, collaboration with the private sector, family and community practices, and long-term political commitment and financial support.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Adequate technical and policy support provided to an increased number of countries to give effect to the health-related articles of the Convention on the Rights of the Child.

INDICATORS • Number of countries that have initiated implementation of child and adolescent healthrelated recommendations resulting from WHO support to the reporting process of the Convention on the Rights of the Child

BASELINES

TARGETS

2. Improved policies, strategies, norms and standards established for protecting adolescents from disease and from behaviours and conditions that pose a risk to health, through research, and technical and policy support. 3. Guidelines, approaches and tools put in place for intensified action towards improving neonatal and child survival, growth, and development, and monitoring of progress validated and promoted.

• Number of countries having developed evidence-based policy recommendations and guidelines on protecting adolescents from major diseases and from behaviours and conditions that pose a risk to health

• Number of countries implementing integrated management of childhood illness activities and which have expanded geographical coverage to more than 50% of target districts Number of WHO-supported research projects aiming to influence the formulation of strategic norms, standards and guidelines for improving neonatal and child survival

•

4. Contributions made to the attainment of global goals by improving child and adolescent health.

• Number of countries with child survival partnership mechanisms established to provide support for coordinated action to implement child health interventions Number of countries applying the WHO strategic approach on HIV and young people

•

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

100 784

Includes Miscellaneous Income.

Child and adolescent health is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

IMMUNIZATION AND VACCINE DEVELOPMENT ISSUES AND CHALLENGES

Three WHO regions (the Region of the Americas, and the European and the Western Pacific Regions) were free of poliomyelitis by the end of 2003; transmission of poliovirus continued into 2004 in the three other regions. In 2004-2005, the major effort was on interrupting transmission in all countries. In 2006-2007, surveillance efforts in the countries under the Global Polio Eradication Initiative will focus on confirming interruption of all wild-type virus transmission so that the Global Certification Commission can certify the world as poliomyelitis-free by 2008. Additionally, any reintroduced or emergent circulating polioviruses will be rapidly detected and responded to. Despite progress, by 2004 more than 33 million children born every year did not have access to safe immunization services. Annually, vaccine-preventable diseases cause over two million deaths, mostly in the poorest countries, including an estimated 610 000 children from measles, despite the availability of a safe, effective and low-cost vaccine. Strengthening immunization services, building managerial capacity at all levels of the health systems in each district to increase and sustain access to immunization services, and surveillance of vaccine-preventable diseases continue to be the major scope of WHO’s technical support to countries and regions with its partners. Within the Global Alliance for Vaccines and Immunization WHO will continue to provide high-quality technical support to improve national capacity for assuring long-term financial sustainability, including increased resources from the national budget and from donors or debt relief; the purchase of all vaccines, including new ones that are deemed cost effective; and the use of auto-disable syringes in countries’ routine immunization services. WHO’s work in the development and promotion of norms and standards for vaccines, together with the existence of a functional national regulatory authority, pave the way for each country to attain the goal of using vaccines of assured quality. WHO’s support to countries will continue through provision of training and strengthening of regulatory capacity and expertise. A critical challenge remains research on, and faster development of, new vaccines. Closing the gaps in knowledge will depend on how fast WHO can harness all research efforts in order to accelerate, where possible, the preclinical development and clinical testing of new vaccines.

GOAL WHO OBJECTIVES

To protect all people at risk against vaccine-preventable diseases. To promote the development of new vaccines and innovation in biologicals and immunization-related technologies; to ensure greater impact of immunization services, as a component of health delivery systems; to accelerate the control of high-priority vaccine-preventable diseases; and to ensure that the full humanitarian and economic benefits of such initiatives are realized. Indicators

• Number of poliomyelitis cases due to wild-type or vaccine-derived poliovirus • Estimated number of measles deaths and cases globally • Percentage of countries achieving immunization coverage of 80% with three doses of diphtheriatetanus-poliomyelitis vaccine in all districts

• Coverage of children less than one year of age with three doses of hepatitis B vaccine STRATEGIC APPROACHES Monitoring and surveillance at global, regional and country levels; coordination of global research and policy development; technical and strategic support to strengthen national and district capacity to implement immunization strategies; strengthening and expansion of global partnerships.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Research supported, guidance provided, partnerships built and research and development capacity in developing countries strengthened for the development of vaccines against infectious diseases of public health significance.

INDICATORS • Number of early-introducers of vaccines in developing countries having taken evidence-based decisions on the introduction of vaccine against pneumococcal, rotavirus or human papillomavirus infection Number of priority developing countries with improved preparedness for introduction of HIV vaccine

BASELINES 6 of 34

TARGETS 28 of 34

•

10 of 32

15 of 32

2. Norms and standards set for production control and regulation of vaccines and other biologicals, and reference standards established.

• Proportion of priority vaccines and biologicals for which necessary regulatory research is under way or which have production and qualitycontrol recommendations; establishment of candidate reference materials

3 (20%) of 15 for priority vaccines and biologicals; 30% for studies on candidate reference materials from 4 WHO regions

15 (100%) of 15 for priority vaccines and biologicals; 50% for studies on candidate reference materials from 4 WHO regions

3. Capacity in countries to implement policies and to ensure that immunization programmes use vaccines of assured quality and implement safe-injection practices adequately strengthened through technical and policy support. 4. Capacity of countries to assure the security of vaccines supply and to increase the financial sustainability of the national immunization programmes adequately strengthened through technical and policy support. 5. Capacity in countries to ensure effective monitoring of immunization systems and assessment of disease burden related to vaccine-preventable diseases adequately strengthened through technical and policy support. 6. Access to current, new and underutilized vaccines maximized and disease-control efforts accelerated in countries and areas by the provision of technical and policy support that effectively contributes to build capacity from district level upwards.

• Proportion of Member States in which the national immunization programme uses only vaccines of assured quality (according to WHO criteria) Proportion of countries assuring sterile injection practices (according to WHO algorithm)

179 (93%) of 192

182 (95%) of 192

•

132 (80%) of 165 target countries

165 (100%) target countries

• Proportion of targeted countries that have prepared and are implementing a financial sustainability plan

32 (42%) of 75

41 (55%) of 75

• Proportion of Member States meeting targets for completeness of surveillance reporting from districts to national level Proportion of Member States with access to accredited laboratory for testing of measles specimens

96 (50%) of 192

153 (80%) of 192

•

96 (50%) of 192

153 (80%) of 192

• Proportion of the infant cohort in all • Member States protected by three doses of hepatitis B vaccine Proportion of Member States achieving immunization coverage of >80% with three rounds of vaccination against diphtheria, tetanus and poliomyelitis in all districts or at equivalent subnational administrative level

68%

84%

96 (50%) of 192

134 (70%) of 192

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS

INDICATORS

BASELINES

TARGETS

• Proportion of targeted Member States • having eliminated maternal and neonatal tetanus Proportion of Member States achieving 90% childhood immunization coverage against measles

15 (26%) of 57

28 (49%) of 57

134 (70%) of 192

173 (90%) of 192

7. Effective coordination and support provided to interrupt circulation of any reintroduced poliovirus, to achieve certification of global poliomyelitis eradication, to develop products for the cessation of oral poliovirus vaccine and to integrate the Global Polio Eradication Initiative into the mainstream of health delivery systems.

• Number of countries and areas having reported endemic poliomyelitis during the previous three years in conditions of certification-standard surveillance Proportion of countries with all laboratories containing wild-type poliovirus and vaccine production facilities meeting Biosafety Level 3 poliomyelitis requirements Proportion of suspected poliomyelitis cases investigated and responded to through the Global Outbreak and Alert Response Network

•

53 (25%) of 215 reporting countries

215 (100%) reporting countries

•

25% of events

100% of events

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

382 003

Includes Miscellaneous Income.

Immunization and vaccine development is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

ESSENTIAL MEDICINES ISSUES AND CHALLENGES

Essential medicines save lives, reduce suffering and improve health, but only if they are of good quality, safe, available, affordable and properly used. In many countries, however, not all these conditions are met. Almost 2000 million people, one third of the world’s population, do not have regular access to essential medicines. Poor quality and irrational use of medicines are also causes of concern. Even when available, medicines may be substandard or counterfeit, if their regulation is weak. The use of traditional or complementary and alternative medicine, widespread in developing countries, is becoming increasingly popular in developed countries, and a source of growing expenditure globally. The central priority remains expanding access to essential medicines, one of the health-related Millennium Development Goals to which the international community is committed. To achieve this goal and guided by the latest Health Assembly resolutions,1 WHO will emphasize access to all essential medicines, with a focus on expanding access to antiretroviral agents to meet the “3 by 5” target. New and continued priorities in the area of medicines policies include the implementation of WHO’s strategy for traditional medicine, tackling the questions of safety, efficacy, preservation and further development of this type of health care, promotion and monitoring of access to essential medicines as a human right, ensuring a public health-oriented approach to national implementation of trade agreements and promoting a stronger ethical dimension in the pharmaceutical sector.

GOAL

To help save lives and improve health by ensuring the quality, efficacy, safety and rational use of medicines, including traditional medicines, and by promoting equitable and sustainable access to essential medicines, particularly for the poor and disadvantaged. To frame, implement and monitor national medicine policies aiming at: increasing equitable access to essential medicines, particularly for high-priority health problems and for poor and disadvantaged populations; ensuring the quality, safety and efficacy of medicines by developing international standards and supporting the implementation of effective regulation in countries; and improving rational use of medicines by health professionals and consumers. Indicator

WHO OBJECTIVES

• Number of countries that have a national medicine policy, either new or updated, within the past 10 years

STRATEGIC APPROACHES

In collaboration with major partners, gathering and dissemination of knowledge based on experience gained in countries, and strengthening of national capability to put it into practice.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Implementation and monitoring of medicines policies based on the concept of essential medicines, monitoring the impact of trade agreements on access to quality essential medicines, and building capacity in the pharmaceutical sector all advocated and supported.

INDICATORS • Number of countries that have plans for • implementing national medicines policy, either new or updated, within the past five years Number of countries integrating flexibilities for protection of public health in the Agreement on Trade-related Aspects of Intellectual Property Rights into national legislation

BASELINES

TARGETS

49 of 103

32 of 105

Resolutions WHA55.14, WHA56.27 and WHA56.31.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 2. Adequate support provided to countries to promote the safety, efficacy, quality and sound use of traditional medicine and complementary and alternative medicine. 3. Guidance provided on financing the supply and increasing the affordability of essential medicines in both the public and private sectors.

INDICATORS • Number of countries regulating herbal medicines

BASELINES

TARGETS

39 of 129

• Number of countries with public spending on • medicines below US$ 2 per person per year Number of countries with generic substitution allowed in private pharmacies

24 of 80 99 of 132

16 106

4. Efficient and secure systems for medicines supply promoted in order to ensure continuous availability of essential medicines. 5. Global norms, standards and guidelines for the quality, safety and efficacy of medicines strengthened and promoted.

• Number of countries with public-sector procurement based on a national list of essential medicines

84 of 127

• Number of international nonproprietary • (generic) names assigned in the biennium Number of psychotropic and narcotic substances reviewed for classification for international control in the biennium

300 4

6. Instruments for effective medicine regulation and quality-assurance systems promoted in order to strengthen national regulatory authorities. 7. Awareness raising and guidance on costeffective and sound use of medicines promoted, with a view to improving use of medicines by health professionals and consumers.

• Number of countries operating a basic regulatory system

90 of 130

• Number of countries that have a national list of essential medicines updated within the past five years

82 of 114

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

62 285

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Essential medicines is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

ESSENTIAL HEALTH TECHNOLOGIES ISSUES AND CHALLENGES

Health technologies are the backbone of all health systems. Evidence-based health technologies are cost effective, meet well-defined specifications and have been validated through controlled clinical studies or rest on a widely accepted consensus by experts. They are essential tools in solving health problems. Even the most simple health system cannot function without at least some of them. Yet, most of the world’s population is suffering from poverty and is denied access to adequate, safe and reliable solutions that health technologies can offer. Some health-care technologies have only one application, whereas others are designed for multiple purposes, such as in services for blood transfusion, diagnostic imaging, clinical laboratory testing and surgery. A safe and reliable service based on these technologies relies on coherent policies and standards for safety, quality and quality control, access and use. While developing countries face a growing diagnostic demand owing to the spread of both communicable and noncommunicable diseases, they experience a profound shortage of diagnosticimaging, diagnostics and laboratory services. At the same time, about half the equipment available in such countries does not function because both economic and human resources are lacking. The safety and efficacy of blood products and related in vitro diagnostic procedures rely on validated quality-assurance systems. Yet such systems are not everywhere in place: about 6 million of some 80 million units of blood donated annually are not tested in accordance with WHO recommendations on screening for infectious pathogens; inadequate safety cultures for injection, including blood-transfusion practices, cause 22 million cases of hepatitis B, 2 million cases of hepatitis C and 260 000 HIV infections. There is a clear need to strengthen national regulatory authorities and manufacturers in Member States. The decline in blood donation is another issue of concern, although the World Blood Donor Day campaign aims to encourage more people to give blood regularly. The lack of skills to perform emergency and surgical procedures at first-referral health facilities and to implement globally-agreed practices in transplantation, including xenotransplantation, raises additional significant public health concerns. WHO is providing support to Member States, through technical cooperation projects, to implement a number of recommendations for improving the use of essential health technologies, which are set out in basic operational frameworks.

GOAL

To strengthen the ability of national health systems to resolve health problems through the use of essential health technologies. To establish safe and reliable services that apply essential health technologies and use biological products through the adoption of basic operational frameworks covering policy, safety, access and use. Indicator

WHO OBJECTIVES

• STRATEGIC APPROACHES Development of norms, standards, guidelines, information and training material and fostering of research on essential health technologies in support of the establishment of effective health services by Member States; provision of support to Member States in establishing and optimizing the use of medical technologies; assignation of highest priority to three key initiatives that cut across these technologies: development of a list of essential medical devices, prevention of health care-associated HIV infections, and use of information technology in preventive and curative health care; performance of much of this work in association with WHO collaborating centres and other partners.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Appropriate strategies promoted and support provided for establishment of nationally coordinated blood-transfusion services with quality systems in all areas.

INDICATORS • Number of countries with testing of • all blood donors for HIV and hepatitis B and C virus infections Number of countries meeting defined criteria for national coordination of blood-transfusion services with quality systems in all areas

BASELINES 106

TARGETS

21 countries

2. Technical capacity of national regulatory authorities strengthened to assure the quality and safety of blood products and related in vitro diagnostic procedures.

• Number of regional networks for strengthening of national regulatory authorities for blood products involving priority countries Number of countries involved in WHO collaborative studies and/or using WHO international biological reference materials

•

At least 2 regional networks will have been established and strengthened 10-12 countries per collaborative study

3. Technical capacity strengthened and quality and safety of, and access to, appropriate diagnostic support and laboratory services improved.

• Extent of savings made in priority countries compared to general market prices through availability of cheap but safe equipment Percentage of laboratories in priority countries with improved performances in external quality assessment schemes and other assessment tools

•

48%

4. Capacity for training support to diagnostic-imaging services improved in each WHO region.

• Number of centres in each region offering training in the recommended use of radiology, including teleradiology Number of targeted countries using the WHO manuals in training programmes

3 centres in 2 regions

At least 1 centre in each region

•

3 countries

Minimum 2 countries in each region

5. Capacity in countries for assessing national regulatory authority enhanced in the area of medical devices and development of follow-up plans. 6. Appropriate support provided for use of training materials and tools to improve the technical skills of health personnel in the safe use of essential emergency procedures and equipment at first-level referral health facilities.

• Number of targeted countries using • the Essential Health Technology Package Number of targeted countries with completed assessments and follow-up plans

6 countries

At least 1 country in each region At least 1 country in each region

Nil

• Number of targeted countries using training material on surgery and anaesthesia for training health providers at district hospitals

Training material on surgery and anaesthesia (in preparation)

At least 2 countries in each WHO region

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 7. Effective guidance for formulation of national policy and legislation provided in order to assure the ethics, safety and quality of cell-tissue and organ-transplantation practices. 8. Standardized procedures for development of WHO model lists of essential medical devices validated and disseminated.

INDICATORS • Number of targeted countries using • WHO core standards as a basis for national transplantation standards Number of targeted countries with access to basic transplantation

BASELINES

TARGETS 10% of targeted countries in each region

Nil

10% of targeted countries in each region

• Number of interested parties that have adopted WHO model list of essential medical devices

Nil

• Number of WHO thematic lists of devices updated and refined

Nil

Standard procedures adopted by at least 4 technical WHO list producers At least 4 thematic lists refined, available and in use At least 1 country in each region At least 33 countries

9. Appropriate strategies promoted and support provided for an effective system for prevention of health careassociated HIV infection.

• Number of targeted countries using • model list of essential infectioncontrol equipment and supplies Number of targeted countries with an effective system for prevention of health care-associated HIV infection

Nil

21 countries

10. Establishment of appropriate components of electronic information for use in health-care systems promoted and effectively supported.

• Number of countries adopting • national policies on use of electronic information in support of health care Number of countries using guidelines for applications of electronic information for health-care delivery

At least 10 countries

At least 10 countries applying electronic information for healthcare delivery

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

31 328

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Essential health technologies is also supported by

results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

POLICY-MAKING FOR HEALTH IN DEVELOPMENT ISSUES AND CHALLENGES

The way in which WHO seeks to influence a wide range of national and international policies, laws, agreements and practices has an impact on the functioning and effectiveness of health systems and the achievement of health outcomes. It reflects WHO’s concern for human dignity, security, ethics, equity and social justice, and the need to maximize health opportunities by tackling social and economic barriers to health and health care. Work in this area will contribute to progress towards better health, poverty reduction, greater health equity and achievement of the relevant Millennium Development Goals and other internationally agreed development goals. The Millennium Development Goals provide an important opportunity to promote the incorporation of health priorities in national and international development processes (including those concerned with poverty reduction). The challenge for WHO is to translate this opportunity into policies and strategies that will increase health investments, focus on the poor and reduce health inequities, and to build institutional capability – both in national governments and in WHO’s country offices – for their implementation. A further challenge will be to identify macro-level or national policy implications for the health sector from community-based work under way in many regions.

GOAL

To maximize the positive impact of processes related to socioeconomic development, poverty reduction and globalization on health outcomes; to raise awareness and advocate the role of better health, particularly of the poor, in achieving overall development objectives; and to bring ethical, legal, and human rights norms into the formulation of national and international health-related programmes, policies and laws. To maintain and further secure the centrality both of health to a wide range of development processes at national, regional and international levels, and of ethical, economic, and human-rights analysis to the achievement of just and coherent policies and laws at national, regional and international levels. Indicators

WHO OBJECTIVES

• Recognition of the role of health in national development in political and development forums,

and its translation into policies, plans and budgets at country level • Recognition of ethics, law, trade and human rights in WHO consultations and in political forums, and their translation into policies, plans and action at country level

STRATEGIC APPROACHES

Provision of guidance, advocacy and technical support to countries on such issues as the relationship between health and human rights, poverty, aid instruments, macroeconomics, equity, ethics, globalization, trade and law; ensuring reflection of recommendations of national and international bodies in these areas in national development policies, plans and budgets and linkage between communitybased initiatives in which WHO is involved into national policy; ensuring the capability of WHO – particularly through country offices – to provide support in these areas, through the development of policy, guidance and direct support; convening of bodies of experts and/or policy-makers at national and international levels to build consensus around different aspects of health and development, and to advance understanding and knowledge of the issues covered; commissioning and conduct of research and analysis that will inform decision-makers in ways that are congruent with WHO’s overarching objective; assuring focus of WHO’s contribution and leadership on achievement of the health-related Millennium Development Goals and other internationally agreed development goals.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Strengthened country capacity to ensure that national development plans and budgets, Poverty Reduction Strategy Papers, public sector reforms and sector programmes (including sector-wide approaches) and intersectoral mechanisms support increased investments in health and improved health outcomes, including achievement of the health-related Millennium Development Goals, and focus on the impact of any proposed measures on poor, vulnerable and marginalized people. 2. WHO fully engaged in global dialogues and dissemination of best practices and processes on development, particularly in relation to the Millennium Development Goals and other partnershipbased mechanisms with the aim of integrating health in the mainstream of development activities, increasing resources, and improving the effectiveness and equity of aid-delivery mechanisms in the health sector. 3. Endorsement by WHO’s governing bodies of the recommendations of WHO’s commission on equity and social determinants of health and adoption by countries.

INDICATORS • Proportion of low-income countries in which WHO has played an acknowledged role in enabling national authorities to develop Poverty Reduction Strategy Papers, national poverty reduction plans, sector programmes that include a coherent and costed approach to health of the poor Proportion of low-income countries in which WHO has made an acknowledged contribution to assessing equity in the preparation of national health plans

BASELINES Less than 10% of eligible countries

TARGETS 50% of eligible countries

•

• Increase in the aid-effectiveness score (devised by OECD’s Development Assistance Committee) in poor countries Increase in resources available to the health sector in low-income countries

•

• Number of country programmes and activities that include in their operations recommendations of WHO’s commission on equity and social determinants of health Number of WHO programmes that adapt their day-to-day operations on the basis of insights provided by WHO’s commission on equity and social determinants of health WHO’s strategy on health and human rights formulated Approval of the strategy on health and human rights by WHO’s governing bodies

•

4. Implementation of WHO’s strategy on health and human rights initiated in order to advance globally the concept of health as a human right; capability strengthened at regional level to provide support to Member States for integrating a human-rights approach into health-related policies, laws, and programmes.

• Extent of progress in implementing WHO’s strategy on health and human rights

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS

INDICATORS • Number of national partnerships forged, tools made accessible, and projects under way to integrate a human-rights approach into health development

BASELINES 4 global tools available to regions and countries

TARGETS Staff tools and training available in 3 regional offices to support countries in implementing WHO’s strategy on health and human rights Implementation of the strategy under way in 3 countries in each region 4 countries in each region with active interministerial mechanisms for trade and health Half-time trade and health adviser in 4 regional offices

5. Increased capacity at country, regional and global levels and within the Organization to measure, assess and act on cross-border risks to public health in the context of globalization, focusing on implications for population health of multi- and bi-lateral trade agreements. 6. Support provided at the three levels of the Organization for analysing the ethical aspects of health and research; support provided to countries through tools, standards, and guidelines for incorporating an ethical analysis into health services delivery, research and public-health activities. 7. Strengthened capacity of Member States to formulate and implement legislation and regulations to protect and promote public health, through technical cooperation and information exchange at country, regional and global levels.

• Extent of capacity to assess and act on health implications of trade and globalization

Number of countries with ministerial mechanisms for trade and health Staff time in regions dedicated to issues related to trade and health

• Number of global and regional programmes and activities that include ethics in plans, activities and products Extent to which countries integrate ethics into health programmes and policies

•

A few topics addressed in some countries

More topics addressed in a larger number of countries

• Number of global and regional • programmes and activities that include a health-law component Extent to which countries formulate health law to meet contemporary public health priorities

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

37 651

Includes Miscellaneous Income.

Policy-making for health in development is also

supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HEALTH SYSTEM POLICIES AND SERVICE DELIVERY ISSUES AND CHALLENGES

It has become increasingly evident that in many countries a vast array of effective interventions are not being provided and delivered, as a result of problems related to both access and quality of care. The impetus given by the Millennium Development Goals and growing interest in the health sector in general has led to a remarkable increase in disease-specific programmes implemented by both international organizations and national bodies. This trend is creating new and complex challenges to health systems. Although these programmes are leading to considerable innovation and experimentation in strategies to increase coverage for specific diseases, governmental institutions responsible for the overall organization of the health sector are not being reinforced. Consequently, it has become necessary to understand and align better health-system planning with disease-specific initiatives in countries, and urgent for governmental institutions to exercise their steering function and ensure overall coherence of their health systems based on principles of primary health care. This reinforcement is needed at several levels. At policy level there should be sufficient governance and regulatory capacity for governments effectively to exercise their steering role in the growing heterogeneity of most health systems. They need to play their part as “stewards” and maintain an overview of the entire health system; to plan and regulate coherently public and private delivery of health services; to ensure that public health functions are strengthened as well as health services; and to detect and counterbalance developments that will impact negatively on more vulnerable groups. At managerial levels such as subnational, district and institutional levels a massive reinforcement of capacity is needed in order to handle the increasing complexity of health-care delivery and boost efforts to promote health, prevent disease and improve quality of care. In this context Member States are increasingly requesting WHO to cooperate directly in their strategic policy-making, to establish a sound basis for those policy discussions by providing advice and guidance on the wide range of issues related to health-system organization, management, and financing, human resources, and information systems for health services. Such guidance needs to be adaptable to heterogeneous situations and both public and private health systems. In some countries the main issue will still be one of coverage and basic delivery, whereas in others there may even be excess capacity and inappropriate use of services. The challenge is therefore one of restructuring delivery in order to improve quality and efficiency.

GOAL

To improve the availability, quality, equity and efficiency of health services by strengthening their links with the broader public health functions and by strengthening the governance, organization and management of health systems. To strengthen health-system leadership and capability for effective policy-making in countries, and to enhance the planning and provision of health services that are of good technical quality, responsive to users, contribute to improved equity through greater coverage, and make better use of available resources. Indicators

WHO OBJECTIVES

•

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Strengthening of WHO’s support to countries for framing health-sector policy and implementing change, through more systematic collaboration in national strategic planning, health-system reform and interinstitutional coordination, in collaboration with other development organizations, and for reinforcing efforts to improve health service delivery, through analysis of constraints, and informed advice on innovative strategies for expanding or restructuring health services by improving the organization and management of different providers; guidance on different models of care which take into account the need for integrated health services across health institutions, and which ensure a continuum of care for patients; projects that strengthen consumer and patient involvement as active players in health-system development and service delivery, particularly on quality of care and patient safety; effective integration at country and international levels of health-systems work with diseasespecific programmes in order to ensure better alignment between support to health system development and the more focused efforts to improve delivery of specific health interventions.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Guidance prepared and technical support provided to improve country capacity in national and local health-sector policy-making, regulation, strategic planning, implementation of reforms, and interinstitutional coordination. 2. Organized approach developed for WHO’s collaboration in health-sector reviews in countries, including an Internet-based mechanism for continuous provision of health-systems policy support; number of new, evidenced, knowledge-based policy briefs increased; strategies formulated for capacity building in health policy. 3. Guidance and technical support provided on improved alignment of population-based public health policies and health service policies.

INDICATORS • Proportion of low-income countries in which WHO has played a key role through collaborating directly in redesigning health-sector policy

BASELINES Estimated number of countries having received direct policy support in 2004-2005

TARGETS Double number of countries having received support for health-system policymaking

• Number of countries using Internet briefs effectively for policy dialogue

Internet-based mechanism with Organization-wide policy briefs

• Number of WHO country office staff trained in strengthening of health systems

Internet-based mechanism for policy dialogue in use in 20 countries Double the number of WHO country office staff trained in strengthening of health systems

• Extent of review of best practice for preparation of advice and guidance on integrating public health in health services, and on engaging publichealth institutions

Existing guidance on integrating public health in health services

Engagement of 20 international publichealth associations; new approaches to training in public health in use in 10 leading publichealth schools

4. Evidenced, knowledgebased guidance and technical support provided to countries for strengthening delivery of health services centred on quality, equity and efficiency.

• Number of WHO regions in which the renewed framework for health systems based on the principles of primary health care has been adapted, and support to countries initiated Number of pilot experiences on integrated care in less developed countries

Existing advice on application of the renewed framework for health systems

•

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 5. Guidance and direct technical support provided to countries on effective integration of health services with disease-specific programmes.

INDICATORS • Adequacy of guidelines, norms and tools for improved articulation between disease-specific programmes and health services

BASELINES Existing strategies for articulation between disease-specific programmes and health services

TARGETS Acceptance by WHO’s governing bodies of a framework for the effective integration of health services and disease-specific programmes; use of that framework in at least 10 countries

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

124 597

Includes Miscellaneous Income.

Health system policies and service delivery is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HUMAN RESOURCES FOR HEALTH ISSUES AND CHALLENGES

There is an increasing recognition that to scale up major health interventions, provide good-quality services, and achieve the health-related Millennium Development Goals requires a health workforce that is sufficient in numbers, appropriate as to profiles, well educated and trained, and adequately deployed, managed and motivated. Furthermore, financial resources cannot be translated into more and better health services unless recipient countries can count on a functional workforce. Without a better understanding of the human-resources component of health systems, health-sector reform cannot be effective or sustainable. This component needs to be an integral part of health and development strategies such as poverty reduction and macroeconomic reforms. The most crucial issue facing health systems is failure of domestic labour markets, resulting in a range of problems from absolute shortage, to underemployment, to oversupply. Migration of health personnel has considerable consequences for countries with small populations or health-system constraints. To tackle such problems, countries require strategies that focus on better alignment of education to practice, increase the motivation and productivity of health workers, identify underlying reasons for retention of personnel, and improve recruitment practices. Implementation of these strategies needs action at different levels and with different timeframes. At national level, weak information systems on human resources need to be strengthened and mechanisms put in place to facilitate dialogue and cooperation between different ministries and the public and private sectors. They way in which development partners undertake activities related to human resources for health in a country should be more closely aligned to its needs. At international level, there is a need to take account of, and begin to act on, macroeconomic policies that have an impact on national health workforces, especially because the market for skilled health workers is global. This requires the development of strategies that actively engage IMF, the World Bank and WTO in seeking solutions outside current thinking. To meet the challenges faced by countries and achieve necessary changes, significant investments are needed. These include investments to strengthen institutions that educate and train the health workforce; to build capability of ministries of health to manage their health-workforce issues; to improve the ability of regulatory systems to ensure quality of providers; to address issues of equity, gender, skill mix and distribution; to construct networks that will share best practices and support implementation; and to promote research in human resources for health so as to improve the knowledge base. Tackling crucial issues of delivery such as HIV/AIDS treatment, responding to epidemiological and demographic changes, and assuring services in countries affected by conflict will require close attention to a broad range of health workers, from the specialist to the person providing support in the home. Training and education of health workers should be aligned with such delivery systems as primary health care and compatible with the strengthening of public health systems in the context of new actors and institutional arrangements. Further, countries need to find mechanisms to work with the growing number of stakeholders in the private not-for-profit and for-profit sectors.

GOAL

To improve the performance of health systems through strengthening development and management of the health workforce in order to achieve greater equity, coverage, access and quality of care. To contribute to managing effectively and creatively the interaction between the supply and demand for health workers. Indicators

WHO OBJECTIVES

• Successful retention of an expanded health workforce in countries, reprofiled to meet health needs • Strengthened national capacity for policy framing and management of the health workforce STRATEGIC APPROACHES

Development of guidance and best practices to support policy formulation and implementation by linking policy frameworks for human resources with other aspects of health-services delivery and healthsystems development, starting with those areas in which WHO is providing support; design of activities through country dialogue; implementation led by countries, focused on solutions, and built upon existing information and policy-making processes.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Guidance and support provided for effective analysis, planning and management of the health workforce in countries.

INDICATORS • Number of countries using WHO • human-resources planning and management guidelines Number of countries using evidencebased tools to improve recruitment and retention of health workers

BASELINES According to surveys to be carried out in 2005 According to surveys to be carried out in 2005

TARGETS At least 20 more countries At least 20 more countries

2. Strengthened leadership, policy-making, public health, management and research capacities.

• Number of countries in which WHO • actively demonstrates institutional capacity for supporting leadership Number of networks established to support research and leadership in public-health education in human resources Functioning health leadership programme

According to surveys to be carried out in 2005 4 at the start of the biennium

At least 15 countries

1 more established in each region

•

At least 35 officers enrolled

At least 30 more officers enrolled

3. Strategies to reduce the outflow of health workers promoted. 4. Practical guidance and tools to ensure quality of education and training and its relevance to needs available to countries and used in targeted countries.

• Number of countries with policies and strategies designed to reduce the outflow of health workers

According to surveys to be carried out in 2005

At least 25 countries

• Number of countries in which WHO supports assessment of education of health professionals, including evaluation of training programmes and review of curricula Number of targeted countries in which tools, guidelines and methods for improving quality and standards of training and education of health professionals are used

According to surveys to be carried out in 2005

20 more countries

•

According to surveys to be carried out in 2005

50 countries

5. Strengthened institutions and processes that will increase capacity for research on human resources for health in countries. 6. Effective guidelines on accreditation, licensing and certification to support mechanisms and frameworks that ensure good-quality preparation and practice of health professionals made available to countries and in targeted countries. 7. Regional alliances and networks set up involving development partners, professional organizations and other institutions to address macroeconomic processes that have an impact on the health workforce.

• Number of institutions in developing countries with an active research programme on human resources for health

According to surveys to be carried out in 2005

At least 30 active programmes

• Number of targeted countries with functioning regulatory mechanisms

According to surveys to be carried out in 2005

20 countries

• Number of alliances and networks established

1 global, 0 regional

At least 2 regional alliances

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

76 838

Includes Miscellaneous Income.

Human resources for health is supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HEALTH FINANCING AND SOCIAL PROTECTION ISSUES AND CHALLENGES

The way the health system is financed and organized is a key determinant of population health and wellbeing. Health financing has become a central issue to many governments as they seek to improve their health systems, with policy debates covering the questions of how funds should be raised, how they should be pooled to spread risks, and how they should be used to provide the services and programmes needed by their populations. In some regions, the level of spending is still insufficient to ensure equitable access to basic and essential health services and interventions, so the major concern is to ensure adequate and equitable resource mobilization for health. In some countries within these regions, external sources have recently provided substantial increases in resources for selected health interventions, leading to increased attention focused on how to sustain such increased expenditure over time. In other settings, health costs have been rising rapidly and a dominant concern is to reduce the rate of growth of health expenditure while maintaining the quality of the health system. Fragmentation of pooling arrangements and passive purchasing methods that generate inappropriate incentives for providers are characteristic of many countries. As fragmentation is also a constraint on the potential to cross-subsidize from the rich to the poor and from the healthy to the sick, many financing systems do not provide adequate levels of social protection. All countries are concerned with ensuring that the resources available to health are used efficiently and that they are distributed equitably, yet disparities in access to services between rural and urban areas and between the sexes remain in many settings. In all but a handful of countries, health financing heavily relies on out-of-pocket payments, placing large, sometimes catastrophic, financial burdens on households who can be pushed into poverty, or further into poverty, as a result. Moreover, the need to make such payments prevents people, especially those who are poor, from obtaining necessary care. Incomplete data and information on the level and distribution of health expenditures hinder policy analysis, as does a lack of information on the effectiveness, and the costs and implications for equity, of different ways of using scarce resources. Many countries do not have sufficient skills in budgeting, financial planning and management, which impedes their potential to maximize health gains from available resources. International experience on the impact of different health-financing reforms has not yet been adequately reviewed and the information made readily available to policy-makers in a form they can use. The challenge is to work with countries and the variety of other partners working in the area of health-system financing to develop ways of obtaining key information, to use it as an input to the debate on policy and its implementation to improve health systems, and to build capacity to obtain and apply this information.

GOAL

To develop systems of health financing that are equitable, efficient, protect against financial risk, promote social protection and can be sustained over time. To formulate health-financing strategies based on principles of equity, efficiency and social protection, and on the best available information and knowledge; to develop capacity to obtain key information and to use it to improve health financing and organizational arrangements as part of national policy. Indicators

WHO OBJECTIVES

• STRATEGIC APPROACHES Provision of policy support to countries in accordance with country needs; development of tools, information and knowledge to support policy dialogue and implementation; building of institutional, organizational and human capacity in collaboration with countries; provision of opportunities to share national and international experiences, evidence and best practices in implementing various financing and social protection options; development of partnerships with international and national institutions, and governmental and nongovernmental organizations.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Consistent policy options, guidelines and recommendations on health financing and social protection developed and used in countries.

INDICATORS • Availability of policy options and guidelines on key dimensions of financing and social protection policy, priority-setting, and ways of reducing the risks associated with out-of-pocket payments

BASELINES 14 policy-issue papers on financing and socialprotection policy, contracting, prioritysetting and use of costeffectiveness analysis, cost of expanding interventions

TARGETS Additional 8 policyissue papers on financing and socialprotection policy, contracting, prioritysetting, use of costeffectiveness analysis, financial cost of expanding interventions, nonhealth benefits of interventions Use of policy options, guidelines and recommendations in 17 countries, including by established commissions on macroeconomics and in sector-wide approaches in selected countries 14 policy briefs available. Comparative case studies on prioritysetting and insurancereimbursement decisions Use in 17 countries, including in policy debate on financial-risk pooling and social protection Improved tools on resource tracking, impact of financing arrangements and outof-pocket payments, contracting, country contextualization for priority-setting, cost of expanding interventions; new tool for estimating nonhealth benefits of interventions

• Extent of the use of these policy options, guidelines and recommendations in countries to improve the social protection, efficiency and/or equity of their financing systems

Use of policy papers in 10 countries, including by established commissions on macroeconomics and health and in sectorwide approaches in selected countries

2. Information on best practices with respect to financing and social-protection policy, priority-setting and generation of key information provided to countries, and its use supported.

• Availability of policy briefs on key questions in health financing, social protection and priority-setting in a form that is readily accessible to policy-makers

• Extent of use of policy briefs in national policy debate and to guide policy implementation

8 policy briefs available; no existing comparative case studies on prioritysetting and insurance reimbursement Use in 10 countries, including in policy debate on financial-risk pooling

3. Key tools, information and knowledge to guide policy framing and implementation validated and their use supported.

• Availability of practical guides on national health accounts and resource tracking; availability of tools to describe and analyse arrangements for collection, pooling and purchasing, and associated issues of system structure, to help in setting priorities for available and new resources and to expand key interventions, to determine the extent and nature of financial risks and catastrophic expenditures, and to assess options to reduce financial risks and expand social protection

First version of tools on financial implications of financing arrangements, contracting, country contextualization for priority-setting, cost of expanding interventions; no existing tool for estimating nonhealth benefits of interventions

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS

INDICATORS • Extent of use of tools, guides and knowledge in countries

BASELINES Use of tools for resource tracking, calculating financial risks to households, financing and contracting in 20 countries; country contextualization for priority-setting undertaken in 4 countries; integrated costing tool used in 4 countries; database available on effectiveness and costs of 300 interventions; no existing estimates of nonhealth benefits; annual reporting of summary ratios of health expenditures

TARGETS Use of tools for resource tracking, calculating financial risks to households, financing and contracting in 30 countries; country contextualization for priority-setting undertaken in 12 countries; integrated costing tool used in 12 countries; database available on the effectiveness and costs of 400 interventions; estimates of nonhealth benefits available for 6 countries; annual reporting of summary ratios of health expenditures New training courses on national health accounts, prioritysetting, costing, risk protection and catastrophic expenditures in 2 regions per year; training courses on implications of health financing and contracting in 8 countries At least one working network on costing, cost-effectiveness, and financing policy, with participation of all regions

4. Strengthened country capacity to obtain information and use it to formulate plans and policies and guide interventions for improving systems of health financing and social protection.

• Number of countries or regions benefiting from training programmes, conducted in collaboration with partners, on the use of the tools and guidelines; analysis of the results, followed by policy dialogue

Training courses on national health accounts, prioritysetting, costing, and catastrophic expenditures in 2 regions per year; training courses on implications of health financing and contracting in 5 countries 2 working networks on national health accounts

• Existence of working networks of technical experts established for priority-setting, costing and costeffectiveness

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

40 109

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Health financing and social protection is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

HEALTH INFORMATION, EVIDENCE AND RESEARCH POLICY ISSUES AND CHALLENGES

Sound health information is the essential foundation of public health programmes, aiming to promote greater equity in health between and within populations. In many countries, and most particularly those with the highest burden of disease, however, basic systems are not in place for counting births and deaths, identifying cause of death, monitoring health status, or tracking use and effectiveness of programmes. Programme planners and managers do not have the information they need to use resources effectively, and at the same time are beset with demands from external agencies to provide data for monitoring the use of their funds. There is an urgent need to reform and strengthen the building of health information systems, including surveys, vital registration, surveillance and service statistics, as a joint effort between health and statistical constituents that can meet the needs of both planners and managers and donors at country and global levels. WHO will play a key coordinating, operational and technical role in this process, including in reporting on progress in achieving the health-related Millennium Development Goals. WHO has the constitutional mandate to establish and revise as necessary international classifications for diseases, causes of death and other public health parameters. The International statistical classification of diseases and related health problems and the International classification of functioning, disability and health are the two principal reference classifications. The main challenges are to enhance the access to, and use of, the classifications, especially in developing countries, and to work on revisions in close collaboration with WHO collaborating centres. Health information and evidence should play a major role in directing resource flows and health programmes at country, regional and global levels. WHO plays a unique role in generating and consolidating knowledge and evidence on public health issues, including the publication of comparative and analytical reports and the promotion of multicountry studies on key public health topics. Failure to put existing and new knowledge rapidly into practice, in the broader context of building health systems, is a key challenge for the health-research community. The response calls for tackling the inequity that exists in access to health information and knowledge, and assuring that knowledge derived from research is accessible, disseminated and shared between the producers and users of research. Such action requires a strong national health-research system based on a favourable enabling environment for research and for collaboration with regional and global research systems. Through its close interaction, mutual learning and integration within the health system, health research that is a tool enables countries to analyse, understand and operate the health system in an efficient manner. An effective and accountable health system must, among other features, be able to link research to health policy, put evidence into the practice of health-care delivery, and obtain people’s support for, and participation in, the research endeavour. Research aimed at improving the health system is the means through which knowledge is translated and applied to building better health systems but is a relatively neglected area compared to the huge investments made in the biomedical and clinical sciences. This imbalance needs to be corrected in order to make effective use of scientific knowledge to inform policy for improving health and health equity. WHO will play a leadership role in this regard in close collaboration with other organizations involved in health research, such as the Council for Health Research for Development and the Global Forum for Health Research. WHO will also play its part in institutional strengthening in countries through, for example, its network of collaborating centres, and in promoting a broader, multisectoral and crosscutting view of health research which includes the social sciences, such as economics, demography, and behavioural sciences.

GOAL

To maximize the potential of health systems to improve health and to respond to health needs in a way that is equitable, effective and efficient on the basis of sound health information and scientific knowledge.

PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

To improve the availability, quality and use of health information at country level; to strengthen the evidence base at regional and global levels in order to monitor and reduce inequalities in health; to develop health-research systems, to build research capacity, and to use research findings to strengthen national health systems. Indicators

• • • • STRATEGIC APPROACHES

Production and use of accurate and timely health information in countries Ability of countries to report on the key health-related Millennium Development Goals Level of resources mobilized compared to the funding gap Equity of access to knowledge and health information

Support for reform and strengthening of country health-information systems, including focus on the subnational level, use of data, and development and implementation of locally relevant tools; development and enhancement of the evidence base for health systems, by consolidation and publication of existing evidence and facilitation of knowledge generation in priority areas; global advocacy and promotion of health research to build better health systems; dialogue and coordination with interested partners at national, regional and global levels, in order to develop relevant activities and initiatives; fostering of cooperation between countries and regions to promote research and knowledge sharing; policy, technical and analytical activities in countries to strengthen health research and its interface with health systems at national and subnational levels; setting of standards of ethical conduct in health research; greater lay-public involvement in knowledge access and sharing for the right to better health.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Strengthened and reformed country health-information systems that provide and use quality and timely information for local health problems and programmes and for monitoring of major international goals.

INDICATORS • Number of countries with adequate health-information systems in line with international standards

BASELINES Number of countries currently meeting the standard

TARGETS 25 additional countries making significant progress towards achieving the standard for a sound healthinformation system At least 10 additional countries using specific materials and tools

• Number of countries adapting or using specific materials and tools, such as the International statistical classification of diseases and related health problems and the International classification of functioning, disability and health, and reviews of health status and health-systems metrics

Number of countries currently using specific materials and tools

2. Better knowledge and evidence for health decisionmaking, by consolidation and publication of existing evidence and facilitation of knowledge generation in priority areas.

• Existence of a WHO database of core health indicators with metadata, focusing on healthrelated Millennium Development Goals Number of areas in which WHO’s work has generated new evidence to redirect health programmes or reinforce existing priorities

Partly harmonized databases in regional offices and headquarters Number of key areas in which WHO needs to generate new evidence through generation or consolidation of evidence

•

Harmonized and consistent high-quality databases with metadata available and well used All priority areas addressed through, for example, analytical reports, or comparative analyses

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 3. Strengthened national health research for healthsystems development, within the context of regional and international research and engagement of civil society; WHO programmes and initiatives in research for health-systems development and for access to, and use of, knowledge effectively developed and implemented on the basis of strategic priorities.

INDICATORS • Number of targeted countries and collaborators using or adapting WHO guidelines and tools for analysis and strengthening capacity of national health-research systems

BASELINES 10 to 15 developing countries having updated their strategies for strengthening national health-research systems using WHO guidelines and tools Draft framework of priorities Draft plan for programme No coordinated initiative in place

TARGETS 10 to 25 targeted developing countries updating healthresearch strategies and applying WHO tools

• Availability of a core set of health• • system research priorities for WHO Effectiveness of WHO global programme in research for healthsystems development Existence of initiative to build capacity in research consolidation in countries

Final list of priorities Programme launched and implemented in all regions Initiative implemented in selected countries

4. WHO-led networks and partnerships established that improve international cooperation for health research, including an effective ACHR at global and regional levels, WHO collaborating centres and expert advisory panels.

• Functionality of mechanisms such as the Partners’ Forum to promote strong partnerships and synergy between key organizations at global level Coverage of the network of national task forces on health research and health systems, that work in close cooperation with WHO global, regional and country counterparts

Minimal coordination, independent activities

•

10 to 15 national task forces on healthresearch systems established in targeted countries Several networks in high-priority areas Draft of new policy agreed by all regions Standard ethics review procedures established at headquarters

• Extent of networking between WHO • 5. Guidelines and standards determined that ensure ethical conduct of health research and best practices disseminated within WHO. collaborating centres in high priority areas Effectiveness and impact of WHO’s policy for collaborating centres

Effective mechanisms for partnerships and coordination of activities between key organizations 10 to 20 additional national task forces on health research and health systems developed in targeted countries Larger number of networks in highpriority areas New policy fully implemented Ethics review procedures harmonized at headquarters and in the regions

• Level of harmonization of ethics review procedures at headquarters and regional offices

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

55 744

Includes Miscellaneous Income.

PROPOSED PROGRAMME BUDGET 2006-2007

Health information, evidence and research policy is also supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

EMERGENCY PREPAREDNESS AND RESPONSE ISSUES AND CHALLENGES

Crisis conditions now affect communities in more than 40 countries, and as many as 2000 million people are at risk because food, water, sanitation, security and health systems have collapsed or are overwhelmed. There is a marked increase in natural disasters, with an estimated 608 million people affected. Weather-related disasters are on the rise. In 2003 there were 10 million refugees, and 25 million internally displaced persons worldwide. The quest to realize the Millennium Development Goals can only be fulfilled if attention is paid to the health aspects of crises. Vulnerable groups bear the highest rates of distress, as their coping mechanisms are already weakened. But the main causes of suffering and death are sicknesses – principally common conditions made more dangerous by crisis conditions – and the breakdown in public health. The Health Assembly had requested WHO to undertake a number of steps to strengthen emergency preparedness, disaster reduction, emergency response and humanitarian action,1 and recently requested it to provide support for strengthening health systems with regard to emergency preparedness and response plans.2 WHO therefore plays a key role in ensuring adequacy of preparedness programmes, reliable assessment and analysis of needs, and an effective, coordinated response to health aspects of crises. Within the United Nations system, WHO – focusing on the health and well-being of all people – assumes this role in advocacy, resource mobilization and direct, life-saving, action. This work is undertaken in conjunction with national authorities, nongovernmental organizations, organizations of the United Nations system and development banks. WHO makes a critical contribution to the repair and recovery of local health systems, linking them with support from outside and concentrating on reducing vulnerability and promoting equity. It also helps identify vulnerable elements of health systems and ensure that they are promptly strengthened. Predicting resource requirements and availability is based on past trends. Taking into account the amount WHO will appeal for under United Nations consolidated and ad hoc appeals during the biennium and funding in support of implementation of a performance-enhancement programme, it is estimated that extrabudgetary resources totalling US$ 175 million can be mobilized. The budget estimates of US$ 106.8 million below reflect only expenditure that with some degree of certainty can be predicted globally. It is not possible to predict in which regions the remaining balance of some US$ 68.2 million will be expended.

GOAL

To reduce avoidable loss of life, burden of disease and disability among populations affected by crises, emergencies and disasters, to optimize health at times of post-crisis transition, and to contribute to recovery and development. To develop and implement policies, programmes and partnerships that increase the capacity to prepare, respond and mitigate the risks to health during crises, and support recovery and sustainable development. Indicator

WHO OBJECTIVES

• Adequacy of national disaster-reduction policies, and plans for response and recovery STRATEGIC APPROACHES Establishing and operationalizing a system for improving WHO’s performance, involving strengthened human and material capacity at country level; development of institutional knowledge and competence through performance monitoring and technical guidance; and dedicated rapid-response mechanisms, throughout Member States, at WHO country offices, with support of regional offices, at headquarters, and in WHO collaborating centres.

1 2

Resolution WHA48.2. Resolution WHA55.16.

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Operational presence in countries strengthened in order to collaborate with Member States and stakeholders in preparing and responding to the health aspects of crises and in formulating and implementing recovery, rehabilitation and mitigation policies.

INDICATORS • Number of countries with preparedness, • • response and mitigation programmes in place Number of WHO country offices meeting agreed standard performance level for health action in crises Percentage of crises in which preparedness measures were taken and adequate response was given, in accordance with agreed levels

BASELINES

TARGETS

2. Global synergy and local effectiveness fostered through enhanced mechanisms for internal and external coordination on technical, administrative and logistic issues, performance monitoring, and development of institutional knowledge and competencies, that enable Member States and stakeholders to deliver the required action in the various stages of crises. 3. Resources mobilized and systems established to permit a rapid and dependable response that emphasizes the health priorities of populations at risk of, or affected by, natural disasters, complex emergencies and protracted crises.

• Number of health updates, guidelines and technical publications produced, updated and disseminated on all areas covered by WHO’s standard performance in crises

• Resources made available for proper pursuit of priority health-sector outcomes in most crises

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

105 498

Includes Miscellaneous Income.

Emergency preparedness and response is also

supported by results expected to be achieved in other areas of work, as set out below.

Area of work

Expected result(s)

PROPOSED PROGRAMME BUDGET 2006-2007

WHO’S CORE PRESENCE IN COUNTRIES ISSUES AND CHALLENGES

The purpose of WHO’s country presence is to mobilize the support of the entire Organization for achieving national health and development goals, and to enable a country to have a greater influence on global and regional public-health action. WHO’s presence enables it to draw on the experience of a country in building a body of public-health knowledge that can benefit the rest of the world. Various studies have identified a set of concerns with regard to WHO technical cooperation at country level, including uneven progress in priority areas; poor coordination with the health work of organizations of the United Nations system and other international bodies; need for greater efforts to mobilize extrabudgetary resources; and unclear functions and status of WHO Representatives and Liaison Officers. In addition, WHO has not always been able to provide a focused and coordinated “one-WHO” response to country-specific needs. WHO “country focus” aims at putting country health needs at the centre of WHO’s work through the strengthening of WHO country offices, under the leadership of the WHO Representative or Liaison Officer. This requires a clear, country-specific, strategic agenda setting out both WHO’s input into national-health and development-coordination mechanisms, and a country’s contribution to international platforms and mechanisms. Although WHO’s Country Cooperation Strategy is now well established, more needs to be done to ensure focus and selectivity on the basis of WHO’s core functions, to achieve full support across the Organization, to adapt WHO’s presence to the requirements of the strategic agenda, and to translate that agenda into a single WHO country plan, budget, resource allocation and operations. Placing country health needs at the centre of WHO’s work also requires maintaining and strengthening a country perspective in all aspects of its policy-related, representational, technical and managerial work. A shared understanding of the roles and responsibilities of different components of WHO and improved communication are critical for heightening the impact of WHO’s work at country level. WHO Representatives and Liaison Officers need to be more empowered, accountable and significantly involved in the shaping of WHO’s policies and strategies. Strong technical and operational country teams need to receive more effective backstopping from regional offices and headquarters according to specific country needs. Lastly, the strategic focus towards strengthening WHO’s work at country level has to have an impact on the way the entire Organization functions. This requires an adaptation of the way priorities are set, resources allocated and operations run by country, region and headquarters.

GOAL

To provide support to Member States for reaching their national health and development goals and to contribute to achievement of the health-related Millennium Development Goals by strengthening WHO’s presence in countries. To ensure relevance and effectiveness of the Organization’s work and its accountability to Member States by adjusting WHO’s presence to each country context, based on WHO’s strengths; allocating technical and financial resources accordingly; and ensuring that country inputs guide WHO’s policy, technical and advocacy work. Indicator

WHO OBJECTIVES

• Number of countries in which the Organization has adapted its plan of work and reallocated its resources in order to address priority issues identified in the Country Cooperation Strategy by strengthening its country presence

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Development, review and implementation of WHO Country Cooperation Strategies, ensuring that they are used as the basis and main input for WHO country plans and budgets; execution of WHO’s core functions through adequate country core presence; strengthening of the managerial, technical and administrative capabilities of country teams; harnessing of the whole Organization’s competence to a single country plan and budget, enabling country teams to perform; easing of communication and dialogue between levels and across technical areas of the Organization, and monitoring of the results of WHO’s country focus at country level; promotion of strategic partnerships and coordination of external inputs to support national health development.

ORGANIZATION-WIDE EXPECTED RESULTS 1. WHO Country Cooperation Strategies that are clearly linked to national strategies and plans; set within such mechanisms as the Common Country Assessment and the United Nations Development Assistance Framework, building on, and contributing to, coordination among partner organizations; fully integrated within WHO’s managerial process, thus guiding operational plans and allocation of resources. 2. Adequate WHO country core presence and capability, with particular focus on the competency of WHO Representatives and Liaison Officers in carrying out WHO’s advisory, brokering and catalytic functions at country level, and its direct support to operations. 3. Systematic and permanent involvement of WHO countryoffice staff in formulation of global policy and strategy.

INDICATORS • Number of countries with WHO presence or programmes that have an updated WHO Country Cooperation Strategy and a related single plan and budget, including regular budget and extrabudgetary resources Effectiveness of mechanisms put in place to ensure that Country Cooperation Strategies are used as critical input for preparation of programme budget including all resources and work plans at all levels

BASELINES 25% of countries with WHO presence

TARGETS 75% of countries with WHO presence

•

Effective mechanisms in place between the three levels of WHO

Mechanisms in place are operating effectively

• Level of adequacy of WHO country core presence and technical, managerial and administrative capability, including competency of WHO Representatives and Liaison Officers, and appropriateness of managerial systems, infrastructure and logistics at country level

Situation as per assessments of WHO’s presence being carried out in 2004 and 2005, in countries where a cooperation strategy has been followed through and completed in accordance with established guidelines Contribution of country-office staff to reference groups and other consultations in 2004-2005 Linked monitoring system in place in all regional offices and headquarters (end 2005) Effective country support units in place

Satisfactory execution of recommendations of assessments carried out in 2004, 2005 and 2006 in countries where a cooperation strategy has been completed

• Proportion of WHO Representatives and other WHO country-office staff providing inputs or involved in reference groups and other consultation mechanisms

All country offices invited to contribute to major Organizationwide consultations

4. Regular monitoring of the formulation and implementation of WHO’s country focus policies and strategies, including an understanding of roles and responsibilities across WHO and the redistribution of resources toward regional and country offices, performed with involvement of all regional offices.

• Availability of WHO management information for the country focus policy, including a core set of data on resource allocation across WHO

• Effective network of country support units with participation of the three levels of the Organization

Adequately functioning management information system and dissemination of results across the Organization Sustained, effective, functional country support units

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 5. Country offices accepted in practice by headquarters and regional offices as countrycentred operations and receiving the technical support they require for exercising their core functions.

INDICATORS • Level of satisfaction among WHO Representatives and Liaison Officers with the technical support received from regional offices and headquarters for their country cooperation strategies Number of complaints raised within headquarters regarding unplanned activities or missions from headquarters and regional offices

BASELINES Results of the first qualitative survey on level of satisfaction of WHO Representatives and Liaison Officers (end 2005) Number of complaints received from WHO Representatives and Liaison Officers

TARGETS 25% increase in level of satisfaction among WHO Representatives and Liaison Officers

•

No complaints received from WHO Representatives and Liaison Officers

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

197 829

Includes Miscellaneous Income.

WHO’s core presence in countries enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

PROPOSED PROGRAMME BUDGET 2006-2007

KNOWLEDGE MANAGEMENT AND INFORMATION TECHNOLOGY ISSUES AND CHALLENGES

WHO from its inception has been a knowledge organization, and in recent years has taken strides to reorient itself to make better use of that aggregate knowledge internally and externally to promote better health in Member States. Management of knowledge concerns use of the most effective ways to create, share and apply an organization’s knowledge assets, and the culture, processes and tools needed to do so. It is an Organization-wide approach that will enable WHO to maintain its position as an authoritative source of information and knowledge for diverse audiences on issues related to public health. The approach provides a framework within which knowledge elements of various types and in appropriate media (information, individual and collective experience, expertise, data, publications, effective practices, and lessons learnt) are better captured, organized, shared and applied to practical problemsolving. Information and communication technology provides the platform which interconnects the three levels of the Organization in a network within which learning can thrive and operations run efficiently. Beyond the challenges of setting up and maintaining the required physical infrastructure, there are others related to the changes in organizational culture that will be needed in order for collaboration and knowledge sharing to take place effectively. The Organization also plays a crucial role in promoting and facilitating the application of effective knowledge management and information and communication technology for improving health within Member States. In this regard, it faces challenges in contributing to build up relevant capability in countries, fostering and monitoring progress in ability to use electronic information in support of health care, strengthening exchange of information, and promoting the effective use of information and communication technology in health care. The linking of knowledge management and dissemination with information technology and communication reflects a holistic approach and puts into practice the values of cooperation and applied problem-solving that WHO promotes. The value of the experiential knowledge of individuals is recognized, as well as that of formally generated knowledge, and maximum effect is drawn from both. All parts of the Organization contribute to, and benefit from, its knowledge pool. To that end a comprehensive Organization-wide strategy is being implemented aimed at putting knowledge assets to best use for all. Challenges include ways to address inequities in information systems in countries, to create a uniform knowledge environment with common information-exchange standards, to enable and empower communities of practice to create, share and apply knowledge more efficiently and effectively, and to improve the Organization’s own system for delivery of the information needed for the effective and efficient management and administration of its programmes, including in the country offices. In this regard, a global management system is being set up that meets the Organization’s requirements and can be scaled to the size of each WHO office while providing it with the information needed to perform its role. As the Organization becomes dependent on information and communication technology in the conduct of its work, it will, with its diverse and decentralized environment, become increasingly reliant on an information architecture that overcomes physical and organizational boundaries in order to share and promote knowledge and experience. In this context, issues of security (protection) and assurance (reliability and stability) of networks and related infrastructure are important.

GOAL

To foster, equip and support an environment that encourages the generation, sharing, effective application and dissemination of knowledge in Member States and within the Organization in order to promote health, using appropriate knowledge management and information and communication technology.

PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

To promote an organizational culture supported by an information technology infrastructure that responds to needs of users in Member States and within the Organization related to knowledge management and information technology. Indicators

• Adequacy of needs-based knowledge management programmes in health systems in Member States and throughout the Organization

• Availability of an appropriate and cost-effective information and communication technology infrastructure that meets the needs of users throughout WHO

• Effective implementation of the Organization-wide global management system STRATEGIC APPROACHES

Promotion of Organization-wide participation in a governance mechanism to guide and monitor strategic information and communication technology plans, with phased development and delivery systems; of the use of cost-effective mechanisms for communication technology across the Organization which will permit efficient functioning by administrative and technical departments and respond to the needs of a diverse user base; of formulation of policies and strategies to ensure that information and knowledge captured, generated and shared is validated and of high quality; incorporation of needs assessment in knowledge management and information technology projects throughout WHO; implementation of global platforms for information and communication technology and data, with reliable and adequate access from all offices; identification and promotion of effective practices in knowledge management and information technology; ensuring that WHO’s health information products and services are relevant to the needs of countries, timely and accessible; increase the number and quality of knowledge workers; promotion of, and support to, communities of practice in health systems and throughout WHO; provision of effective support to ensure efficient infrastructure and collaborative environment, including communications systems, applications, user training and computer security; use of an Organization-wide governance to guide the development and implementation of effective and coordinated strategic information technology and knowledge management plans; development of a culture of “experience” along with “expertise”; development of, and support for, information and communication applications for health systems that are integrated with learning networks and systems; development of shared standards and compatible systems for information and document management to help foster knowledge exchange, retention, and creation; establishment of mechanisms to capture experiential knowledge; promotion of innovation in collaborative workspaces in order to further integrate learning systems, work processes and information technology; provision of support for national capacity building and raising public awareness.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Knowledge management policies and strategies developed to enable learning in health systems and in the Organization.

INDICATORS • Availability of effective policies, practices, toolkits and training for knowledge management in Member States and the Organization

BASELINES Policies, toolkits and training for knowledge management available in some offices

TARGETS Access to effective policies, practices and toolkits by target health systems and the entire Organization; most target countries engaged in their development Thriving communities of practice in target health systems and throughout the Organization Better use of knowledge-sharing environments Knowledge sharing across institutional boundaries

• Existence of communities of practice to foster managerial and programmatic effectiveness

Some communities of practice supported within the Organization

2. WHO’s information products and health information and communication technology seamlessly integrated into learning systems.

• Extent of use of custom-organized interfaces for sharing information

• Proportion of staff who contribute to and benefit from the collective knowledge pool

Suboptimal use of interfaces for sharing information Vertical knowledge sharing within the Organization

100

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS

INDICATORS

BASELINES

TARGETS

3. Unified information management and technology architecture at WHO designed and implemented.

• Percentage of key documents used by the Organization for decision-making that are captured, organized and stored electronically Degree of commonality of standards for information and communication infrastructure, across all WHO locations

•

Most current (but not less recent) documents captured and accessible electronically Base standard of compatible technology components available, founded on informal agreements

All key documents captured, organized and stored electronically An agreed set of standards and products to meet business requirements for information compatibility, enable sharing of expertise, and achieve economies of scale Demonstrated competitiveness of communications networks, compared to industry standards and agreed business requirements Strengthened country office infrastructure to meet a common service level Frameworks and tools accessible and available for all priority WHO work in countries Greater adoption and more consistent use of available information products through training, outreach and cross learning Priority information products available in most commonly spoken languages in countries Over 4 million visits and 3 million downloads per month Impact indicates more directed use in Member States through priority institutional initiatives

4. Appropriate technology infrastructure and information strategies in place to meet the business requirements of functionality, reliability and cost-effectiveness.

• Reliability of access to information technology systems and information content

Most WHO locations linked through a single supplier

• Adequacy of information technology systems and information content at country level

Variable levels of information technology infrastructure and service at country level Limited availability of frameworks and tools in countries for applying information Suboptimal adoption and use of available information products

5. WHO’s information products and tools to use electronic information applied effectively and efficiently to address health issues in countries.

• Accessibility of frameworks and tools to make it possible to apply relevant information, including electronic, in support of health care in countries Cost-effectiveness of the use at country level in support of health care of available information products and tools for use of electronic information

•

6. Selected priority information products in relevant languages from headquarters and regional offices appropriately generated, disseminated and archived.

• Availability of information in relevant languages and in collaboration with regional offices

• Number and distribution of visits to, • and downloads from, WHO’s web site Impact of WHO information products, as measured by citations in scientific literature, reviews, or mentions in the media

Most information products available in selected official languages Over 2.5 million visits and 2 million downloads per month Impact consistent with broad coverage by global media and international research literature

101

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 7. Cost-effective provision of existing technologies to the Organization.

INDICATORS • Availability of corporate applications, supporting both health technical functions and administrative support functions, according to established business-service requirements

BASELINES Continuity strategies limited Varying levels of systems availability and support, inconsistent with the business need

TARGETS Compliance with agreed information technology service levels (including service continuity plans) funded and implemented to meet current business requirements in terms of security, accuracy and usability Comprehensive, timely information available electronically Reconciliation eliminated

8. Core programmes sustained with appropriate streamlined business processes and control mechanisms; fully operational global management information system in place that facilitates the Organization’s performance and can be scaled to the size of each WHO office.

• Availability of global information for • managerial and administrative purposes Level of required reconciliation of administrative data

Information available locally in fragmented form Fragmented information systems that require manual reconciliation

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

139 043

Includes Miscellaneous Income.

Knowledge management and information technology enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

102

PROPOSED PROGRAMME BUDGET 2006-2007

PLANNING, RESOURCE COORDINATION AND OVERSIGHT ISSUES AND CHALLENGES

WHO introduced results-based management for Programme budget 2000-2001. Since then, its application has been refined and extended across all levels of the Organization with each subsequent programme-budget cycle. These positive steps have led to a stronger emphasis on results, better targeting of resources, and greater accountability in support of the Organization’s country focus. Nevertheless, various issues remain to be resolved if results-based management practices are to be applied consistently across all institutional levels and areas of work. Difficulties experienced include ensuring consistency between strategic and operational planning, making adequate use of lessons learnt from performance assessments and properly reconciling the unique needs of countries and country workplans with the achievement of Organization-wide objectives and expected results. The timeframes for various managerial processes have been reviewed in the light of the need for mechanisms for closer consultation and coordination between headquarters, and regional and country offices. The degree of acceptance and compliance with Organization-wide rules has varied considerably within headquarters, across regions, and in countries, hindering the integrated planning, monitoring and reporting necessary for more effective programme management. Offices have not internalized the culture of planning, performance monitoring, and reporting that is essential for implementing results-based management. For the biennium 2006-2007, the main challenge will be to revise WHO’s managerial framework in the light of recommendations arising from a review undertaken in 2004-2005 of its scope, periodicity and interlinkage of components, namely, strategic and operational planning reflecting country focus, an integrated programme budget covering all sources of funds, performance monitoring, quality assurance, evaluation and reporting. The revised framework will then be integrated into the day-to-day operations of programmes at all levels. There is also a need to improve intra-Organizational cooperation and to use shared processes and a management information system compatible throughout the Organization. An effective system for planning, mobilization, coordination and administration of voluntary resources will be extended to all levels of the Organization in order to realize a single programme budget that integrates all sources of funds and to meet the Director-General’s commitment to moving resources from headquarters to regions or countries, with a target of 75% of resources to regions and countries and 25% to headquarters. Organizational culture must continue to evolve so that programme managers and decision-makers at all levels effectively use the information generated by the managerial system to improve their performance. In order to facilitate this process, changes need to be made to harmonize administrative practices and procedures within a context of decentralization; and an integrated learning and support framework for results-based management needs to be introduced.

GOAL

To apply consistently across the Organization the principles of results-based management and related processes, namely, strategic and operational planning, resource planning and coordination, performance monitoring, quality assurance and evaluation, in support of WHO’s leadership role in international health and its programme development and operations. To implement fully functional Organization-wide systems and mechanisms for results-based management that provide effective support for WHO’s accountability policy and country focus. Indicators

WHO OBJECTIVES

• Proportion of expected results that are fully achieved at each organizational level • Number of ad hoc programme evaluations requested by stakeholders, as an expression of confidence in the Organization’s quality assurance and evaluation framework

103

PROPOSED PROGRAMME BUDGET 2006-2007

STRATEGIC APPROACHES

Development of understanding of results-based management principles and compliance with WHO’s managerial framework; strengthening of institutional and staff capacity for long-term strategic planning, biennial programming and budgeting, operational planning, performance monitoring, quality assurance, evaluation and reporting; strengthening of the Organization’s programme management information system, including systems for resource planning and coordination; establishment of a regular system for the training and coaching of staff in the principles of results-based management.

ORGANIZATION-WIDE EXPECTED RESULTS 1. WHO’s revised managerial framework and its related processes applied in a coordinated and consistent manner for strategic planning, biennial programming and budgeting, operational planning, performance monitoring and reporting, including support for the country focus. 2. Global system for planning, mobilization, coordination and administration of voluntary resources in support of resultsbased management and the country focus applied throughout the Organization. 3. Capacity for quality assurance services strengthened and advice and assistance provided to make programme delivery across all levels of the Organization more relevant and cost effective. 4. Culture and practice of results-based management sustained at all levels of the Organization.

INDICATORS • At each organizational level, proportion of areas of work for which workplans have been developed and monitored and which are fully consistent with strategic plans and the programme budget

BASELINES 50%

TARGETS 75%

• Proportion of headquarters programmes, and regional and country offices in which the Organization-wide system for planning, mobilization, coordination and administration of voluntary resources is consistently applied

None

100%

• Proportion of programme managers’ requests for assistance in making programme delivery more relevant and cost effective fulfilled

None

75%

• Proportion of professional staff, at each level of the Organization, trained in the principles and practices underlying the revised WHO resultsbased managerial framework (strategic and operational planning, performance monitoring, quality assurance, evaluation and reporting)

10%

75%

5. A globally compatible programme management information system fully in operation, that integrates data from all levels of the Organization, and supports efforts to improve performance and accountability at all levels, and to focus on country work.

• Proportion of agreed core data set that is provided in workplans at each level of the Organization and captured in the global database

None

75%

104

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 6. WHO’s work systematically evaluated to assess its medium-term impact and ensure good stewardship of the Organization’s resources. 7. Risks to the Organization identified and mitigated by controls designed to ensure good corporate governance.

INDICATORS • Number of thematic and programmatic evaluations completed during the biennium in accordance with the framework on programmatic evaluation

BASELINES None

TARGETS 8

• Level of implementation of annual audit plans

Fulfilment of annual audit plan

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

27 578

Includes Miscellaneous Income.

Planning, resource coordination and oversight enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

105

PROPOSED PROGRAMME BUDGET 2006-2007

HUMAN RESOURCES MANAGEMENT IN WHO ISSUES AND CHALLENGES

As the world’s leading public health agency, WHO needs a versatile, productive, skilled and motivated workforce, dedicated to the Organization’s mission. The challenge to WHO is therefore to attract and retain the most talented women and men, from all Member States. Good planning of human resources, based on actual and projected needs, is essential to the effective management of staff. Managers need to have employment packages that are closely aligned to the type and duration of the function performed. Changes made in previous years will be evaluated to ensure that WHO has an appropriate range of contract choices at its disposal. WHO needs to promote continuously an organizational culture in which staff achieve high levels of performance through sound management and development; and in which they enjoy fair treatment, job security and safety, a healthy working environment, and staff/management relations based on mutual trust and respect. Following the full implementation of WHO’s global competency framework during the biennium 2004-2005, the main challenge will be to ensure that human resources management fully assimilates the competencies and behaviours of the new management culture. WHO’s new global management and leadership development programme is a key part of this process. The impact of increased investment in staff development and learning through creation of the global staff development fund, and the learning programmes it will support, should produce a measurable cultural shift across the Organization, leading to higher levels of satisfaction and better performance. In view of the global nature of its public health operations, the Organization needs staff members who have professional experience across regions and countries. This major challenge will be met by the introduction and implementation of a regulated system of mobility that will apply to all internationally recruited staff. The mobility programme will build on the experience of the voluntary scheme introduced in the 2004-2005 biennium, applying the lessons learnt. The new system will need to balance the interests of programmes and staff with those of the Organization. WHO will continue to participate actively in pay and benefits reforms, within the United Nations common system, with a view to making the compensation package more responsive to, and supportive of, the current needs of Member States, United Nations organizations and staff. The proposed reforms include introduction of performance-related pay, grouping of grade levels, and the establishment of a senior executive service. The recruitment strategy designed to broaden the diversity of the WHO workforce will be reviewed and amended as necessary.

GOAL

To apply best practice in all aspects of human resources management at all organizational levels, in support of WHO’s leadership role in international health. To provide the strategic direction, policies and procedures necessary to ensure that human resources services are delivered in a timely and effective manner in support of WHO’s role to promote and protect health. Indicator

WHO OBJECTIVES

• Operational excellence in the timely delivery of high-quality human resources services at headquarters and in regional and country offices

STRATEGIC APPROACHES

Formulation of policy, design of systems and delivery of human resources services to meet current and future organizational goals through continuous improvement of technical and people-management capabilities, processes and systems.

106

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. New global human resources information system and streamlined, re-engineered procedures established, providing staff globally with improved quality and quantity of information and better access.

INDICATORS • Availability of internally consistent global information across offices

BASELINES Lack of internally consistent humanresources information throughout the Organization Reprofiling limited due to lack of tools and information

TARGETS Human resources module of the global management system implemented and operational All organizational units using reprofiling tools and skills-gap analysis

• Degree to which organizational units can be reprofiled and analysis of gap between required and available skills and competencies can be undertaken

2. Effective learning programmes that meet staff and organizational needs launched, ensuring the effective use of individual development plans across the Organization.

• Level of staff satisfaction with development opportunities offered at WHO

Limited number of development opportunities Limited leadership and management learning programme available

• Level of satisfaction with management and leadership capacity at WHO reported by staff

Expanded availability of learning programmes based on assessed demand Leadership and management learning programme implemented for all senior and middle managers 80%

3. Rotation and mobility system fully implemented, based on a compendium of vacancies issued at least once a year. 4. Conditions of service improved and staff-friendly policies implemented; WHO pay and benefits system brought into line with the United Nations field-oriented organizations’ system. 5. Procedures and systems maintained, enabling the Organization to recruit staff and meet its contractual obligations as an employer, while providing a caring and supportive environment for all staff.

• Proportion of staff having completed their maximum standard assignment length who participate in the rotation and mobility programme

Limited voluntary rotation and mobility

• Degree of improvement in stafffriendly policies

Special-operations living-allowance policy not applied. Lack of a post-traumatic stress disorder programme and global counselling services Delays in payment of entitlements Completed survey on organizational climate

Implementation of special-operations living-allowance policy; post-traumatic stress disorder and stress management programmes in place Automatic processing of entitlements and lump sums Improved yearly survey results

• Timeliness of payment of salaries and allowances to all staff

• Frequency of appeals for noncompliance with the Organization’s regulatory instruments

107

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

52 261

Includes Miscellaneous Income.

Human resources management in WHO enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

108

PROPOSED PROGRAMME BUDGET 2006-2007

BUDGET AND FINANCIAL MANAGEMENT ISSUES AND CHALLENGES

Budget and financial management are continuing functions that must be efficient and allow for sound internal control to support the work of the Organization at all levels. Flexibility is required in order to accommodate circumstances and needs particular to individual locations; consistency is also necessary to ensure that the correct balance is struck between service and control. Timely, accurate and relevant management information is vital to support the delivery of work across the Organization, while integrated reporting is necessary to improve the planning and monitoring processes of the Organization – meeting the needs of managers as well as the statutory and other requirements of Member States. The growth of voluntary contributions and the increasing complexity of donor agreements place increasing demands upon the Organization. There is therefore a need for appropriate strategies to ensure that the integrated programme budget is financed on a sound, sustainable basis. Staff involved in budget financial management should have the necessary skills, expertise and capability to handle the increased volume and complexity of financial resources, associated reporting and other requirements that will result. A major challenge is to continue to improve budget and financial management through increased decentralization, including the development of appropriate policies, procedures and guidance. There is a need for new information technology systems that are simplified and streamlined and that respond efficiently to both changing programme requirements and the concerns of Member States. An internal control framework should also be maintained to promote accountability and minimize the risk of fraud. Appropriate use of financial information to support the health activities of the Organization is crucial to ensuring effective management by the technical areas in an accurate and timely manner. Financial information is one of the measures by which success in achieving objectives can be judged by Member States and others that provide financial resources or benefit from the output of the Organization. Relevant and effective support and guidance are necessary to implement policies.

GOAL

To apply best practice in all aspects of budget and financial management at all organizational levels within a sound internal control framework, in support of WHO’s leadership role in international health. To follow best practice in budget and financial management coupled with integrity and transparency, providing effective and efficient support for budget and financial administration across the Organization for all sources of funds, including relevant financial reporting at all levels, both internally and externally. Indicators

WHO OBJECTIVES

• Timely financial information and accessible analytical tools that allow managers at all levels of

the Organization to make well-informed decisions on planning and operational matters • Budget presentation, implementation and monitoring, enabling Member States and other donors to judge financial performance • Acceptance by governing bodies of the biennial financial report, audited financial statements (including an unqualified audit opinion) and the interim financial report and statements • Response to internal and external audit report recommendations, leading to enhanced accountability and supporting appropriate internal control

STRATEGIC APPROACHES

Formulation of relevant policies within a framework of financial integrity and continuous improvement in order to assure a seamless budgetary and financial process, efficient, effective operations, and a sound accountability framework, for all sources of funds and at all levels of the Organization; provision of a balanced response to the different, but equally important, requirements of Member States and donors as providers of funds, and of the Organization, at all levels.

109

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Policies and guidance prepared for implementation of new, streamlined functions under delegated authority to countries and regions in line with implementation of the new global management system. 2. Integrated budget estimates drawn up, including financing strategies; income and expenditure projections, monitoring and reporting carried out for all sources of funds on a fully integrated basis. 3. Statutory and other financial reports prepared and submitted to the Health Assembly in accordance with WHO Financial Regulations and Financial Rules, policies and procedures.

INDICATORS • Comprehension and implementation throughout the Organization of policies underpinning the global management system

BASELINES Updated WHO Manual and related procedures and appropriate training programme

TARGETS Revised policy and procedures fully reflected in the WHO Manual and training programme carried out at all levels

• Timely and relevant submission of • budget estimates to governing bodies Timely reporting to satisfy both needs of internal management and requirements of Member States

Compliance with Financial Regulations Global consolidated database updated by 18th working day each month; ad hoc reports on financial implementation Interim financial report finalized by 31 March 2007 Final financial report finalized by 31 March 2008 Unqualified audit opinion Income recorded within 5 days Chart of accounts aligned with programme budget Actual rate of collection 2004-2005

Compliance with Financial Regulations Global consolidated database updated by 10th working day each month; monthly reporting by 15th working day Interim financial report finalized by 28 February 2007 Final financial report finalized by 28 February 2008 Unqualified audit opinion Income recorded within 2 days Chart of accounts aligned with programme budget Improved rate of collection compared with 2004-2005 Chart of accounts aligned with programme budget Payment on due date of contract

• Submission of interim financial • • report for biennium 2006-2007 to External Auditors by 31 March 2007 Submission of final financial report for biennium 2006-2007 to External Auditors by 31 March 2008 External audit opinion and recommendations

4. Financing strategy for integrated budget management (income and accounts receivable) drawn up and effectively implemented.

• Timely recording of income • Accuracy of income database • Level and timeliness of collection of receivables for all sources of funds

5. Expenditure and accounts payable managed in order to implement the integrated programme budget.

• Accuracy of expenditure database • Timely payment of suppliers and contractors according to contract terms

Chart of accounts aligned with programme budget Payment within 10 days of receipt of payment instruction Actual performance 2002-2003 compared to benchmark investment percentage Level of bank charges for 2004-2005 Rate of protection achieved for 2004-2005 within budget appropriation

6. Funds of the Organization invested and foreign exchange risks managed within acceptable liquidity and risk parameters in order to maintain the necessary level of liquidity and maximize investment potential.

• Level of investment earnings as compared to accepted benchmarks

Out performance of benchmark investment percentage by 0.25% No increase in level of bank charges Full exchange-rate protection achieved within budget appropriation

• Efficiency of banking and payment • operations Execution of hedging operations within budget appropriated by the Health Assembly

110

PROPOSED PROGRAMME BUDGET 2006-2007

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

45 661

Includes Miscellaneous Income.

Budget and financial management enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

111

PROPOSED PROGRAMME BUDGET 2006-2007

INFRASTRUCTURE AND LOGISTICS ISSUES AND CHALLENGES

The ability of WHO to deliver its health programmes throughout the world depends on the support and services it provides in infrastructure, which includes making safe and adequate office space available to its employees. United Nations facilities are potential targets for terrorist attack; constant attention is therefore needed to ensure the safety and security of all WHO staff. The Organization’s various geographical locations affect the quality and choice of available infrastructure services, posing challenges for the provision of a safe, equitable and affordable service to all WHO staff. The broad challenge is to make sure that administrative support and security are appropriate yet economical; no resources should be directed unnecessarily from other essential programme activities. Infrastructure services cover a range of infrastructure and logistic support functions essential for all WHO sites: accommodation, office supplies and all matters related to office services and concessions; general building management and maintenance, including provision of utilities; servicing of conferences and meetings; production, printing and distribution of publications and technical, administrative and conference documents; archives, mail and security; information on travel and travel policy; and contracting and procurement. In addition to the procurement of drugs and medical supplies, other goods and services have to be purchased and delivered worldwide. A significant portion of this work is related to emergency and humanitarian aid, in situations where commercial alternatives are unavailable or unaffordable. Not only must contracting and procurement services be efficient and cost effective, they must also be unusually flexible in order to cope with unpredictable demands. The challenge is to purchase these commodities and services in the most cost-effective manner, through umbrella agreements and electronic commerce facilities, and to ensure their timely delivery to the recipients concerned.

GOAL

To apply best practice in all aspects of infrastructure support at all organizational levels, in support of WHO’s leadership role in international health. To frame an enabling policy and creating an institutional environment to support the timely implementation of WHO’s programmes in Member States. Indicator

WHO OBJECTIVES

• Appropriateness, timeliness, cost-effectiveness and reliability of infrastructure and logistic support services at all organizational levels

STRATEGIC APPROACHES

Sharing of best practices and resources across the Organization and implementation of innovative costreduction mechanisms; drafting of service-level agreements that improve management of client expectations; fostering of collaboration with other organizations of the United Nations system whenever cost-sharing is viable.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Established offices operated in a cost-effective and efficient manner. 2. Global governing bodies and technical meetings provided with effective infrastructure and logistic support.

INDICATORS • Number of established best practices adopted in order to effect efficiency gains

BASELINES No best practices adopted for implementation Number of services revised and adapted in previous year

TARGETS Minimum of 8 best practices adopted

• Number of services that need to be refined

Decrease in number of issues addressed and zero recurrence

112

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 3. Health supplies of the highest quality at the best price procured for Member States and technical programmes. 4. Security and safety of grounds and premises improved. 5. Real estate facilities improved.

INDICATORS • Increase in the proportion of direct procurement carried out using negotiated agreements (such as UN Web Buy)

BASELINES Percentage of direct procurement as at end of 2005

TARGETS 10% increase in direct procurement

• Number of WHO sites that comply with minimum operating security standards

Complying sites as at end of 2005

All sites

• Availability of an updated 10-year • rolling master plan of real estate projects Proportion of projects implemented with financing from the Real Estate Fund that deviate from recognized best practice for local construction and environmental norms

Master plan of previous biennium Percentage of implemented projects that deviate from best practice at end of 2005

10-year rolling master plan adopted Less than 10% of implemented projects that deviate from best practice

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

134 617

Includes Miscellaneous Income.

Infrastructure and logistics enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

113

PROPOSED PROGRAMME BUDGET 2006-2007

GOVERNING BODIES ISSUES AND CHALLENGES

The formal contribution of Member States of WHO to its work takes place within a series of governing bodies at global and regional levels. The work of WHO also contributes to, and is influenced by the United Nations system as a whole, and the linkage of WHO governing bodies to those of relevant parts of the system is important. As the framing of appropriate public-health policy becomes more complex and crucial, WHO’s governing bodies and those of relevant bodies of the United Nations system must be provided in the most efficient and effective way with both the input and the setting required for informed decisionmaking at global and regional levels. Careful and deliberate selection of the most pertinent issues, and greater participation and transparency, are essential in order to sharpen the focus of debate during shorter governing body sessions with less documentation. In drawing up agendas and prioritizing topics for consideration, dialogue between Member States and between regional- and global-level governing bodies must be maintained in order to bring about consensus on technical and policy matters. As the number of governing body sessions has grown, the level of attendance has increased, and requirements for documentation and information have been more complex, so has the burden of the demanding, skilled and highly pressured work that needs to be performed by the language, documentation, document production, and meeting services. Moreover, in view of the importance of plurality of languages for assuring access of all Member States to accurate and concise scientific and technical information and for improving health policies in the world, a considerable volume of material has to be edited, translated and made available in all official languages of the Organization. New technologies facilitate the dissemination of documentation, making it possible, for example, rapidly to issue documentation for governing body sessions on the Internet; yet distribution of printed material is still needed in order to assure availability of documentation everywhere. The issue of multilingualism throughout WHO needs to be viewed in the context of the Organization’s communications with Member States and the world. The rise in the number of governing body subsidiary sessions and increased need for language services has meant that costs in this area of work have grown considerably. The high cost of individual sessions, especially at regional level, has meant that only a few countries could consider hosting meetings.

GOAL

To ensure sound policy on international public health and development that responds to the needs of Member States. To assure the good governance of WHO through efficient preparation and conduct of the regional and global governing body sessions, and effective policy-making processes. Indicator

WHO OBJECTIVES

• Greater consensus in deliberations of the Health Assembly, Executive Board and regional committees

STRATEGIC APPROACHES

Expansion and improvement of communication and coordination channels between Member States, regional and global governing bodies, and WHO’s Secretariat; more effective use of technology and better control throughout preparation process in order to speed up provision of concise and accurate documentation; careful review of the agendas of governing body meetings to ensure their relevance to WHO policy development; development of methods to encourage participation of Member States, organizations of the United Nations system and other intergovernmental bodies in the work of governing bodies.

114

PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 1. Resolutions adopted that focus on policy and strategy and provide clear orientations to Member States and WHO’s Secretariat on their implementation.

INDICATORS • Proportion of resolutions adopted that focus on • policy and can be implemented at global, regional and national levels Appropriateness of health contents in resolutions or policies of other bodies in the United Nations system

BASELINES

TARGETS

2. Communication between Member States, Executive Board members and WHO’s Secretariat improved.

• Frequency of effective use of communication channels between Member States and governing bodies at global, regional and country levels, concerning the work of WHO

3. Governing body meetings held in all the official languages of WHO at global level and in agreed official languages for the regional committees.

• Proportion of governing body meetings held in appropriate official languages

• Timeliness and availability of documentation in the official languages

• Adequacy of multilingualism in WHO 4. Communication and coordination in establishing the work programmes of regional and global governing bodies improved.

• Degree of congruence of agendas and resolutions of the regional and global governing bodies

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

37 403

Includes Miscellaneous Income.

Governing bodies enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

115

PROPOSED PROGRAMME BUDGET 2006-2007

EXTERNAL RELATIONS ISSUES AND CHALLENGES

In promoting integration of a health dimension into social, economic and environmental development, WHO seeks to achieve greater impact through its Member States; and by joining forces with other bodies of the United Nations system and a range of institutions offering knowledge and experience in other fields. WHO’s corporate approach to cooperation with current and future partners is implemented through its external relations. To that end, WHO maintains operational linkages with intergovernmental, governmental and nongovernmental partners, regional political bodies, and parliamentary groups. Cooperation with development banks and with institutions of the European Union has developed and needs to be further strengthened. WHO leads major initiatives to coordinate health-related activities in the United Nations system, and has striven to assure the prominence of health on the agenda of the international community. Member States provide the Organization’s core and extrabudgetary resources. The corporate approach to sustainable financing of WHO activities resulted in better alignment of voluntary contributions with WHO’s programme budget. Several governments moved to multiyear commitments, thereby assuring predictability and coherence. A formal consultative exercise for interested parties covers the work of WHO as a whole. In the rapidly changing environment for development cooperation, this donor base will be expanded in order to meet the requirements of WHO activities. Targeted approaches to foundations, including in the context of global alliances, also produce a significant increase in support. Recognition is growing of the benefits of greater collaboration with the private sector in order to improve public health outcomes. WHO is increasingly engaged in public-private partnerships and global alliances which involve a variety of stakeholders. WHO’s work on public-private interactions for health will emphasize cooperation with companies to improve access to health-related commodities; promote research and development; redress company practices that have a negative impact on public health; and provide support to Member States on interaction with the private sector. Guidelines have been drawn up to provide a framework to technical programmes. The Committee on Private Sector Collaboration reviews all proposals in order to advise the Director-General. Nongovernmental organizations play a growing role in shaping and implementing both global and national health policies. Their contribution is reflected in the various kinds of interaction they have with WHO. In addition to maintaining a system for formal relations with such organizations, WHO needs to make collaborative arrangements more coherent and efficient, improve dialogue with civil society, and work more efficiently with and through organizations in advocacy and outreach efforts at country level. The growth in interactions with partners throughout the Organization raises the question of both strategic management for a corporate approach, and increasing risk of conflicts of interest. Existing rules and methods for the establishment of partnerships need to be developed further, especially in terms of governance, respect of WHO’s mandate, and promotion of public health. Relations with the media and the provision of information to the general public are important for raising awareness of health issues and creating a positive image of WHO. Ensuring that WHO “speaks with one voice” will reinforce the impact of a common message, based on evidence, and enhance WHO’s image. In collaboration with nongovernmental organizations and the private sector, and through WHO’s regional offices, efforts are being made to improve support for community public health using the Health Academy project, advocacy, and documentation of external partners’ activities at country level.

GOAL

To ensure that health goals are incorporated in overall development policies, and that resources for health are increased.

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PROPOSED PROGRAMME BUDGET 2006-2007

WHO OBJECTIVES

To negotiate, sustain and expand partnerships for health globally; to strengthen WHO’s collaboration with intergovernmental and governmental bodies, civil society organizations, the private sector and foundations; and to secure the Organization’s resource base. Indicator

• Number of functioning partnerships established with bodies of the United Nations system, the private sector and civil society

STRATEGIC APPROACHES

Respect of the programme adopted by the Health Assembly; introduction of measures to manage conflict of interest with the private sector; facilitation of exchange of information between major target groups in health information marketplace; greater promotion of the health agenda in political and socioeconomic spheres; better staff awareness of issues related to collaboration with the private sector, including conflict of interest.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Sustained and expanded partnerships for health globally; strengthened collaboration with intergovernmental and governmental bodies, civil society organizations, the private sector and foundations; and secured resource base for WHO.

INDICATORS • Number of consultation and briefing sessions with WHO’s sister agencies, other organizations and interested parties in the health sector Number of policy areas where there is congruence with other stakeholders

BASELINES

TARGETS

•

2. Effective mechanism for coordination of input to and feedback from important international forums, including major United Nations conferences and summits, and the Millennium Development Goals. 3. New partners mobilized for WHO, notably through global alliances and improved interaction with the private sector.

• Degree of reflection of WHO’s health goals and priorities in final declarations and plans of actions of global, regional and national conferences, and development agendas

• Number of private-sector partners working with WHO to achieve public health outcomes

• Number of assessments made for the Committee on Private Sector Collaboration, and level of support to regions and clusters

4. Improved knowledge of nongovernmental and civil society organizations working with WHO, and increased transparency, through enhanced communication and policy dialogue.

• Number of targeted organizations that benefited from training sessions and seminars using WHO policy papers, tools, and guidelines on interaction with civil society organizations

5. Health Academy project extended to pilot Member States in all regions.

• Proportion of Member States in which the Health Academy has been established

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RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

35 600

Includes Miscellaneous Income.

External relations enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

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PROPOSED PROGRAMME BUDGET 2006-2007

DIRECTION ISSUES AND CHALLENGES

The overarching theme for the Organization will continue to be “results in country”. This presents a challenge to senior management to implement activities in such a way that they reflect the priorities and concerns of Member States, and draw on the synergistic strengths of headquarters, and the regional and country offices. The Organization must continue to increase the proportion of resources allocated at country level, while maintaining stewardship of its technical agenda. In doing so, an appropriate balance needs to be struck between the provision of global public goods and support to country-level action. As a whole, WHO will aggressively pursue measurable health outcomes, particularly as related to the Millennium Development Goals. Following the shift to results-based planning and budgeting, the Organization will engage more thoroughly in results-based auditing to assure the greatest level of efficiency and accountability. As the number and types of organizations involved in global public health continues to increase, WHO must provide the political and technical leadership necessary to maintain the provision of health services, development and refinement of health infrastructure, and the implementation of public health policy. Lastly, WHO must create an organizational culture that produces sound results by means of strategic thinking, prompt and effective action, teamwork, flexibility, networking, and innovation.

GOAL

To advance global public health and contribute to attainment of the Millennium Development Goals, particularly directing efforts at country level. To direct the work of the Organization within the overall framework of WHO’s Constitution, so as to maximize Organization-wide contribution to the work of Member States in achieving significant gains in health status. Indicator

WHO OBJECTIVES

• Extent of delivery of all areas of work set out in the Programme budget, as reflected in the end-ofbiennium performance assessments, and programmatic and thematic evaluations

STRATEGIC APPROACHES

Close and permanent interaction with Member States and partners; collaborative institutional development and coordination of actions between headquarters and regional and country offices; due diligence in stewardship, governance and oversight of resources; all these approaches carried out in accordance with WHO’s Constitution and to the effect of realizing results at country level.

ORGANIZATION-WIDE EXPECTED RESULTS 1. Effective direction and management of the Organization.

INDICATORS • Level of endorsement of reports submitted to the governing bodies

BASELINES Endorsement of all regular reports on implementation of resolutions and decisions All global planning coordinated between senior managers of headquarters and regional and country offices

TARGETS Endorsement of all regular reports on implementation of resolutions and decisions All global planning coordinated between senior managers of headquarters and regional and country offices

2. Coherence and synergy between the work of the different parts of the Organization.

• Degree of collaboration and coordination for Organization-wide programme planning and implementation; and communication of policies and strategies during meetings of senior management across the Organization

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PROPOSED PROGRAMME BUDGET 2006-2007

ORGANIZATION-WIDE EXPECTED RESULTS 3. Legal status and interests of the Organization protected through timely and accurate legal advice and services. 4. Awareness of Member States and global partners of the work and role of WHO, and its contribution to significant developments in public health infrastructure, services, policy and outcomes. 5. Catalytic and start-up funds provided for programmes of particular need under the purview of the DirectorGeneral and Regional Directors.

INDICATORS • Responsiveness to requests for legal advice and services

BASELINES All legal inquiries addressed and documented

TARGETS All legal inquiries addressed and documented

• Accuracy of representation of WHO’s work in major international, regional and country media

All WHO priority programmes accurately reported to relevant media

• Strategic allocation of the DirectorGeneral’s and Regional Directors’ development funds toward activities and initiatives that advance the mission of the Organization

Funds allocated as directed by the Director-General and Regional Directors

RESOURCES (US$ thousand) Assessed contributiona TOTAL 2004-2005 TOTAL 2006-2007 country level at which allocated regional headquarters percentage by source of financing a

Voluntary contribution

All financing

Percentage by level

28 590

Includes Miscellaneous Income.

Direction enables the Organization effectively to deliver its technical support to Member States. As it supports virtually all the technical activities it is excluded from the tables showing linkages between areas of work.

120

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR SOUTH-EAST ASIA

Forty-first Meeting of the Consultative Committee for Programme Development and Management, WHO/SEARO, New Delhi, 19-21 July 2004

Agenda item 3.3

SEA/PDM/Meet.41/6.2 16 July 2004

PROPOSED PROGRAMME BUDGET 2006-2007

DRAFT REGIONAL AREAS OF WORK STATEMENTS FOR PROPOSED PROGRAMME BUDGET 2006-2007

CONTENTS Page INTRODUCTION................................................................................................................................1 SUMMARY OF THE PROPOSED REGIONAL PROGRAMME BUDGET FOR 2006-2007......2 REGIONAL AREAS OF WORK STATEMENTS............................................................................5 1. COMMUNICABLE DISEASE PREVENTION AND CONTROL......................................5 2. COMMUNICABLE DISEASE RESEARCH ......................................................................6 3. EPIDEMIC ALERT AND RESPONSE ..............................................................................7 4. MALARIA ............................................................................................................................8 5. TUBERCULOSIS..............................................................................................................10 6. HIV/AIDS...........................................................................................................................11 7. SURVEILLANCE, PREVENTION AND MANAGEMENT OF CHRONIC, NONCOMMUNICABLE DISEASES ...............................................................................13 8. HEALTH PROMOTION....................................................................................................14 9. MENTAL HEALTH AND SUBSTANCE ABUSE ............................................................16 10. TOBACCO ........................................................................................................................17 11. NUTRITION ......................................................................................................................18 12. HEALTH AND ENVIRONMENT......................................................................................19 13. FOOD SAFETY ................................................................................................................21 14. VIOLENCE, INJURIES AND DISABILITIES ..................................................................22 15. REPRODUCTIVE HEALTH.............................................................................................23 16. MAKING PREGNANCY SAFER .....................................................................................25 17. GENDER EQUITY, WOMEN AND HEALTH.................................................................26 18. CHILD AND ADOLESCENT HELATH............................................................................28 19. IMMUNIZATION AND VACCINE DEVELOPMENT ......................................................29 20. ESSENTIAL MEDICINES ................................................................................................31 21. ESSENTIAL HEALTH TECHNOLOGIES.......................................................................32 22. POLICY MAKING FOR HEALTH IN DEVELOPMENT .................................................33

23. HEALTH SYSTEM POLICIES AND SERVICE DELIVERY..........................................34 24. HUMAN RESOURCES FOR HEALTH...........................................................................36 25. HEALTH FINANCING AND SOCIAL PROTECTION....................................................37 26. HEALTH INFORMATION, EVIDENCE AND RESEARCH POLICY ............................38 27. EMERGENCY PREPAREDNESS AND RESPONSE...................................................42 28. WHO’S CORE PRESENCE IN COUNTRIES................................................................43 29. KNOWLEDGE MANAGEMENT AND INFORMATION TECHNOLOGY .....................44 30. PLANNING, RESOURCE COORDINATION AND OVERSIGHT ............................... 46 44 31. HUMAN RESOURCES MANAGEMENT IN WHO ........................................................47 32. BUDGET AND FINANCIAL MANAGEMENT.................................................................48 33. INFRASTRUCTURE AND LOGISTICS..........................................................................49 34. GOVERNING BODIES ....................................................................................................50 35. EXTERNAL RELATIONS ................................................................................................51 36. DIRECTION ......................................................................................................................52

INTRODUCTION With the introduction of One WHO Budget, the emphasis of the organization is to have one budget covering all levels of the organization rather than to have separate budgets for each WHO office or even the region. Therefore, the terminology of Part II of the budget has been eliminated. Nevertheless, the Regional Director has felt that it is useful to prepare a separate document describing the work of the region in relationship to the work of the entire organization. In determining the region-specific programmes in the context of the work of WHO overall, this will help focus the work of all countries and the Regional Office. It will also help promote the accountability of the region for its work by identifying the specific strategies and goals for the region in the 2006-2007 biennium. The 2006-2007 Proposed Programme Budget for the region is organized by the same 36 Areas of Work as the organization-wide budget. However, Regional Area of Work Statements will describe the specific emphasis for regional work during the biennium. Each Area of Work Statement includes Regional Expected Results along with indicators and targets for regional work. It is hoped that these will provide clear objectives for the work of the entire region and provide a better basis for assessing the work accomplished by the region at the end of the biennium.

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SUMMARY OF THE PROPOSED REGIONAL PROGRAMME BUDGET FOR 2006-2007 The proposed South-East Asia Region’s budget is taken from the proposed budget for the entire organization (Proposed Programme Budget 2006-2007). The first draft of this document was prepared in July 2004 and will be discussed at the Regional Committee meeting in September 2004. Based on these comments, further revisions will be made and a second draft will be presented to the WHO Executive Board in January 2005. The final budget will be approved by the World Health Assembly in May 2005. The organization of the budget is by the 36 Areas of Work applied to all levels of the organization. Budget figures are broken down by: (1) Budget financed by Assessed Contribution and Miscellaneous Income and (2) Budget financed by Voluntary Contributions. It is proposed that the SEARO budget for assessed contribution be increased by 12.6% from $93.454 million to $105.14 million. Voluntary funds are estimated to increase by 19.8% to $229.334 million. Therefore, the total amount of the SEARO 2006-2007 budget is proposed to be $334.474 million dollars or an overall increase of 17.4% compared to the 2004-2005 budget. It must be pointed out that this proposed budget will not be final until World Health Assembly approval in May 2005. As can be seen, the proposed budget shows an increase in assessed contributions of Member States, despite the fact that there have been no increases in assessed contributions for recent biennia. Furthermore, voluntary contributions for 2006-2007 depend on what donors contribute during the course of the biennium. Nonetheless, this represents the expected work and budget of the organization and the region dependent on the availability of resources. Table 1 shows how the breakdown of the total proposed regional budget by Area of Work and the percent changes compared to the 2004-2005 budget.

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Table 1: Proposed SEAR budget for assessed and voluntary funds S. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 2006-2007 Areas of Work Communicable disease prevention and control Communicable disease research Epidemic alert and response Malaria Tuberculosis HIV/AIDS Surveillance, prevention and management of chronic, non-communicable diseases Health promotion Mental health and substance abuse Tobacco Nutrition Health and environment Food safety Violence, injuries and disabilities Reproductive health Making pregnancy safer Gender, equity, women and health Child and adolescent health Immunization and vaccine development Essential drugs and medicine policy Essential health technologies Policy making for health in development Health system policies and service delivery Human resources for health Health financing and social protection Health information, evidence and research policy Emergency preparedness and response WHO's core presence in countries Knowledge management and Information technology Planning, resource coordination and oversight Human resources development in WHO Budget and financial management Infrastructure and logistics Governing bodies External relations Direction Exchange rate hedging and IT fund TOTAL Proposed budget (thousands) $26,000 $1,405 $14,000 $9,434 $28,000 $28,000 $8,500 $2,866 $3,000 $3,430 $2,000 $7,533 $1,840 $2,202 $3,037 $9,000 $1,186 $12,000 $60,000 $5,500 $2,504 $3,373 $10,080 $10,156 $5,176 $8,225 $10,601 $27,695 $9,000 $4,075 $1,600 $1,575 $6,665 $300 $2,000 $1,700 $816 $334,474 17,4% Percent change over 2004-2005 32,4% 122,7% 67,6% -12,0% -17,5% 35,5% 112,3% 0,0% 35,3% -10,8% 43,4% 14,7% -32,7% 20,9% -17,5% 101,0% -0,1% 103,3% -10,1% 73,3% 14,7% -1,0% 9,8% ? ? ? 43,5% 36,2% 107,5% 240,4% 32,0% 17,4% 20,9% 0,7% 74,8% 22,7%

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REGIONAL AREAS OF WORK STATEMENTS 1. COMMUNICABLE DISEASE PREVENTION AND CONTROL

Regional Issues and Challenges The South-East Asia Region accounts for >60% of the 13 million people who die each year from infectious and parasitic diseases: one in two deaths in some developing countries. The region accounts for 75% of the global leprosy cases, 70% of the global human rabies deaths, 40% of the global TB cases, 20% of the global HIV infections. In addition, Annual outbreaks of Dengue Fever and Japanese encephalitis are reported from many countries of the region, with high case fatality rates. Most deaths occur among people living below the poverty line, i.e. on incomes of less than US$ 1 a day. Poor people, women, children and the elderly are the most vulnerable groups. Infectious diseases continue to be the world's as well as the region’s leading killer of young adults and children. Diseases or infections requiring intensified control include dengue/dengue haemorrhagic fever, intestinal parasitoses, leishmaniasis, trachoma, SARS, zoonotic diseases such as avian flu, rabies, Japanese encephalitis, nipah viral disease, cysticercosis and leptospirosis. Dracunculiasis is eradicated from the region; leprosy and lymphatic filariasis, are targeted for elimination at global or regional level. While mortality associated with many of these neglected diseases is not high, lifelong disability and chronic social and economic consequences may be dramatic. Some of the diseases like leprosy and LF have a high degree of stigma and prejudices. These diseases need strong advocacy to attract media and donor attention, and for effective implementation of the available cost-effective interventions. Dealing with these neglected diseases requires strong control measures including vector and animal reservoir control, surveillance systems, social mobilization and capacity building and emphasis on communicable diseases in complex emergencies. The major challenges for WHO to address these issues are many. They include strengthening and sustaining political commitment, policy support and mobilization of adequate resources from national governments and partners, increasing access to drugs and interventions for the different prevention, control and eradication initiatives and reinforcing health systems within the framework of countries' priorities and strategic plans and strengthening capacity of general health services to tackle communicable diseases. Dealing with communicable diseases in complex emergencies in countries will be another challenge. Development of new tools, including drugs, vaccines and diagnostic tests, and cost-effective strategies for those communicable diseases for which effective tools and strategies are still lacking or improved tools/strategies are required are important challenges. Facilitation of alliances of partners to work in synergy at global, regional and national levels to deal with neglected diseases are also important challenges. Further, the elimination of globally targeted diseases like leprosy and lymphatic filariasis, and promotion of regional control strategies for diseases such as for rabies, JE, DF/DHF and others and to increase community awareness and ensure community participation in support of these programmes are among the major challenges. Goal To reduce the mortality, morbidity and disability associated with communicable diseases and reduce their negative impact on health, social and economic well-being of the people in the region.

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WHO Objectives To provide technical support to member states and their international and national partners, to reduce morbidity and mortality through prevention and control and, where appropriate, eradication and elimination of selected communicable diseases. Indicator • Number of countries with ongoing or newly established national programmes targeting selected communicable diseases, who are able to reduce morbidity and mortality due to these diseases, by 50%.

Strategic Approaches Formulation of evidence-based strategies and cost-effective interventions, provision of support to countries and involvement of relevant partners for implementation. 2. COMMUNICABLE DISEASE RESEARCH

Regional Issues and Challenges A major burden of disease in the SEA countries is contributed by infectious and parasitic diseases. This includes high burden diseases and major killers such as HIV/AIDS, TB and Malaria as well as other Vector-borne diseases, viz; dengue, lymphatic filariasis, kala-azar, schistosomiasis and Japanese encephalalitis. In addition, diseases like leprosy and rabies are also major public health problems in the region. The region is also vulnerable to emerging diseases such as SARS and Avian flu. These diseases disproportionately affect the socio-economically poor, physiologically vulnerable and geographically unreachable populations and the marginalized groups such as children, women and the elderly. Some of them also cause disabilities, stigma and discriminations. The combined effects of these diseases leads to impeding social and economic development and a continued cycle of poverty, with all its negative consequences. Ecological changes brought about by environmental modifications such as rapid urbanization, unbalanced industrialization and development activities, population displacement and migrations across countries and continents create new paradigms facilitating rapid disease transmission and spread. These problems pose major challenges to member countries in implementing the nation-wide programmes for control or prevention of infectious and vector-borne diseases. At present, research activities which are being undertaken in some of the Member Countries are fragmented, and lack coordination as well as adequate resources. In addition, the limited research results are often not utilized or applied to programme implementation and monitoring. Therefore, there is a strong need for sustained efforts for operational research in spite of the scarcity of funds and to strengthen the operational research capacity in collaboration with national centres of excellence and WHO collaborating centres. The Special Programme for Research and Training in Tropical Diseases (TDR) has made important contributions in the control of communicable diseases and has now expanded its mandate to include dengue and tuberculosis, in addition to the previously identified six diseases. TDR has contributed to the successful development of miltefosine, the oral drug for visceral leishmaniasis which is undergoing the phase IV trial. TDR is also promoting the ‘Small Grants’ Project for research in smaller countries – 4 countries in SEAR are eligible for the Small Grant Project – Bhutan, DPR Korea, Maldives and Timor-Leste. The main research-related challenges of this Region are sustaining the political commitment and policy support to research in communicable diseases; generation of adequate resources for laboratory and operational research from national governments; strengthening research capacity of institutions and health professionals in Member Countries; Improved synergy, collaboration and coordinated action between researchers, policy makers and those responsible for disease control programmes; involvement of the

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private sector to support research; and facilitation of networking, exchange of technical information and research guidelines among research institutions; national centres of excellence, WHO collaborating centres and researchers. Goal To promote and support research in infectious and parasitic diseases for cost-effective interventions for prevention, control and elimination/eradication of communicable diseases. WHO Objectives To promote and strengthen operational research in Member Countries in collaboration with National Centres of excellence and through WHO Collaborating Centres. Promote linkages with research institutions for dissemination of research knowledge and its utilization for disease control, elimination, eradication and programme implementation. Indicator Number of countries contributing to research in selected diseases, having applicability to prevention or control programmes in the countries. Strategic Approaches • • 3. Provision of research-related technical support; Establishment of partnerships and linkages between research institutions and researchers EPIDEMIC ALERT AND RESPONSE

Regional Issues and Challenges Efficient and prompt epidemic alert and response needs an effective national disease surveillance system in place. The process of developing and strengthening disease surveillance has been a continuous effort of the WHO for more than three decades. The phenomenon of globalisation in the 21st century has altered the traditional distinction between national and international health. Very few, if any, urgent and serious public health risks are solely within the purview of national health authorities. Increased potential risks of international spread of diseases due to enhanced trade and travel can only be addressed efficiently through multilateral efforts. To meet the constant threat of emerging, re-emerging and new diseases, the surveillance mechanism is required to be dynamic and ever evolving having an in-built capacity of deleting or incorporating diseases or heath events according to their public health importance and burden, availability of cost-effective interventions and resources, national and international concern. To maintain its functional relevance it should be able to appreciate and interpret early warning signals and alert public health managers for proactive anticipatory measures. The same will require building up good public health and epidemiologic infrastructural capability, particularly human resources, in field epidemiology, information technology support and up-gradation, establishing standards and norms, quality assurance programme, implementation of surveillance activities through an integrated approach, etc. Reliable and rapid laboratory diagnostic support is one of the most fundamental prerequisites for effective and prompt response to any outbreak. At present many outbreaks remain undiagnosed. The failure to diagnose such infections during early phase of outbreaks leads to enhanced morbidity and mortality which can be averted. Facilities to diagnose new/ emerging infections e.g. Ebola, SARS, Nipah, etc., and most of the agents with bio-terrorism potential are limited or non-existent in most of the countries.

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Challenges being faced by member countries for establishing effective and efficient epidemic alert and response mechanism are: absence of appropriate national policy, insufficient infrastructure, non-availability of norms, standards and guidelines, inadequate regulatory mechanism, poor coordination between major surveillance partners due to vertical and often inadequate and inefficient structure of surveillance, poor allocation of resources to modernize public health education and epidemiological services, including laboratories. Further, improper utilization and maintenance of laboratory equipment and non-availability of quality diagnostic kits and reagents on continuing basis, absence of strong national and international linkages, inadequate/scanty operational research activities, and inadequate containment measures to combat increasing anti-microbial resistance are important challenges. Changing epidemiological scenario vis-à-vis emerging and re-emerging diseases of major public health significance cannot be adequately addressed with the existing IHR. Significant rise in non-communicable diseases and increasing potentials for bio-terrorism also pose formidable challenges. Goal The overall goal of the area of work under Epidemic Alert and Response (EAR) is to strengthen national surveillance, early warning and response system in all member countries to recognize, report, verify, investigate and respond to new, emerging, and remerging diseases. WHO Objectives To support Member Countries, both technically and operationally, in: 1. Further developing/updating national policies and strategies for implementing integrated disease surveillance with special reference to strengthening early warning and response systems, development of epidemic preparedness and response plans, ensuring reliable and rapid diagnostic support services, efficient and prompt response; 2. To develop core human capacity in field epidemiology, operational research, laboratory diagnosis and epidemic alert and effective response; 3. To further strengthen country regulatory mechanism in tune with revised IHR. Strategic Approaches • • • Advocacy for national policies, formulation of evidence-based IDSR strategies, and implementing the same in all the member countries of the region; Advocacy for the revised IHR and providing technical support to the member countries for its implementation; Capacity building: Developing skills in epidemiology through an appropriate regional strategy in FETP, strengthening core competencies covering epidemiology, public health laboratory, information technology support and public health mapping for implementation of IDSR and reinforcement of IHRs. MALARIA

Regional Issues and Challenges In the South-East Asia Region, during the last couple of decades, there are declining trends in the reported cases of malaria. However, the proportion of P falciparum malaria has increased from about 12% to more than 45%. Increasing levels and expansion of resistance to first and second line antimalarial drugs are necessitating a policy change. According to WHO estimates, based on the loss of 1.87 million DALYs every year, the economic losses are about US$ 3 billion each year in the Region. Besides the loss of life and productivity, malaria hampers children’s schooling and development. Malaria is a deterrent to investment

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and tourism that adds to the economic burden. This leads to a widening gap between malarious and non-malarious areas. Focal epidemics of malaria are common in the countries of SE Asia region. If epidemics are not controlled promptly, malaria becomes endemic and reverses the gains achieved. The global malaria control strategy (GMCS) articulated in 1992 continues to remain relevant. RBM initiative has provided a boost to the GMCS. New developments in the control of malaria include rapid diagnostic tests, artemisinin based combination treatment, prepackaged drugs, long-lasting insecticide treated nets, tools to test quality of antimalarials, health mapper and information technology. Since the RBM initiative, GFATM (in 7 countries during the first 3 rounds), the World Bank, USAID and other donors have supported scaling up of malaria control in the countries of the Region. Additional resources have to be mobilized for further scaling up and sustenance of the control programme. The major challenge for WHO is to increase its own capacity and capacity at the national level to provide technical support for scaling up the control efforts as a part of health system reforms and country cooperation strategy. Partnerships with other sectors and mainstreaming of malaria programme within the health sector should be strengthened further for the success of RBM initiative. Epidemiology of malaria varies from country to country and even within each country. Therefore, technical support by WHO should be country specific and through promotion of intercountry cooperation. The challenges comprise of provision of support to policy change based on current treatment practices and findings of monitoring of therapeutic efficacy of antimalarials. Countries in the Region will continue to rely on the IRS but the prevention strategies should be based on IVM which reduces the overall reliance on insecticides in accordance with POPS convention. People’s participation in prevention and adoption of COMBI approach is an important input for the success of RBM initiative. Monitoring and evaluation of the malaria control programme is inadequate even though consensus on the key indicators has been reached in a consultation in Kunming, China and Haryana, India. Surveillance and networking of therapeutic efficacy of antimalarial drugs should be expanded during the scaling up of the programme. The preparedness to deal with focal epidemics of malaria is required to respond early and effectively to the epidemics. Special surveys in collaboration with HIV/AIDS and TB as independent surveys or as a part of DHS or MICS are needed to determine the impact of the programme and make a stronger case for resource commitment and partnerships. Goal Reduce the malaria morbidity by 50% and mortality by 75% by 2010 using 2000 as the baseline and continue to reduce it further to halt and begin to reverse the incidence of malaria by 2015 in accordance with MDG. WHO Objectives To promote and facilitate access of populations at risk to effective treatment of malaria; promote the application of effective preventive measures against malaria for populations at risk; support countries to build capacity for malaria control; and strengthen malaria surveillance systems and the monitoring and evaluation of control. Indicators • • • • Malaria and all cause death rate among target group Number of malaria cases, severe and uncomplicated, among target groups Proportion of households having at least one treated bednet. Percentage of patients with uncomplicated malaria getting correct treatment within 24 hours of onset of symptoms

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•

Percentage of health facilities reporting no disruption of stock of antimalarial drugs for more than one week during the previous three months.

Strategic Approaches Provide technical support to the MOH in the countries of the Region to review and revise the policy and strategic plans in the countries. Advocate for coordination with countries through sustaining the intersectoral partnerships and mainstreaming of malaria control with other departments in health sector. Increase the capacity of WHO at the Regional and country levels to strengthen the response to the threat from HIV/AIDS, TB and Malaria. Assist in the development of a consensus on the application of evidence-based interventions, tools and products using a stratified approach to deal with the focal problem of malaria in the region. Support the countries awarded funds from GFATM and other investments to reduce the malaria burden through scaling up of the programme. Promote the development of evidence base and research to tackle effectively the regional problems relating to malaria control and enhance the capacity in research. Support evidence base through stronger surveillance for drug resistance and monitoring the quality of drugs and collaborate with IDS, HMIS and malaria control programme to monitor progress towards achievement of goals and targets. 5. TUBERCULOSIS

Regional Issues and Challenges Despite the remarkable progress made in the Member Countries in the Region in expanding DOTS and the excellent treatment outcomes being achieved under DOTS, the number of TB cases benefiting from these services remains low, with an estimated 46% of all new smear positive cases being detected as of the end of 2003, as compared to the 70% target to be achieved by 2005. A wide range of issues need to be addressed in order to continue to expand DOTS, sustain and improve on the current quality of services, and to increase case detection rates. First and foremost is the need to develop adequate technical and managerial expertise within the Region, and to ensure that necessary infrastructure and logistics support are available to ensure quality assured services for TB, particularly in countries where health care has been decentralized. While national TB control programmes in Member Countries have initiated intersectoral partnerships, particularly with the large and active private health sector, medical schools, NGOs and business and industry, these will need to be rapidly scaled up and extended in order to realize the expected impact of universal DOTS. Effective IEC and social marketing approaches are essential to overcome the continuing low community awareness of TB and the traditional stigma attached to the disease. The parallel epidemic of HIV/AIDS and the emergence of multi-drug resistance require the adoption and urgent implementation of comprehensive and feasible approaches to HIV-related TB and anti-TB drug resistance. While most countries are benefiting from the increased resources made available through international initiatives such as the Global Fund, the Global Drug Facility and through bilateral agreements at country level, concerns regarding disbursement and longterm financing of TB control remain. Regional and national level coordination and collaboration are essential for optimal planning, implementation and evaluation of the utilization of current resources, as well as to develop coordinated approaches, including targeted advocacy, to ensure sustained and adequate financing in the medium and long term.

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Support for research efforts aiming to increase utilization and acceptance of DOTS, reach poor and vulnerable populations, ensure gender equity, and develop an evidence base for new policies, particularly in the context of on-going health sector reform in several Member Countries, is equally essential. Goal The overall goal is to reduce the morbidity, mortality and transmission of TB until it is no longer a public health problem in the Region. WHO Objectives To achieve universal coverage with DOTS in the Region and sustain at least 85% treatment success and 70% case detection among new smear positive cases in all Member Countries in SEAR in order to halve prevalence and mortality due to TB by 2015. Indicators Indicator DOTS population coverage Treatment success rates Case detection rates Regional Baseline (Dec 2005) 100% 85% Between 60-70% Regional Target 100% Sustained at least 85% or more Sustained at least 70% or more

It is expected that through achieving universal DOTS coverage, detecting at least 70% of all new smear positive cases annually and successfully treating 85% of these cases TB prevalence and mortality will be halved by 2015. (Indicators 23 and 24 under the MDGs). Strategic Approaches The area of work will contribute to the RERs for tuberculosis control through the provision of assistance to strengthen financial, technical and managerial capacity for DOTS implementation; facilitation of the increased involvement of all development partners and stakeholders including communities, NGOs private sector and other public sectors; development and promotion of specific policies, strategies and interventions for wider application of DOTS, HIV-TB co-infection, multi-drug resistant tuberculosis; effective surveillance, monitoring and evaluation; and support for IEC and research efforts towards wider acceptance and utilization of DOTS. 6. HIV/AIDS

Regional Issues and challenges HIV/AIDS continues to devastate families, communities and societies in many parts of the world, primarily affecting populations who are poor, vulnerable and socially marginalized. Of the 40 million people currently estimated to be living with HIV/AIDS, two-thirds are in Africa, followed by the South-East Asia Region with six million (15% of the global total). Twenty-five million people have already died. In many countries, for example Thailand, AIDS is the leading cause of death among young adults. Despite advances in drug development and reductions in prices of HIV medicines, only 400,000 patients in developing countries have access to ARV treatment. Currently, only 4% of those who need ARV in the South-East Asia Region are being treated. The rest will die of AIDS since they have no access to these life-saving drugs. This represents a major

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disparity between developed and developing countries and among the rich and poor, which is a major ethical issue globally. In September 2003, the WHO and UNAIDS declared the failure to provide treatment to AIDS/HIV patients as a global health emergency and called for providing 3 million people in the developing world with ART by 2005 (the “3 by 5” initiative). Following this announcement or coinciding with it, many countries in the South-East Asia Region accepted the challenge and announced national ART scale-up programmes on World AIDS Day, 1 December 2003. However, the progress in “3 by 5” has been slow and needs a major thrust at both national and international levels. HIV care and treatment primarily include provision of care and support to people living with HIV/AIDS (PLWA) along the continuum from institutional, community and home levels. Comprehensive care includes clinical management of HIV/AIDS with ART as well as diagnosis and treatment for HIV-associated infections including TB, diarrhoea, and fungal infections. Voluntary counselling and testing, as well as psychosocial support are also included. Many countries of the South-East Asia Region have embarked on efforts to scale up ART. HIV prevention still remains the bedrock of HIV/AIDS control programmes. The basic prevention interventions such as condom promotion and provision, health promotion and education to reduce sex partners, the treatment of sexually transmitted infections, harm reduction among injecting drug users, and finally, creating an enabling societal environment must remain a top priority, along with provision of HIV treatment. In response to the growing threat of HIV/AIDS to security and political stability worldwide, there is a need to strengthen leadership and build partnerships in the area of HIV/AIDS and security for all countries including South-East Asia Region. While all national programmes in the South-East Asia Region promote multisectoral responses, HIV care falls within the domain of the public health sector – an area where the health sector has to take a lead role as outlined in the World Health Assembly resolution on Global Health-sector strategy in 2003. Goals Reducing morbidity and mortality related to HIV/AIDS and alleviating socio-economic impact due to HIV/AIDS by accelerating prevention and care, including antiretroviral therapy. WHO Objectives To support Member Countries, both technically and operationally, in: • creating an enabling environment for the effective scaling-up of HIV prevention, care and treatment programmes involving all sectors of the society including people living with HIV/AIDS; • scaling-up interventions to prevent HIV transmission among high risk groups and vulnerable populations; • expanding coverage of antiretroviral treatment as part of comprehensive HIV/AIDS care into health and community services in the public and private sector; • utilizing strategic information for programme planning.

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IMPACT Indicators Indicator Baseline (end of 2005) Target (2007)

• Number of countries scaling-up targeted • 5 countries (INO, • All 11 countries condom programmes and STI management MMR,THA) • Number of countries implementing continuum of care including VCT • 8 countries • All 11 countries implementing continuum of care including VCT • 450,000 people • 900,000 people receiving ART receiving ART • All 11 countries

• Number of people receiving ART

• Number of countries with strengthened • All 11 countries expanded HIV/STI surveillance Strategic Approaches

• Develop and update regional strategies, guidelines and tools, and training packages to enhance essential health sector interventions and services in HIV/AIDS prevention, care and support; • Support countries in scaling-up antiretroviral treatment as part of comprehensive HIV/AIDS care from health facility to home and community; • Support countries in strengthening surveillance, monitoring and evaluation of the response to the HIV epidemic including operational research. 7. SURVEILLANCE, PREVENTION AND MANAGEMENT OF CHRONIC, NONCOMMUNICABLE DISEASES

Regional Issues and Challenges The South-East Asia Region is passing through a phase of the epidemiological transition. In this process the Region is challenged with the heavy burden of infectious diseases and with the increasing burden of chronic, noncommunicable diseases (NCD). Environmental, demographic, and lifestyle changes are leading to more cardiovascular diseases, cancer, diabetes and chronic pulmonary diseases. The rapid rise of NCD threatens economic and social development as well as lives and health of millions of people in SEAR. According to 2002 estimates NCD contributed to 51% of all deaths and 44% of the disease burden in SEAR. Further increases in relative share of NCD in total deaths and disease burden, in total number of deaths and DALYs lost, as well as in the age specific incidence and mortality rates of major NCD are expected in coming decades. Increases in NCD morbidity and mortality are largely attributable to demographic, socioeconomic and cultural transition, that result in unfavorable changes in population distribution and level of several behavioural and physiological risk factors. Best part of NCD is either preventable or amenable to treatment. The World Health Organization is recommending the widespread application of public health measures to strengthen collaborative and intersectoral action focused on prevention of major NCD through integrated epidemiological surveillance, population-based interventions on major risk factors including tobacco consumption, unhealthy diets and physical inactivity and equitable, cost effective management of major NCD with optimal utilization of existing capacity of health systems.

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Significant progress has been made in implementing Vision 2020: Right to Sight. However, in the absence of data disaggregated for gender and disadvantaged population, monitoring of Vision 2020 has been difficult. Strengthening capacity of countries to appropriately monitor the progress is one of the major challenges for the Region. Sound epidemiological information is now available from South-East Asia Region which has confirmed the earlier suspected high burden of deafness and hearing impairment in the Region. The challenge now is to translate this knowledge into action. However, this has been handicapped by lack of adequate support. There is, therefore, a need to intensify effort in strengthening partnership mechanism for making required resources available. Goal To reduce the toll of morbidity, disability and premature mortality related to NCD. WHO Objectives • • To support Member States in developing national NCD prevention and control policies, strategies and implementation plans. To provide technical assistance in planning, implementation and evaluation of national NCD programmes.

Strategic Approaches • • • Strengthening capacity of Member States in establishing mechanism for conducting epidemiological surveillance with focus on sustainable collection of information on risk factors as well as mortality and morbidity data on selected priority NCD. Promoting health and supporting development, implementation and evaluation of population-based NCD prevention approaches and strategies aimed at reduction of exposure to common modifiable risk factors for major NCD. Technical support in promoting equitable and cost-effective approaches for management of chronic NCD. HEALTH PROMOTION

Regional Issues and challenges In 1986, the first International Conference on Health Promotion, held in Ottawa, defined health promotion as “process of enabling people to increase control over and to improve their health.” This concept went beyond the traditional boundaries of health education. Health promotion also sought to improve health by securing foundation for all the basic prerequisites of health, an important one, being equity. The Fifth International Conference on Health Promotion, which was organized in Mexico in 2000, where the Ministers of Health declared that health promotion must be fundamental component of public policies and programmes in all countries in pursuit of equity and better health for all. It also called for the establishment of countrywide plans of action for health promotion. One major objective in the Framework for Countywide Plans of Action for Health Promotion is to systematically integrate health promotion into the health care reform agenda. All countries in SEA Region have responded positively. A number of countries have developed national health promotion strategies and plans. Many countries, however, still have very limited resources and capacity. It is time now to strengthen the capacity at local and country levels for effective health promotion. The challenge ahead is now to avail this global support for health promotion to build the evidence-base and capacity for its effective implementation at community, national and international levels.

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It is apparent, however, that most countries have made very slow progress in appropriately applying principles of health promotion into practice. There are no well established partnerships and collaboration with other sectors to create healthy public policy. More importantly, even within the health sector, services for preventive measures are accorded a very low priority as compared to medical care. It is time now for WHO and Member Countries to seriously review and work out how health services shall be reoriented and how health promotion can be effectively delivered through the existing health systems. The section on Health Promotion in the Programme Budget 2004-2005 refers to the public health impact of several major risk factors that can be reduced through health promotion, as documented in the World Health Report 2002. Around the world, health system reforms with a renewed focus on primary health care provide an opportunity to integrate health promotion into health systems. The Regional Office has supported countries to develop small-scale health promotion projects, through the healthy setting approach. Although some progress has been demonstrated, few have shown their capacity to expand this concept into a national health promotion policy. For health promotion to be effective and for communities to benefit from the preventive aspects of good health, this will have to become an integral part of the health system. Those that deliver health service will have to be strengthened with new skills to enable them to play this additional role. The WHA Resolution A 57/11 requested WHO to address major risk factors to health, to continue to advocate an evidence-based approach to health promotion, including providing technical support to countries to be capable of implementing, monitoring, evaluating and disseminating effective health promotion interventions at all levels. The PB 2006-2007 will continue efforts from previous and current biennia, towards the development of an intensified, innovative, well-coordinated and effective health promotion movement in the Region during through the building of national capacities of Member Countries. Goal To create and maintain environment and conditions which support healthy living and wellbeing of the people of South-East Asia Region throughout the life span. WHO Objectives To develop and implement multi-sectoral public policies for health and integrated gender and age-sensitive approach that facilitate community empowerment and action for health promotion, self-care and health protection throughout the life course in cooperation with relevant national and international partners. Strategic Approaches • • • • • • • Develop Regional Policy/Strategies on Health Promotion and promote regional policy to policy makers of member states and development partners. Interagency advocacy consultation on partnership for health promotion. Documentation and disseminate success stories and lessons learnt based on health promotion policies and approaches Identify sustainable financial mechanism for health promotion Support the development of national health promotion policy and plan of action based on Regional Policy/Strategies on Health Promotion. Develop a regional compendium of indicators for evaluation of health promotion strategies and approaches Document and disseminate outcomes of health romotion on the region as part of regional publications.

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MENTAL HEALTH AND SUBSTANCE ABUSE

Regional Issues and Challenges: The activities organized by WHO during 2001, designated as the “Year for Mental Health”, have created a substantial amount of awareness amongst Member Countries about issues related to mental health, limitations in existing policies, limitations in appropriate service delivery, the large treatment gap for many neuropsychiatric conditions, and also the possibility of rectifying many of the limitations. There are many unique issues related to mental health in the regional Member Countries: scarcity of qualified manpower; lack of understanding of neuropsychiatric disorders as being medical in nature, thus, patients being taken to sorcerers and faithhealers; a substantial amount of services are provided by the informal sectors and unique patterns of alcohol abuse particularly in rural and remote areas. Finally, stigma against neuropsychiatric disorders is still widely prevalent. The Regional Office is playing an active role in providing technical support to Member Countries in developing strategies to enhance the existing health care delivery systems to meet the mental health needs of the community. The Regional Office supports the countries in two broad areas of work, first, to assist them in developing appropriate policies and secondly, in converting policy into programmes. More and more Member Countries (nine out of eleven in 2004-2005) are allocating Country Budgets towards activities in community mental health. Goal To reduce the burden associated with mental and neurological disorders, and substance abuse, and to promote mental health worldwide. WHO Objectives • • • To advocate with governments and their partners in the international community to place mental health and substance abuse on the health and development agenda. To assist Member Countries in formulating and implementing cost-effective responses to mental disorders and substance abuse. To promote mental health in all Member Countries.

Impact Indicators with baselines and targets: Impact Indicator Proportion of targeted countries that have implemented reforms in policies in the area of mental health. Proportion of targeted countries that have implemented reforms in services in the area of mental health. Number of countries that have increased their budget for mental health services. Baseline Target

2 countries (IND and 4 other countries THA) have implementing implemented reforms reforms in policies. in policies. 4 countries (IND, INO, MAL and MMR) have implemented reforms in services. Baseline will be measured from 2006. 4 other countries implementing reforms in services. 4 countries increasing budget for mental health.

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Strategic Approaches § § § § § § § § Development of mental health legislation in keeping with advances in medical sciences. Development of tools for evidence-based planning and service development for mental disorders. Development and implementation of strategies to address the most common and disabling mental disorders (epilepsy and psychosis). Development of technical material for promotion of mental health particularly amongst adolescents. Development of strategies for community-based rehabilitation of the intellectually impaired. Development of strategies for meeting the mental health needs of vulnerable groups, such as, women and the elderly. Development of community-based strategies for prevention of harm from alcohol and substance abuse. Development of EIC material to reduce stigma against mental disorders.

10. TOBACCO Regional Issues and Challenges Currently, 1.3 billion persons use tobacco in the world. Tobacco continues to be the second major cause of death in the world. Currently 4.9 million people die every year globally from tobacco use; out of this number, 1.1 million deaths occur from the SEA Region. The forces of globalization have led the tobacco industry to expand ever further in search of new markets in developing countries. In response to the globalization of the tobacco epidemic, WHO’s Member States unanimously adopted WHO's first global treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC), in May 2003. The treaty will enter into force once it has been ratified by forty Member States. So far, through 168 countries have signed the FCTC, only 23 have ratified it. Out of 11 SEAR countries, 10 have signed the FCTC and 5 have ratified it. Meanwhile, a vicious link has been established between tobacco and poverty. Tobacco contributes to the continuing poverty of low-income households and countries because money is spent on tobacco instead of food, education and health care. Given the existing poverty in the Region, this vicious link has implications for SEAR Member States. SEARO has been making efforts in building capacity in the area of surveillance and information system both in the Regional Office as well as in the Member Countries. A Regional Online Database System has been developed for dissemination of tobacco control information and also as part of Global Information System for Tobacco Control. A Regional Survey Template has also been developed in order to gather information for the Regional Database System. Global Youth Tobacco Survey (GYTS) has been undertaken in nine countries and repeated in three countries. The remaining countries will be covered in this biennium. Surveys were also undertaken among the health professionals. In order to effectively implement the FCTC, Member Countries are being encouraged to enact national tobacco control legislations. Regional Office will be providing technical support in developing these legislations.

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Regional Office has been making continuous efforts in the area of advocacy, public and media campaign about harmful effects of tobacco use in a number of ways. These efforts will continue in the biennium in order to reduce prevalence and use of tobacco among the population. In order to advance the tobacco control campaign in the Region, the goal of the Regional Office will be to protect people from the devastating health, social, environmental and economic consequences of all kinds of tobacco consumption and exposure to tobacco smoke through implementing effective tobacco control measures and assisting Member States in their efforts to implement the WHO Framework Convention on Tobacco Control. 11. NUTRITION Regional Issues and Challenges Each year malnutrition is implicated in more than half of the 11 million deaths of children under five in developing countries. Malnutrition cripples children’s growth, renders them susceptible to disease, dulls their intellects, diminishes their motivation, and saps their productivity. Hunger and malnutrition are among the most devastating problems facing the world’s needy, and are especially compromising for the health of the poorest nations. The fact that 79% of the world’s malnourished children live in South-East Asia Region is evidence that inappropriate, inadequate, unsafe feeding of infants and young children, is still very prevalent. This figure is shocking, not only because of persisting enormous magnitude of malnutrition, but because of the contribution of malnutrition to infant and young child morbidity and mortality. Therefore, there is an urgent need to reinforce healthy infant and young child feeding under normal and difficult situations (emergencies, HIV/AIDS). The incidence of low birth weight which reflects intrauterine growth retardation is also high in the majority of the member countries. Micronutrient deficiency disorders, particularly iodine deficiency disorders, iron deficiency anemia and vitamin A deficiency are still major public health problems in the region. Though considerable achievements have been made in the control of IDD, it still requires immense political commitment for the Member States to reach the sustainable goal of IDD elimination by 2005. Anemia is one of the most widespread public health problems affecting an alarming 600 million people and approximately 60% of the pregnant mothers in the region. Given the magnitude of these problems, greater efforts are needed to strengthen and implement programmes both to prevent and control these micronutrient deficiencies. In addition, the noncommunicable diseases like hypertension, cardiovascular disease, diabetes mellitus, obesity, etc. caused by rapid urbanization and economic development have posed a new challenge and area for action. Tackling these vast nutritional challenges will contribute to achieve the Millennium Development Goals (MDGs). The ability of member states need to be strengthened both to identify and reduce all forms of malnutrition and to promote healthy nutrition and lifestyle. Goal To prevent, reduce and, ultimately, eliminate malnutrition in all its forms; to reduce other diet related illnesses; and to promote well-being through healthy diet, lifestyle and nutrition. WHO Objectives To provide Member States and the international community with technical guidance and collaborative support for improving their effectiveness in identifying, preventing, monitoring and reducing malnutrition and diet related health problems, and in promoting healthy lifestyle.

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Indicators: • Proportion of regional expected results that are fully achieved.

Strategic Approaches To support evidence based actions to tackle all forms of malnutrition by:• • • • Focusing on prevention and control of malnutrition, including nutritional issues related to (i) emerging problems associated with nutrition transitions (ii) emergency situations and (iii) HIV/AIDS epidemics. Evidence based advocacy for integrating nutrition in the health and development agenda in member countries and to push from agenda to action. Facilitating and supporting operational research to improve interventions and their delivery in the member countries. Collaborating with other relevant organizations and agencies like FAO, WFP, UNICEF, UNAIDS, ICCIDD, Micronutrient Initiative, etc).

12. HEALTH AND ENVIRONMENT Regional Issues and Challenges According to the World Health Report 2002, environmental hazards are estimated to cause or contribute to the premature death of millions of people and result in the ill-health or disablement of millions more each year in countries of South East Asia Region. Dismal living conditions and poor environmental quality are having an increasing effect on health, particularly that of poor and vulnerable populations. One quarter of the global burden of disease is due to environmental health determinants. Children are more likely than adults to be exposed to contaminated water and soil, polluted air in the home, and toxic chemicals and are more vulnerable to the health effects of environmental contaminants. The highest environmental burden of disease, however, is due to indoor air pollution (acute respiratory infections) and to poor water supply and sanitation (diarrhoeal diseases). Air pollution, both indoor and ambient, is a major health threat to children. Nearly 75% of the population in the SEA Region cook with biomass fuels. An estimated 500,000 women and children die in India alone each year due to indoor air pollution-related causes. Outdoor air pollution, mainly from traffic and industrial processes, is a serious problem particularly in the ever-expanding megacities of SEAR countries. Unsafe water, sanitation and hygiene are responsible for a mortality of about 800,000 per year. More than 200 million persons in this Region lack access to safe sources of drinking water. Many more lack access to safe sources of drinking water, and no SEAR country has an adequate national programme of drinking water quality surveillance and control. No other WHO Region has lower sanitation coverage: more than 880 million persons, being 58% of the SEAR population, lack access to sanitation facilities. Most countries have hygiene promotion programmes but all are in need of strengthening as evidenced by the widespread lack of personal and food hygiene, responsible for about onethird of the high prevalence of diarrhoea in the Region. A separate but related challenge exists to strengthen countries’ capacities to prevent and mitigate water-related health emergencies associated with natural disasters. Groundwater is a significant source of drinking water in many SEAR countries. Arsenic contamination of groundwater, of natural origin, has been reported from Bangladesh, West Bengal and, to a lesser extent, from other countries. It is estimated that 40 to 50 million people may be exposed to unsafe levels of arsenic and close to 1 million are projected to contract arsenicosis and its debilitating complications such as cancer.

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The inadequate management of thousands of industrial, agricultural and household chemicals often results in unnecessary exposure to toxic chemicals, and sometimes in chemical incidents. Children who work from an early age in cottage industries - such as the bangle industry or production of firecrackers - are often exposed to toxic and hazardous chemicals that are widely and unsafely used. Chronic exposure is linked to damage to the nervous and immune systems and to effects on reproductive function and development. Very little is done, so far, to protect children’s environmental health in most SEAR countries. Less than 10% of the more than 1000 tons of health care wastes that are produced daily in the SEA region are disposed of safely. Unsafe management of medical waste poses a series of life threatening risks, for health care personnel as well as for the patients, and also to the general public. One major problem is that many used syringes get recycled back into the market, often without disinfection. Globally, about 100,000 cases of HIV infections are attributed to the reuse of contaminated syringes. The occupational and environmental epidemiology in SEAR needs strengthening to provide a uniform tool to combat the high prevalence of hazards in the workplace and the environment. These hazards range from biological, chemical and physical ones that are concentrated in the occupational settings or amplified during the process of development and industrialization. With a work force of about 750 million persons in SEAR, member countries do not have comprehensive national plans on occupational health and have limited access to tools and technologies for mitigation of occupational risks. Goals • • To cut in half, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation, with corresponding health gains. To have national chemicals management profiles (NCMPs) in place in the majority of Regional countries.

WHO Objectives To support countries in their efforts to promote healthy environments for sustainable human development through strengthening their capacities to assess and manage effectively critical environmental determinants of health leading to a reduced environmental burden of disease. Indicators • • • Number of countries ensuring optimal health benefits from the investments in water and sanitation services. Number of countries implementing an active chemical safety programme, including the establishment of poison control centres. Number of countries having initiated occupational health programmes for high risk workers in industry and agriculture.

Strategic Approaches • • • • Engagement in environmental health policy through science-based evidence for advocacy. Technical support to the implementation of health-based environmental standards. Strengthening the development, evaluation and management of knowledge on health and environment linkages. Supporting research on the epidemiological evidence of the environmental burden of disease and the development of methods for cost-benefit evaluations.

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13. FOOD SAFETY Regional Issues and Challenges Unsafe food results in diseases of different type and severity, and in many cases result in long-term suffering and death. Unsafe food, in conjunction with unsafe water, is the prime cause for diarrhea and other infectious diseases, killing an estimated 800,000 people each year in South-East Asia. Despite the extent of food-borne diseases, many governments have not yet clearly articulated written policy on food safety, nor, in several countries, is there any one authority with a clear mandate for food safety as the responsible authority. National Plans of Action for Nutrition (NPAN) have been drawn up by all the countries of the Region. In most of these countries, however, such programmes are not yet seen as key policy instruments of relevance to food control authorities. Globalization of the food trade and development of international food standards have raised awareness of the interaction between food safety and export potential for developing countries. Further, with the adoption, and in some cases rejection, of foods produced by new technologies including genetic engineering, irradiation of food, or modified-atmosphere packaging, food safety considerations have broadened to encompass consideration of not only safety issues but also health benefits, environmental effects, ethical issues, and socioeconomic consequences. Changes in food production result in new types of food that may harbor less common pathogens. Intensive animal husbandry technologies, introduced to minimize production costs have led to the emergence of new zoonotic diseases which affect humans. The emergence of new pathogens such as enterohaemorrhagic Escherichia coli and bovine spongiforming encephalopathy and pathogens not previously associated with food is a major public health concern. The emergence of increased antimicrobial resistance in bacteria-causing diseases is also aggravating this picture. There has been a shift in food safety policies away from traditional enforcement as the primary control mechanism. In many countries these had proven ineffective, and for others too expensive to administer. New policies are being introduced with a preventive basis for regulatory measures for food safety as the main thrust. Food safety has also moved on in many countries from a “whole of population” approach to the development of strategies to address the difficulties experienced by sensitive population groups such as children, pregnant women and the elderly, the combined low-level exposure to several chemicals, endocrine effects from pesticide residues and other chemicals, and effects on development of the foetal neural system. Estimates of the exposure of specific subpopulations are often hampered by inadequate data on dietary intake and on levels of contamination of food. There are also clear, but to date not quantified, differences in exposure to chemicals in different areas of the Region. The integration and consolidation of agricultural and food industries, and the globalization of the food trade are changing the patterns of food production and distribution. These conditions require a response that reflects the holistic nature of food safety from producer to final consumer to ensure that exposure to unacceptable levels of microbiological agents and chemicals in food is prevented. Food safety programmes are increasingly focusing on a farm-to-table approach as an effective means of reducing food-borne hazards. This holistic approach to the control of food-related risks involves consideration of every step in the chain, from raw material to food consumption, including food hygiene. Food control programmes vary dramatically between the countries of the Region, and there remain major concerns about the adequacy and relevance of food legislation and regulations; food control infrastructure; government resources allocated to food control, training activities, and the limited integration of the Hazard Analysis and Critical Control Path (HACCP) system into food regulations. Information from countries suggests only moderate development of codes of practice, and training in HACCP has been only sporadic, largely due to a lack of trained personnel. Much more technical assistance and support would be

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required if countries were to adopt HACCP-based food regulations and implement HACCPbased systems of food inspection. Also, the implementation of food safety controls continues to be impacted by ongoing health sector reforms that advocate a move towards outsourcing of key services rather than the central government being the sole health services provider. Goals • To have reduced adverse health effects of microbial and chemical food contamination, and the associated food-borne burden of disease, throughout the Region To have substantively strengthened food safety authorities, and supporting laboratories, in place in the majority of countries of the Region

•

WHO Objectives To support health sector authorities in their cooperation with agricultural sector agencies and other stakeholder groups, such as consumers and international food traders, in their efforts to assess, communicate and manage food-borne risks to human health. Indicators • • • Number of countries having developed effective food standards and regulations, based upon international food safety standards and guidelines. Number of countries having established rapid information exchange mechanisms based upon reliable data on food-borne diseases and on food contamination levels. Number of countries cooperating effectively with relevant international bodies such as the FAO/WHO Codex Alimentarius Commission.

Strategic Approaches • • • • Engagement in food safety policy development through science-based evidence for advocacy. Technical support to the initiation of holistic food safety management systems, following the HACCP approach. Strengthening the establishment of adequate databases on the incidence of foodborne diseases and outbreaks, including support to food testing laboratories. Supporting research in identifying priority food-borne hazards, particularly chemical contaminants, and in evaluating cost-effective measures for their prevention and control.

14. VIOLENCE, INJURIES AND DISABILITIES Regional Issues and Challenges South-East Asia Region has a disproportionately high burden of injuries and violence with more than a quarter of global injury burden. Road traffic injuries, already high are predicted to increase by 144% in South-East Asia, more than any other Region in the world. Public health response to prevent and control injuries and violence has been slow in SEAR countries. The major concern is the lack of effective information system for programme and policy development, which is the key priority for this Region. In addition, national capacity to respond to injury prevention and control needs to be enhanced through development of appropriate human resource for health and technical guidelines.

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Increasing number of persons with disability due to ageing population, injuries and “survival” of infant and young children due to “successful” medical intervention is a major challenge to health system. Integration of rehabilitation services in PHC has remained weak in this Region. Goals • • • • Two countries will have strengthened injury surveillance system Two countries will have strengthened pre-hospital trauma care system Two countries will incorporate injury and violence prevention in medical and nursing undergraduate education Two countries will have strengthened integration of rehabilitation in PHC

WHO Objectives 1. Support provided to target countries for implementation of surveillance and response systems for prevention and care of injury and violence. 2. Support provided to the member countries for integration of rehabilitation services into PHCs Indicators • • • • Number of countries implementing information system for injury and violence Number of countries implementing pre-hospital trauma care system Number of countries implementing training modules and programs for injury and violence prevention Number of countries implementing the integration of rehabilitation in primary health care

Baseline • • • • Thailand and Maldives have injury information system Thailand has a pre-hospital trauma care system A framework for teaching injury prevention and control in nursing and medical education and modules for training will be available by 2005 India has ongoing pilot projects for integration of rehabilitation into PHC

15. REPRODUCTIVE HEALTH Regional Issues and Challenges Reproductive and sexual health is fundamental to individuals, couples and families, and to the social and economic development of communities and nations. However, good reproductive and sexual health continues to elude millions of men and women from the South-East Asia Region. In 2000, pregnancy-related complications claimed the lives of more than 170,000 women. Neonatal mortality and stillbirth, which are closely related to women’s health and care during pregnancy, childbirth and the postpartum period, has not declined over the past two decades despite the progress made in reducing infant and child mortality. Access to and use of contraceptives have been significantly improved in the last three decades; however, there are problems with unmet need for accessing safe and effective contraception in most

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member countries, especially for the poor and the marginalized, adolescent and unmarried couples. This results in unintended pregnancies and almost 20 million induced abortions annually, some of which are terminated under unsafe conditions. Approximately 40% of these unsafe abortions are among young women aged 15-24 years. Complications arising from unsafe abortions account for some 12% of all maternal deaths. The increasing prevalence of STIs, including HIV/AIDS, poses a threat to the health and welfare of the society, especially women, children and young people. Other issues, such as violence against women and women trafficking are problems, which are against human and reproductive rights, faced by most member countries. Goal • To support member countries in the attainment by all peoples of the highest possible level of reproductive and sexual health.

WHO Objectives • To strengthen national efforts in ensuring the widest achievable range of safe and effective reproductive health (RH) services being provided across the health system and integrated into primary health care by 2015.

Impact Indicators, Baseline and Targets Impact Indicators Baseline Target (2007) 50% of countries

1. Number of countries integrating at least N.A three components of RH services in primary health care. 2. Number of countries reporting progress on at least any two RH indicators. Strategic Approaches • • • • • • N.A

50% of countries

To ensure that up-to-date practices are implemented throughout the health system, thus strengthening the quality of care. To provide evidence on causes, determinants, prevention and management of morbidity and mortality related to reproductive and sexual health. To identify and overcome obstacles to the access to and use of reproductive and sexual health services. To contribute to the empowerment of individuals, families and communities to increase their control over their reproductive and sexual health. To create supportive regulatory frameworks at the national and local levels. To create a dynamic environment of strong international, national and local support for rights-based reproductive and sexual health initiatives.

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16. MAKING PREGNANCY SAFER Regional Issues and Challenges Each year, some 15% of the estimated 40 million women who become pregnant in SEAR, suffer life-threatening complications related to pregnancy, many experiencing long-term morbidities and disabilities. In 2000, an estimated 174,000 women died during pregnancy and childbirth from largely preventable causes. Most maternal deaths arise from postpartum haemorrhage, prolonged labour, eclampsia and sepsis, including septic abortion. The practice of unsafe abortion in most member countries, resulting from unwanted pregnancy, contributes some 12% of maternal deaths. More than 90% of maternal deaths occur in countries with high population and high maternal mortality ratio (MMR), such as India, Bangladesh, Indonesia, Nepal and Myanmar. Factors commonly associated with these deaths are the absence of skilled health personnel during childbirth, lack of services able to provide emergency obstetric and neonatal services for complicated cases, inequities and vast gap in accessing maternal and neonatal health services in community, and ineffective referral systems. Proportion of delivery attended by skilled health personnel in Nepal and Timor-Leste was 13.5% and 19.5% in 2002; in Bangladesh and Bhutan was 21.8% and 23.7% and in India 42.3%. Majority of poor women in most member countries deliver their babies without the help of a skilled birth attendant. Women from the poorest households, and the marginalized, are most likely to suffer ill health and death as a result of complications during pregnancy, childbirth and the postpartum period. Of the approximately 2.2 million infant deaths in 2000, 1.4 million occur during neonatal period. Approximately two-thirds of the neonatal deaths occur during the first week of the neonatal period. Moreover, some 1.6 million babies are born dead. Nepal, India, Bangladesh, Myanmar, Timor-Leste and Bhutan have neonatal mortality rate (NMR) ranging from 34 to almost 50 per 1,000 live births. Many of these deaths are related to the poor health of the women and to inadequate care during pregnancy, childbirth and the postpartum period. These figures, together with MMR, have remained unchanged since the early 1980s. Goal • To support member countries in achieving the Millennium Development Goals in the reduction of maternal mortality ratio (MMR) by three-quarters, and in the reduction of neonatal mortality rate by half between 1990 and 2015.

WHO Objectives • To strengthen national efforts to implement policy and cost-effective interventions that will ensure the health systems provide all women and newborn with a continuum of care throughout pregnancy, childbirth and the postnatal period, with special attention to skilled care at every birth.

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Impact Indicators, Baseline and Targets Impact Indicators Proportion of births attended by skilled health personnel: • • • • • • • • Bangladesh Bhutan Nepal Timor Leste India Indonesia Maldives Myanmar 21.8% 23.7% 13.5% 19.5% 42.3% 62.3% 70% 77.5% At least 40% At least 40% At least 40% At least 40% At least 70% At least 80% At least 80% At least 85% Baseline Target (2007)

Strategic Approaches • • To build political and social commitment and effective partnerships. To provide technical support to address the key interlinked elements required to build the continuum of care: o o o o • • • Human resource development in maternal-newborn health care; Provision of accessible, quality maternal-newborn health care services which are used by women; Empowerment of individuals, families and communities to increase their control over maternal-newborn health; Integration of other primary health care programmes with maternal-newborn health services.

To develop and adapt evidence-based standards/guidelines for effective maternalnewborn care, and support countries in dissemination and implementation. To monitor and evaluate progress towards strategic goals and improved maternalnewborn health. To generate evidence for effective maternal-newborn health programming.

17. GENDER EQUITY, WOMEN AND HEALTH Regional Issues and Challenges Differences and inequalities in socially attributed roles and responsibilities of women and men and gender-based disparities in access to resources, information and power have different consequences for women’s and men’s health. These factors, in interaction with other social inequalities and biological characteristics, are reflected in women’s and men’s exposure to health risks, access to, and use of, preventive and curative measures, health status and social consequences of ill-health. The Platform for Action adopted at the Fourth World Conference on Women (Beijing, 1995) identified “women and health” as a crucial theme and recommended “gender mainstreaming” as the strategy for implementing actions in all critical areas of concern,

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including health. United Nations General Assembly resolutions and the Millennium Development Goal 3 also call for the consideration of gender to be integrated into the policies and programmes of bodies of the United Nations system and for acceleration of efforts to achieve equality between women and men. WHO’s policy seeks to integrate a gender perspective into its programmes and health-sector policies and strategies. Efforts to-date have focused on building up evidence about the way gender inequality affects health; gender-based violence; gender and HIV/AIDS; and the integration of gender considerations into health research, policies and programmes. However, more work is needed to ensure that this approach becomes a core component of all public-health work. Raising awareness and fostering partnerships between WHO, other organizations of the United Nations system, governmental bodies and nongovernmental organizations are essential. Good practices in reducing gender inequality in health systems need to be developed and documented. Capacity needs to be built in both national health systems and WHO to bring gender perspectives into the mainstream of all policies, and that integration needs to be monitored. As gender is a cross-cutting issue, political will, commitment from senior management and accountability are essential to ensuring that it is considered in all WHO’s work. Goal To achieve better health for girls and women, boys and men, through the promotion of gender equality between men and women, women’s empowerment and the promotion of health research, policies, and programmes that adequately address gender issues. WHO Objectives To develop and provide support for the use of tools, strategies and interventions for the effective integration of gender considerations into health research, policies and programmes, in order to redress gender inequality and mitigate its impact on health. Indicator

Proportion of targeted Member States and other health partners that are using one or more WHO tools for integration of gender and women’s health in the development of health policies, strategies and programmes. Strategic Approaches Provision of support for data collection, research, reviews and policy analysis to improve knowledge on the impact of gender inequality and roles on health and health care, and formulation of appropriate strategies; formulation, piloting and evaluation of indicators, tools and standards for the integration of gender perspectives into public-health policies, programmes and research, and for application in activities related to gender and women’s health; development of skills and expansion of capacities at all levels of national health systems and within WHO to generate sex-disaggregated data, analyse them from a gender perspective and use the results to bring gender into the mainstream of health policy and programme development; advocacy and fostering of partnerships between WHO and other organizations of the United Nations system, nongovernmental organizations and other entities in order to raise awareness of, and disseminate information on, equality between men and women and health equity, with creation of intersectoral networks in countries to support this process.

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18. CHILD AND ADOLESCENT HELATH Regional Issues and Challenges The number of children under five years of age dying every year reaches nearly 11 million; most of these deaths are in developing countries. The major killers remain unchanged, with over half of the deaths due to pneumonia, diarrhoea, malaria, measles, and HIV/AIDS; malnutrition underlies more than 50% of all deaths. The 11 Member Countries of the WHO South-East Asia Region are home to about a quarter of the world population. The Region carries a disproportionate burden of mortality in children under five. The Region also accounts for almost one-third of the global child deaths. Seven Member Countries in the South-East Asia Region (Bangladesh, Bhutan, India, Maldives, Myanmar, Nepal and Timor-Leste) have a significantly higher under-five mortality rate than the global average. Forty-two countries all over the world account for 90% of the annual child deaths. From the South-East Asia Region India (with 2,402,000 deaths), Bangladesh (with 343,000 deaths), Indonesia (with 218,000 deaths) Myanmar (with 132.000 deaths) and Nepal (with 76,000 deaths) figure on the list. Health of the newborn has been a relatively neglected area in the Region. Over 40% of child mortality is accounted for by deaths in the neonatal period. The Region accounts for about 1.5 million neonatal deaths every year. High prevalence of low-birth weight approaching 33% in some countries contributes to the high neonatal mortality. Adolescents (10-19 years) constitute 18-25% of the population in SEAR countries. Though adolescents are considered to be healthy, they face various health problems that include under-nutrition, early marriage and early childbearing, obesity, substance abuse, violence, injuries and suicide. It is being increasingly recognized that behaviours and health problems during adolescence can have grave public health and socio-economic implications. Globally more than 50% of new HIV infections occur amongst young people (10-24 years) every year. The vulnerability of young people in SEARO due to decreasing age at sexual debut, injectable drug use and lack of accurate information and services exposes them to increased risk of HIV infection. Focus on young people provides a window of opportunity to deal with the HIV pandemic. Cost-effective evidence based interventions are available, and where implemented on a reasonable scale have significantly reduced newborn and child mortality, improved child growth and development to a healthy adolescent But their current coverage is not sufficient to benefit those in greatest need. Most Member Countries of the Region have a reasonable public health infrastructure in place. The challenge is to make it responsive to community needs. This would involve improving skills and competency of health care providers, exploring alternate mechanisms for delivery of interventions, logistics and supplies, and establishing a system of constant monitoring and supervision. For adolescent in addition to supporting the social environment of adolescents the programme needs agespecific/appropriate information. Integrated management of childhood illness (endorsed by the Health Assembly in resolution WHA 48.12) is a cost-effective health sector and community-based strategy that supports and complements other global initiatives to promote child survival, growth and development. Implementation of the Global strategy for Infant and Young Child Feeding, (endorsed by the Health Assembly in resolution WHA 55.25) supports interventions to improve feeding practices, reduce malnutrition, and improve growth and development. In addition, WHO/SEARO will maintain strong partnerships with other organizations agencies, nongovernmental organizations, governments, professional organisations, the

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private sector and communities, and it will guide international and national policies through support for instruments such as the Convention on the Rights of the Child. Goals • • To reduce by two-thirds the rate of infant and child mortality by the year 2015 from the 1990 rate (in line with corresponding Millennium Development Goal). To reduce by 25% globally HIV prevalence among young people 15-24 years old by the year 2010 (in line with corresponding UNGASS children and UNGASS AIDS goal).

WHO Objectives To enable countries to pursue evidence-based strategies in order to reduce health risks, morbidity and mortality along the life course, promote the health and development of newborns, children and adolescents, and create mechanisms to measure the impact of those strategies. Indicators • • • Number of countries fully implementing policies and programmes on newborn and child health and development (baseline:4 target: 9). Number of countries fully implementing policies and programmes on adolescent health and development (baseline: 3 target: 6). Number of research projects supported by WHO that resulted in the formulation of strategic norms, standards and guidelines for reducing child mortality and improving child and adolescent development (baseline: 3 target: 5).

Strategic Approaches • • Advocacy for development of appropriate policies, strategies and investment. Providing WHO’s cost-effective and evidence based mechanisms and guidelines to deal with diseases and conditions that represent the greatest health burden to populations; implementation of such tools in countries with feedback for further research. Building regional and country capacity through technical support. Strengthening partnership better coordination and maximizing better utilization of resources. Supporting research and generating evidence. Measuring progress.

• • • •

19. IMMUNIZATION AND VACCINE DEVELOPMENT Regional Issues and Challenges The primary priority of IVD both globally and in the region remains polio eradication. In 2004-2005, the major effort in SEARO was to interrupt transmission in India, the last remaining endemic country in the region. In 2006-2007, the challenge will be to maintain certification standard AFP surveillance in all countries in the face of other health priorities and declining resources. In addition, intense effort will be required to complete certification documentation and implement containment procedures. By 2004, the WHO surveillance networks in 5 countries in SEARO have already expanded their role beyond AFP to include other vaccine preventable diseases (VPD). While these surveillance and laboratory networks continue to focus on AFP through certification, WHO must work closely with each country to determine how the extensive

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human resources and infrastructure dedicated to polio can be channelled to address other communicable diseases or assist in strengthening immunization systems. Beyond polio, other VPD continue to cause significant morbidity and mortality in the region. In spite of encouraging trends in routine vaccination, in 2002 over 10 million children in the region were not immunized against measles and an estimated 196,000 died due to this disease. In order to make a sustainable impact on measles and other VPD by 20062007, unprecedented attention must be focused on reaching previously underserved populations. This includes expanding immunization beyond infants and women of child bearing age to include school age children and adolescents. WHO’s role will be the continued provision of high quality technical support for strengthening service delivery, national policy setting, monitoring and evaluation, and sustainable financing of immunization services. Regardless of the target population, the essential premise of basic Expanded Programmes on Immunization (EPI) remains the safe provision of high quality vaccines. Injection safety assessments in multiple countries throughout the region in 2003 found that 60-70% of all immunizations were unsafe. Although all member countries began introducing auto disable (AD) syringes by 2004, full implementation by 2006-2007 will require technology transfer for expanded regional production of these syringes and development of safe, sustainable waste management. While providing assistance to consolidate improvements in basic EPI in 2006-2007, WHO will be challenged to expand the horizons of currently available vaccines. Previous vaccine research has tended to focus on needs of developed countries. WHO must assist in developing research capacity in SEAR member countries to ensure the availability of new and under-utilized vaccines relevant to regional priority diseases such as Japanese encephalitis, Rota virus, dengue, and pneumococcal disease. A key role of WHO remains ensuring the capacity of National Regulatory Authorities to oversee the quality control of current production and research and development of these new vaccines. Goal To protect all people in the region at risk against vaccine preventable diseases. WHO Objectives To assure the certification of polio eradication in the region; to obtain reliable data on vaccine preventable diseases and status of immunization services down to the district level; to insure adequate vaccine quality; to strengthen national planning and management capacity to equitably and safely deliver immunization services; and to foster development and introduction of new vaccines where warranted. Indicators • Number of poliomyelitis cases due to wild or vaccine-derived poliovirus. • Number of member countries meeting key surveillance indicators at second administrative level. • Number of measles deaths and cases estimated regionally. • Percentage of countries in the region achieving district level DTP3 immunization coverage of >80% in all districts. • Coverage of children less than one year of age with three doses of hepatitis B vaccine. Strategic Approaches • • Monitoring and surveillance at country/district levels; Coordination of regional collaboration on vaccine procurement, quality control, and research/development;

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Training and technical support for planning and developing management capacity at national and district level for immunization services and vaccine quality control; Coordinate and expand regional partnerships. ESSENTIAL MEDICINES

Regional Issues and Challenges Essential medicines save lives, reduce suffering, and improve health, but only if they are of good quality and safe, available, affordable, and properly used. However, it is estimated that 2 billion people – one-third of the global population – do not have regular access to essential medicines. In SEAR with a quarter of the world’s population this would translate into 500 million and quite likely to be more, as developing countries have a disproportionate share of those without access. However, the average expenditure on medicines in the region is between 5-10 USD/person/year. This is sufficient for providing essential medicines to all and making a remarkable impact on health. Why then is it not so? For the human right to health to be realised, the beginning is an elected government responsible to the people. Such a government would inform the people, encourage discussion and empower them to make the decisions that would realise their right to health. For example whether health care (and in it, medicines) should be funded by the State through government revenue or a mixture of public and private sector with good regulation to ensure cost effective services is a choice that the people need to make. Unfortunately governments that do this in the region are rare and therefore the fundamental premise from which health should begin is lacking. The WHO mandate does not extend to assisting in the genesis of such governments. Therefore WHO is limited to working “downstream” in the health care system and its activities are modifying, shaping, moulding, and rectifying deficiencies/leaks of system that has a fundamental problem. This limitation has to be understood to design country proposals and activities in health. A National Drug Policy (within a National Health Policy) should underpin medicines activities in a country. Countries in the region lack such a policy but manage with ad hoc policy such as government legislation, regulation and ministerial/administrative order. There is emphasis on the mechanics of drug procurement and cost, rather than a policy on access (health insurance? equitable user fee?) and then deciding on how drugs can be paid for. Irrational drug use is so widely prevalent, that in some areas more than 50% of the drugs are thought to be wasted. Poor quality drugs are manufactured and supplied as there is insufficient national regulatory control to ensure the minimum quality required. However when markets (i.e. exports with external supervision) demand it, the pharmaceutical industry in the region can readily produce drugs of world class quality. Supervision and monitoring which are crucial when resources are very constrained, are either non-existent, weak in some areas and almost non-existent in others. The escape valve for all these deficiencies is the iniquitous private sector fulfilling real/perceived/unnecessary demands. SEARO’s contribution is to provide the technical knowledge, sharing of country (both regional as well as extra-regional) experiences, tools that have been developed to analyse and sharpen the focus on medicines activities. The central priority remains that of expanding access to essential medicines, one of the health-related Millennium Development Goals to which the international community is committed. To expand access, no major new knowledge or initiatives are required – it is improving on what exists. Goal To help save lives and improve health by ensuring the quality, efficacy, safety and rational use of medicines, and by promoting equitable and sustainable access to essential medicines, particularly for the poor and disadvantaged.

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WHO Objectives To frame, implement and monitor national medicine policies aimed at: increasing equitable access to essential medicines, particularly for priority health problems, the poor and disadvantaged; ensuring the quality, safety and efficacy of medicines by developing international standards and supporting the implementation of effective regulation in countries; and improving rational use of medicines by health professionals and consumers. Strategic Approaches • • • • • Advocate and support the implementation and monitoring of medicines policies based on the concept of essential medicines. Provide support for a public health friendly approach in trade agreements and monitor the impact of these agreements on access to quality essential medicines. Provide guidance on financing the supply and increasing the affordability of essential medicines in both the public and private sectors; inter and intracountry comparisons of essential medicines (through price surveys) to be a major component. Promote efficient, transparent procurement and distribution systems for medicines supply in order to ensure continuous availability of essential medicines. Instruments for effective medicine regulation and quality assurance systems promoted in order to strengthen national regulatory authorities. Evaluation of national drug regulatory authorities as well as regional cooperation on drug regulation to be a major tool in achieving this. Awareness raising and guidance on cost-effective and sound use of medicines promoted, with a view to improving medicines use by health professionals and consumer.

•

21. ESSENTIAL HEALTH TECHNOLOGIES Regional Issues and challenges Strong health systems rely heavily on access to and use of health technologies. The health technologies range from the tongue depressor to magnetic resonance imaging equipment and from health laboratories to blood transfusion services. The blood transfusion services (BTS) in Member Countries of SEAR are in varying stages of development. Against an estimated annual requirement of 15 million units of blood, around 8 million units are collected. Voluntary non-remunerated donations vary from 40-93% in different countries. Paid donors continue to be a major source in Bangladesh. Almost three fourth of the collected blood is utilized as whole blood. Quality of screening for major infections such as HIV and hepatitis B & C remains questionable. This is a critical issue in SEAR where number of people living with HIV, hepatitis B and hepatitis C is estimated to be 6 million, 85 million and 25 million, respectively. Various key issues that plague blood transfusion services include absence of national policy and allocation of resources to modernize blood transfusion services, insufficient infrastructure, non-availability of norms, standards and guidelines, lack of social awareness about the importance of voluntary donation, inadequate regulatory mechanism, irrational clinical use of blood, quality of blood products and weak quality management of blood banks. Upgradation of health laboratories in general, and public health laboratories in particular, has been a neglected area in spite of glaring impact on management of various outbreaks notably due to SARS, highly pathogenic avian influenza, Nipah virus, rickettsiosis, dengue fever, Japanese encephalitis and leptospirosis. At present many outbreaks remain undiagnosed even after their natural course. Facilities to diagnose exotic infections e.g. Ebola and most of the agents with bio-terrorism potential are limited. Efficient laboratory support to care and diagnosis of HIV/AIDS is considered essential but very primitive in most

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parts of high burden countries. In spite of WHA Resolution 27.62 (1974) and RC resolution SEA/RC49/R4 (1996), challenges being faced for efficient public health laboratories include absence of national policy and allocation of resources to modernize public health laboratories, insufficient infrastructure, non-availability of norms, standards and guidelines, inadequate regulatory mechanism, weak quality management of public health laboratories, improper utilization and maintenance of equipment and non-availability of quality diagnostic kits and reagents on continuous basis. Evolving epidemic of HIV/AIDS in SEAR countries warrants strengthening of laboratory support since both diagnosis of HIV/AIDS as well as initiation and monitoring of antiretroviral therapy are entirely dependent upon the laboratory parameters. Transplantation of human organs and tissues is increasing. The infrastructure and expertise have improved in selected tertiary care institutions. Being a new technology with far reaching ethical implications, norms and standards to efficiently regulate it are urgently required. WHO has recently developed basic operational framework for eight essential health technologies. These frameworks describe the basic requirements for a particular technology in the country along with the WHO products and deliverables that can assist in implementation of these basic requirements. Goal To strengthen the ability of national health systems to address health problems through the use of essential health technologies including blood transfusion services WHO Objectives To support Member Countries, both technically and operationally, in establishing safe and reliable services for essential health technologies through the adoption of basic operational framework covering policy, access, safety and use. Indicator Indicator Number of countries with basic operational framework of blood transfusion services integrated into national health system Baseline Only one country (Thailand) has basic operational framework of blood transfusion services integrated into national health system Target At least four countries will have basic operational framework of blood transfusion services integrated into national health system

Strategic Approaches • • • Advocacy for basic operational framework, and development of national policies, Provision of technical support to Member Countries, and Capacity building

22. POLICY MAKING FOR HEALTH IN DEVELOPMENT Regional Issues and Challenges WHO as a lead international inter-governmental organization for health development advocates and influences on a wide range of national and international policies, laws, agreements and practices of the functioning and effectiveness of health systems and the achievement of health outcomes. It always maintains the principle for human dignity,

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security, ethics, equity and social justice, and the need to maximize health opportunities by tackling social and economic barriers to health and health care. WHO took the opportunity to promote the health priorities in national and international processes for development within the framework of poverty reduction, greater health equity and achievement of the relevant Millennium Development Goals and other internationally agreed development goals. The challenge for WHO is to translate this opportunity into policies and strategies that will increase health investments, focus on the poor and reduce health inequities, and to build institutional capability – both in national governments and in WHO’s country offices – for their implementation. A further challenge will be to identify macro-level or national policy implications for the health sector from community-based work under way in many regions. Goal To raise awareness and advocate the role of better health, particularly of the poor, in achieving overall development objectives, including MDGs; and to bring ethical, legal, and human rights norms into the formulation of national and international health-related programmes, policies and laws. WHO Objectives To continue to sensitize and raise awareness and influence the policies on the need to maintain and further secure the centrality of health to a wide range of development processes at national and regional levels. Indicators • Awareness and Reemphasis placed on the role of health in various high level national and regional forums and their translation into policies, plans and action at country level Strategic Approaches • Continuation of technical and strategic support to countries on such major policy and programme issues relating to achieving the development goals, within the framework of equity, social justice, ethics and globalization; Providing strategic support to WHO country offices to facilitate appropriate technical support to the countries in these areas, through the development of policy, guidance and direct support; Focusing WHO’s contribution on achievement of the health-related Millennium Development Goals and other internationally agreed development goals.

•

23. HEALTH SYSTEM POLICIES AND SERVICE DELIVERY Regional Issues and Challenges In many countries of the Region, national capacity and resources – human, financial and material – are still insufficient to ensure availability of and access to essential health services of high quality for individuals and populations, especially those most vulnerable. Problems include inability of governments to assure quality of providers and of service delivery, imbalances in human resources, fragmented services that lead to inequitable coverage, and inefficiencies in resource allocation and management. This requires improving government capacity, especially in the area of stewardship, and adjusting approaches to financing and resource generation as well as to provision of health services. Extending health enabling conditions and quality care to all is the imperative for health systems. The thrust must be on strengthening health systems based on PHC principles. Thus, there is a real need to redefine, adjust and strengthen PHC approach in the

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context of the new and emerging health care issues in the Region e.g. HIV/AIDS, SARS etc. Changes in demographic profiles and in the socioeconomic environment present massive new challenges to public health in the Region. Increased preventable risks and chronic, noncommunicable diseases, as well as violence, threaten societies already burdened by communicable diseases. Another major challenge facing the health systems in the Region is inequity in health. In spite of increased coverage in health services through primary health care during the past two decades, 25-30 per cent of the population does not have access to standard quality health care. Community involvement – including the dimensions of participation, ownership and empowerment – is key. The profit–oriented approach and privatization of health care without effective regulatory systems has had a negative impact on people’s health in the Region. The challenge lies in devising ways for financing health systems that could meet the health care needs of the people. The role of the private sector needs to be defined and a judicious mix of the public and private sector is needed to provide for a suitable health system. Also new models for health workforce strengthening must be developed based on a new approach that emphasizes decentralized management of health problems at the district level. The health sector must take the prime responsibility to foster a multi-sectoral, multidisciplinary approach for development of appropriate resources for health, achieving equity in health status by undertaking more effective measures for disease prevention and health promotion. Goal To work in close collaboration with Member States to improve their capacity to deliver quality health services affordably, efficiently and equitably to all people, especially the poorest and most vulnerable sections, through strengthening PHC and the health system as a whole. WHO Objectives 1. To strengthen strategic health system leadership and effective policy-making capabilities in countries. 2. To enhance the planning and provision of health services that are of good technical quality; responsive to users; contribute to improved equity by achieving greater coverage; and make better use of available resources. Strategic Approaches • Strengthen WHO’s support in the area of health sector reform by promoting a better understanding among Member States of the rationale and process of decentralized planning and management, social health insurance, etc. and by providing evidencebased information and documentation and disseminating lessons learnt from other Member States. Assisting countries to scale up efforts in health service delivery by providing technical and operational support to national authorities in organization and management of National and District Health Systems based on the principles of PHC. Strengthen MOH’s capacity in order that they may play a strong stewardship role through development of basic minimum/essential health care services, standards setting/quality assurance, regulation and accreditation.

• •

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24. HUMAN RESOURCES FOR HEALTH Regional Issues and Challenges Integrated HRH planning involves estimating future requirements for human resources and identifying efficient ways of meeting those requirements. There is no ‘right’ number and mix of health professions. Need-based approaches have been used by many countries with WHO support. Utilization-based and demand-based approaches are also possible. Countries in the Region are yet to develop data systems for HR except for a few countries. Training programmes, both within and between countries, are not standardized for the different health professions. Guidelines and curricular outlines are yet to be systematically developed according to needs and current development in technology. In the past, reorientation and innovations in technology and education have been applied to only medical and nursing programmes. Education of allied health professionals, consisting of a numerically larger group in the health teams representing professions and occupations with variable skills, was ignored. With changing trends to achieve better health outcomes through home based care, more attention needs to be given to streamline this essential group of health workers. Equity and access to basic health services still remain a problem in Member Countries. Universal coverage is high on political agenda of most governments in the Region. However, the significant link remains the family doctor who caters to a wider spectrum of health conditions, in collaboration with public health practitioners. Only three countries of the Region have recognized family medicine as a specialty with training curricula. Although public health is increasingly considered as a major profession, very little attention is given to updating educational and training programmes. Appropriate career structures are yet to be developed in Member Countries. In health services administrative sector many officials lack formal training in public health. Many public health professionals also lack opportunities for continuing education in their fields. Lack of formal training creates barriers to individual development as well as to the development of public health as a recognized profession. Countries are yet to develop appropriate strategies in HR management. In many instances, even the available resources are not appropriately utilized. Very little evidence is used in management and HR planning. Management and leadership competency is still not considered in training and recruitment. Systematic inquiry and research are needed to develop HR in the context of SEAR. Goal To improve the performance of health systems through strengthening health workforce development and management to achieve greater equity, coverage, access and quality of care for the population. WHO Objectives To support Member Countries in : • • Strengthening national capacity for human resources policy development based on evidence-based models of workforce planning and up-to-date HR information system. Developing fully trained, contextually relevant human resources representing an optimal mix of competencies required to serve the health systems.

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Strategic Approaches Development of policy guidance and best practices to support HRH policy formulation and implementation by linking policy frameworks for HRH with other aspects of health services delivery and health systems development. Activities are to be developed through country dialogue and be country-led, focused on solutions and built upon existing information and policy development processes. 25. HEALTH FINANCING AND SOCIAL PROTECTION Regional Issues and Challenges Social Health Insurance alone is not a panacea or remedy to replace other mechanisms or forms of health care financing, e.g. particularly financing based on general tax revenue. The Government should not shirk from its responsibility to ensure and regulate provision of health care including essential public health functions, whether directly by public or private health care providers. The ultimate goal of health care financing is to achieve universal coverage. Health care financing based on general tax source is the fairest way. However, as per the Commission on Macroeconomic and Health findings, more donor investment is urgently needed to close the financing gap in health in the poorest countries of the world. In addition, a few middle-income countries would also require assistance, particularly to meet financial costs of controlling HIV/AIDS, tuberculosis, malaria and other emerging communicable and non-communicable diseases. Health system strengthening would be a cross-cutting objective for all health programmes. Alternative health care financing options should be considered in some countries of the Region, including Sector Wide Approaches and a National Commission on Macroeconomic and Health. Decentralization policies should support the process. WHO’s work here could focus on assistance in development of policies and strategies to improve health care financing, development of health care financing policies and strategies to improve access to health services, and responsiveness and fairness of financial contribution and their measurement. Some countries in the Region started to work on the NHAs and, at least two countries, have already updated their NHAs. However, the process should be accelerated. In some countries, the current estimates may require to be revised, including macro-variables, for which experimental values have been estimated by international agencies without a solid background. In some countries, few data have been published on public spending and external resources; the available data have sometimes been taken from IMF, and this should be discussed in the countries. A series of public spending data on health and some estimates on household spending has been published – validation of the data should be performed. Verification of the estimates may result in some changes and new estimates. At least one country has made sub-national estimates, where a shift to higher public spending may occur, as the estimators are accessing information previously ignored. Some countries are in the process of “first estimates” after advocacy meetings. In the Region, experience from at least two countries in the NHA work, to facilitate discussion and to share experiences obtained not only by the leaders but also between the groups that have new work in progress. National capacity including the use of available data should be built. The challenge is to take advantage of the existing resources in the Region as a key to promote the estimates in all countries in the region and to promote developmental adjustment needed, to reduce the costs of estimates and to ensure a cost-effective process. More detailed efforts should be made to obtain information from lesser known stakeholders both public (state and local levels) and private (NGOs, medical insurance, enterprises). The ideal process is to involve all stakeholders to participate in this effort. This area would include WHO support – advocacy for establishing NHAs and using the WHO produced guidelines. While the Region bears the double burden of diseases with the high incidence of infectious and non-communicable diseases, the majority of countries still spend less than 5

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% of GDP per capita on health. Almost 70-80 % of health expenditure is met from out-ofpocket expenses. The proportion of people covered with social security or social health insurance is nominal. Only a few countries adopted social health insurance, a mechanism for financing and managing health care through pooling of health risk and financial contributions of members. There is no single prescription for countries to implement social health insurance; countries could build on their own experiences, stage their own health financing reforms, enhance capacity building and introduce institutionalization, information exchange and continuous monitoring and evaluation. Only four out of eleven member countries of the Region introduced social health insurance schemes, but did not have wider coverage for some decades, except for one country. Other countries had not yet implemented social health insurance schemes on national scale. Most social health insurance schemes in the countries of the region covered mainly the protection of financial risk for hospital care and usually for inpatients only. WHO technical support is needed here, to review country situations on social health insurance, provide evidence-based research findings, developing policy directions, providing models for consideration and facilitating policy debates among the stakeholders. Experiences of countries already having wider social health insurance coverage need to be documented. A policy framework had to be developed for introducing or expanding social health insurance providing, at the same time, for increased public expenditure. Goal Develop systems of health financing that are equitable, protect against financial risk, promote social protection and efficiency and can be sustained over time. WHO Objectives To develop health financing strategies based on principles of equity, social protection and efficiency, and based on the best available information and knowledge. To develop capacity to obtain key information and to use it to improve health financing and organizational arrangements as a part of national policy. Strategic Approaches • • • Provide opportunities to share national and international experiences, evidence and best practices in implementing various financing and social protection options. Provide policy support to countries in accordance with country needs. Develop partnership collaborations with international and national institutions, government and non-governmental organizations.

26. HEALTH INFORMATION, EVIDENCE AND RESEARCH POLICY Regional Issues and Challenges Evidence based information is crucial to frame and implement health and health related policies and practices based on sound evidence. The work will seek to ensure that national health planning and policy development and capacity are strengthened. The work will focus on strengthening national capacities so that comprehensive, complementary and disaggregated data including gender sensitive data are generated, compiled, interpreted and disseminated for use by all those concerned with the development and delivery of health policies and interventions with the aim of improving performance of the health systems. In the countries of South-East Asia, data collection systems are overloaded with details, which may not be required for policy/decision-making. The appropriate feedback mechanisms are not well established. There is limited analysis due to weak linkages in the data transmission system at various levels. Required information is not available in a timely manner.

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Sometimes it is incomplete and thus not usable for evidence-based decision-making. Organizational culture which values or encourages analytical thinking is lacking. Appropriate tools for translating data into information for decision-making are not always applied properly. Disaggregated data, including gender distribution, are often not available in the form required for policy debate and decision-making. Existing human resources are not sufficiently trained for applying the latest analytical tools and methods to synthesize information for decision-making. Health information systems are not well equipped for emergency preparedness and vulnerability reduction. Therefore, these are less responsive to contain natural disasters and emergencies. During 2004-2005, Regional Strategic Plan for Enhancing Health Information for Evidence Based Decision Making in South-East Asia Region would be formulated, with the countries’ inputs. In order to facilitate evidence-based policy debate and decision-making at the respective level of the health system, the above issues would be addressed. Vital registration, routine HIS (including public and private sectors), surveys (including WHS), mortality, morbidity and disability, collection, analysis, presentation would be addressed here. The work of WHO here would also include providing the latest global health information, examples of good practices and WHO policy positions to countries. This could be considered as a separate regional expected result formulation, due to the fact that it is a WHO unique trade mark, and, in our Region (but it seems in some other WHO Regions, too), this area has not yet been adequately emphasized and in some countries neglected. ICD-10 implementation has been initiated in some countries of the Region, in the public institutions. However, its implementation has not been adequate, both in the area of mortality (vital registration) and morbidity (hospital data, private hospitals). Our main work in this regional ER would be focused on the in-country and regional training activities, in collaboration with the WHO CC in our Region which might be established during the 2004-2005 biennium. This work would also include hospital records management and would cover both public and private sectors. In some countries, national or sub-national burden of disease studies have already been conducted. Mortality part of the burden of disease studies has mostly been available, with or without ICD coded method. However, morbidity part, particularly prevalence, duration, disaggregated by age-groups and sex, has not bee adequate. In more-than-half countries of the Region, there is an expertise available for conducting the Burden of Disease studies and for within-country training. This methodology implemented in the country should complement existing routine health information. To assist in the evidence based decision making, use of the available GIS tools should be promoted. Our main work here could be directed towards in-country and regional training and technical assistance in conducting the studies. A wide range of stakeholders collect health information at the country level, using different tools and methods for all areas of measurement. These stakeholders include public and private sector, national and international NGOs, UN agencies, donors, etc. Improving the availability of health information for the use by decision makers has become one of the crucial steps in this area of work. It is based on the premise that the complexity of the health information field – multiple actors, types, sources, users and uses of information requires collaborative and inclusive response. In SEAR, “information paradox” has been observed and should be also addressed by partnership development. Monitoring of MDGs could be used as a tool for improving partnership at the country level. This regional ER would address evidence base to guide the development and implementation of health-related interventions in line with the poverty reduction strategies and the MDGs. Regional collaboration (with ESCAP, ASEAN etc.) in addressing the above mentioned issues would be emphasized. The SEA region concludes five major areas of issues and challenges in health research, they are:

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• • • • •

Development of National Health Research Systems to keep pace with the National Health Systems Development. Formulation of health research policy and health research priorities . Research Ethics. Capacity Building and capacity strengthening of health researchers, health research managers, health research policy makers. Resource Mobilization for Health Research.

Many national health research systems are not ready to face the rapid movement of challenges in health. In order to identify the strengths and the weaknesses of the system, countries need to analyze and review their national health research systems. The findings would be an advocacy tool for policy makers for direction and strategic development of national health research system. The SEA-ACHR is a statutory body for setting up new policies and strategies on health research areas relevant to the regional problems and needs, and to advise the Regional Director on the formulation and implementation of health research policies and strategies in the Region. This is in line with the resolutions and policy guidance of WHA, EB and RC and also within the overall framework of the global WHO research policy. The regional ACHR will continue in the coming years. Interregional collaborations received greater needs, mostly due to common research problems shared by SEARO and its neighbouring regions. Resources to carry out research become scarcer, therefore building networks are essential to mobilize resources for conduct of research that will give interregional and global impacts. WHO could play a catalytic role between the parties involved. SEARO will continue network and bilateral collaborations with existing forums and partners for health research at international (GFHR, COHRED, Global Alliance for H. Policy and H. Systems etc) and regional levels ( INCLEN, APHRF, FERCAP, SAFHR , National Health Accounts, etc.). Establishing or improving the system for health research management is a critical issue and challenge for SEAR countries. Capacity building for health research managers are required for the creation of conducive and effective environment of health research. Selected SEAR countries are setting up facilities to train specific types of health research managers, adapting the regional modules on health research managements. SEARO is constantly endeavouring to increase the number of WHO Collaborating Centres in the areas of work related the organization’s priorities. Support is given to increase awareness of the importance of WHO Collaborating Centres, increase capacity and capability of WHO Collaborating Centres and provide technical support for developing strategies for networking. Countries of SEAR expect WHO to assist in capacity building of ERBs especially when dealing with research proposals involving human subjects, including to cope with problems faced on ethics in international collaborative research. Because of the complexity of the problems and issues, this effort will need long term activities and technical as well as other support from WHO and relevant organizations.. Many medical students are not well equipped with knowledge and skills dealing with medical ethics, hence technical support is needed by countries to strengthen teaching in medical ethics. Goal To improve the availability, quality and use of health information for improved efficiency and effectiveness of health programmes. To stimulate research through policy and strategies for health research, identifying emerging trends in the scientific knowledge, strengthen research capability and stimulating

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researchers/scientists to tackle priority health problems as to arrive with evidence based health policy. WHO Objectives Health Information • To collect, validate, analyze and disseminate information on the regional health situation and trends. • To support countries in their efforts to enhance national capacity and capability in health planning and management by strengthening country health information systems. • To provide support to countries for the development of efficient and effective health policies based on sound evidence. Research Policy To stimulate research in the member states through providing policy and strategies for health research, identifying emerging trends in the scientific knowledge, strengthen research capability and stimulating researchers/scientists to tackle priority health problems with evidence based health policy Strategic Approaches Health Information • To assess the regional health situation and trends, including risk factors and measure inequalities in health status and the burden of disease among the poor and other vulnerable groups; assess the health-related quality of life and health state preferences; develop and update international classification systems; provide help in strengthening epidemiological information services; help in assessment of health systems performance at national and sub-national levels; promote use of national health accounts; and provide evidence on alternative health financing options. To strengthen national health information systems, in order to facilitate national health policy formulation, planning, management, monitoring and evaluation of health systems, and also to ensure the development of efficient and effective health policies and programmes based on sound evidence. To analyze national health policies and their links to equity, efficiency and quality, including the relationship between health improvement and economic development, and prepare a systematic description of health systems. To enhance policy dialogue with Member States and other development partners through greater use of evidence-based information.

•

• •

Research Policy The update of the WHO Regional research policy includes: • identification of health research priorities of emerging trends of health problems; • policy and technical support in strengthening national health research systems including capacity building to assess performance of health research systems; • setting up mechanisms for network and partnerships to improve national, regional/inter regional and international cooperation in health research, including practical and sustainable links between the global and regional Advisory Committee on Health Research; • support to countries for adopting best practices in reviewing research proposals involving human subjects and increasing capability of WHO CCs to engage in research in high priority areas and mechanism for effective data base and effective use of Expert Advisory Panels.

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27. EMERGENCY PREPAREDNESS AND RESPONSE Regional Issues and Challenges The magnitude of disasters and their effects have considerable impact on the morbidity and mortality of the population of SEAR member countries with 25% of the world’s population. Over a period of time: • • • • • 38% of the world’s disasters have occurred in SEAR member states; almost two-thirds (59.55%) of the total deaths in disasters worldwide have happened in this WHO region; 37% of those affected by disasters in the world are from SEAR countries; 19% of Asia’s refugees/displaced persons (7% of the World’s) are of SEAR countries origin (e.g., Bangladesh, Bhutan, DPRK, Indonesia, India Myanmar and Sri Lanka. Timor-Leste); 2.7% of Asia’s (6% of the world’s) refugees are hosted in SEAR countries (e.g., Bangladesh, India, Indonesia Nepal, Thailand).

SEAR member states have a wide range of differences in terms of issues and challenges in emergency preparedness and response. Although there are some similar hazards and vulnerabilities, countries in the region still have a wide disparity in the following: 1) 2) 3) 4) national capacities in addressing disaster and emergency issues in all phases of the disaster cycle; priority hazards to be addressed within countries; socio-cultural and political systems which largely influence occurrence of complex emergencies, coping and response and rehabilitation capabilities, and coverage and quality of basic services prior, during and after a disaster or emergency

Due to the unique events and potential emergencies in the region, Member States have placed importance on emergency preparedness and response by discussing it further in Regional fora such as the CCPDM, High Level Task Force and the Regional Committee. In these activities consensus on the following strategic directions were found: Building Political Commitment in Mainstreaming Disaster Risk Management; Developing National Capacities to Reduce Vulnerabilities; Improving Information Management; Preparedness, vulnerability assessment and mitigation for health infrastructure; and Strengthening Intra and Inter-Sectoral Collaboration with all partners working for disaster management at every phase. WHO has a vital role to play in reducing the impact of crises on health and development - encouraging humanitarian assistance that confronts main public health priorities and reduces excessive morbidity and mortality. WHO makes a critical contribution to the repair and recovery of local health systems, bringing together those in country with support from outside and concentrating on reducing vulnerability and promoting equity. WHO also helps identify the vulnerable elements of health systems and ensure that they are strengthened – promptly to prevent emergencies from becoming disasters. Goal To maximize reductions in avoidable loss of life, burden of disease and disability among populations affected by crises, emergencies and disasters, to optimize health at times of post-crisis transitions, and to contribute to recovery and development WHO Objectives Member States - and the wider international community - demonstrate a greater impact on the health dimensions of crises and the well-being of affected communities.

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Indicator National disaster-reduction policies are developed, plans are laid and implemented, and the co-ordination and impact of relief improved. Strategic Approaches A system for developing WHO's performance, involving (a) strengthened human and material capacity at country level, (b) support from regional offices, (c) development of institutional knowledge and competence through performance monitoring and technical guidance co-ordinated through headquarters and regional office, and (d) dedicated rapid response mechanisms, is established and made operational throughout Member States and WHO country and regional offices, headquarters units and Collaborating Centres 28. WHO’S CORE PRESENCE IN COUNTRIES Regional Issues and Challenges The Regional Director has placed major emphasis on improving WHO’s work at the country level and has delegated more authority to country offices. WHO’s presence in the countries of the region is the key factor in improving WHO’s support for the health development of the region’s Member States. Of the six WHO regions, SEAR countries have the largest proportion of funds allocated to country level. Efforts are needed to strengthen country presence and ensure that this presence makes a greater contribution to health development in SEAR countries. At present, WHO country work is too diverse and does not always reflect the health priorities in the country. Furthermore, many SEAR countries now have strong national programmes and a large number of development partners working in the health sector. Because of this, there is a need for further analysis and discussions to identify those areas where WHO can make the greatest contribution to health development of the country. This is the objective of the Country Cooperation Strategies (CCS). More needs to be done to ensure that this process will increase the focus of WHO’s work in each country. With a sharper focus for WHO’s work and clearer expected results, the WHO country offices must improve their capacity to implement WHO programme and provide necessary technical support to the country’s health development initiatives. This will require strengthening the staff in both technical and administrative areas. Furthermore, many countries, especially small countries with limited staff, need efficient backup from the Regional Office and Headquarters. This calls for improved connectivity of the country office with other offices of the Organization. Connectivity will become more important as modern computerized management systems are implemented to make administrative procedures more efficient. This will continue to be a high priority during the biennium. Furthermore, training of country office staff will be undertaken to increase their efficiency and competence. As the country offices are strengthened, efforts must be made to improve country coordination mechanisms, especially with the Ministries of Health. Efficient and effective mechanisms must be established based on local conditions and organizations. The objective is not to burden the government with unnecessary meetings and consultations, but to ensure that they are involved in key policy and management decisions as appropriate. With a large number of health sector donors and technical agencies in many of the countries, SEARO often plays an important role in coordinating health partners. WHO’s broad mandate in the health sector and its close relationship with Ministries of Health make health partner coordination an important role in many countries. In addition, as a United Nations agency, WHO has a mandate to coordinate its work with other UN agencies in the

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country. Efforts will continue to improve the capacity of country offices to improve health partner coordination and assist the government with donor coordination. Finally, it is recognized that WHO staff play a key role in helping generate additional resources for health development programmes. Some funds are managed directly by WHO whereas others, such as the Global Fund (GFATM) are implemented by the government. WHO’s role in resource mobilization will continue to grow and there must be additional efforts to strengthen country offices in this area. Goal To improve the effectiveness and efficiency of WHO work in countries by strengthening the capacity of country offices and ensuring close cooperation of with the government and health development partners. WHO Objectives Strengthen WHO country presence by focusing the work of the organization on improving the country office, its local programmes, technical support and coordination activities. Indicators • • • • Increase the quality of Country Cooperation Strategy focusing the work of WHO in the country and identifying specific action for improved country presence. Improved country coordination mechanisms. Improved connectivity of the country office. More effective work with health development partners, especially UN agencies.

Strategic Approaches The major element of the strategy to strengthen country presence is the Country Cooperation Strategies. These will be used to focus WHO work at the country level and ensure appropriate coordination with the Ministry of Health and health development partners. The CCS should also clearly outline how WHO presence can be strengthened in order to implement the strategy. This will include country office staff, administrative support, resource mobilization and support from other levels of the organization. Once the CCS identifies the specific needs for each country, the Regional Office will help identify resources and undertake needed activities to implement these desired changes. 29. KNOWLEDGE MANAGEMENT AND INFORMATION TECHNOLOGY Regional Issues and Challenges This is a newly regrouped area of work streamlining the use of most effective ways to create, share and apply the Organization's knowledge assets and the culture processes and tools to reorient WHO's enhanced and effective support in this field to the member countries. Integrating knowledge and dissemination with information and communication technology reflects a holistic approach, putting the Organization-wide knowledge assets to best use for all. The programme will enhance the management of knowledge elements in various forms and media, that would be better captured, organized, shared and applied to the practical issues of health and health development. WHO and its Member States have increased connectivity through the advancement of information and communication technology (ICT) and related infrastructure, providing the opportunity to improve learning processes and to achieve effective management of its programme operations. There is a need to improve the organizational culture and practices in order to have efficient knowledge sharing and programme collaboration. Challenges

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include narrowing the gap of inequities in information systems in countries, creating a uniform knowledge environment with common information exchange standards, facilitating user groups to share and apply knowledge, and improving the Organization-wide management information system. Significant progress has been made towards building capacity of country offices for knowledge and information sharing through the development websites and web-based information systems. Regional policies have been developed to empower the user community to utilize ICT more efficiently and effectively. There is a continuous need to strengthen the ICT infrastructure systems and services to render a reliable and secure platform for the Organization to promote better health in Member States. During the past two decades, health science libraries of the Health Literature, Library and Information Services (HELLIS) Network in the region, have been managing national health information resources to some extent. These activities need to be further expanded in terms of coverage, content and methodology with emphasis on management and resource sharing standards and norms. Goal § To promote health, using appropriate knowledge management and information sharing, through well-managed ICT environment and technology both within the Organization and the Member States.

WHO Objectives § To promote the Organization-wide ICT infrastructure and culture, systems and services in order to enhance organizational efficiencies, accountability and improved decision making, and in support of enhanced knowledge management and sharing.

Indicators § § § Availability of effective policies, practices and tools for knowledge management and sharing. Availability of appropriate and cost-effective information and communication technology infrastructure Support to the effective implementation of Organization-wide Global Management System, and integration of regional applications with the GSM for regional applications and requirements.

Strategic Approaches § § § § Continuing practice of the use of cost-effective ICT infrastructure responding to the diverse needs of the Region Provide support to the countries for capacity building, and foster knowledge management and sharing in equitable manner using cost effective ICT environment. To enhance and facilitate mechanisms to capture experiential and tacit knowledge, development of shared standards and compatible systems for information management. A strategy to promote use of international standards and norms for information management, retrieval and resource sharing by demonstrating its benefits through regional networks such as HELLIS.

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30. PLANNING, RESOURCE COORDINATION AND OVERSIGHT Regional Issues and Challenges The region has placed a greater emphasis on strengthening country offices and supporting country programmes. There has been more delegation of authority to country offices and an increased emphasis on support from the Regional Office. In order to implement these improvements in programme management, the most important element is planning. Therefore, initiatives to improve the capacity of country offices to plan country programmes and support from the Regional Office will be the emphasis in this biennium. Starting in the 2000-2001 biennium, WHO has centered programme management around result-based planning. Efforts have been underway to ensure that country and regional offices plan work with clear results and performance indicators. Furthermore, the work plans should be based on a logical framework to achieve these results. The results of these efforts have been mixed and there will be greater emphasis on improving resultsbased planning during this biennium. Training for country staff wi ll be provided as needed to increase their planning capacity. Another requirement for improved programme management is a reduction in the number of expected results in countries and at the regional level. Too many expected results are difficult to manage and lead to poor programme performance. Efforts will be made to focus the work of the region and countries on a smaller number of results. The selection of results for WHO support should be based on the Country Cooperation Strategies, identifying the WHO results most beneficial to the country. With better planning and more focused results, programme management in the regional will emphasize the quality of programme implementation. Monitoring and assessment will be strengthened with emphasis on the usefulness of information and analysis for programme managers. Periodic reviews will be undertaken and computerized information systems will be used to improve information for programme managers. Finally, more emphasis will be placed on resource coordination for regional and country programmes. Results-based programming requires that managers calculate the resources needed for implementation. Planning sections in the countries and SEARO will monitor the available resources and requirements for additional resources before and during the biennium. Goal To increase the effectiveness of WHO’s work in the region especially at the country level by focusing work on key programmes and improving the planning and implementation of these programmes emphasizing increased accountability. WHO Objectives To implement various WHO regional and country initiatives to improve the focus of WHO work, improve planning and strengthen programme management, especially at the country level: Indicators • • • Reduced number of expected results. More expected results with clear targets and performance indicators. Higher achievement of expected results based on targets.

Strategic Approaches Efforts will be made to increase the planning and programme management capacity of staff in countries and at the Regional Office. Country Cooperation Strategies will be the

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major tool to work with countries to sharpen the focus of WHO work there. Improved monitoring and assessments will be used to help implement programmes and increase accountability of programme managers. 31. HUMAN RESOURCES MANAGEMENT IN WHO Regional Issues and Challenges In the face of many challenges confronting WHO as a global leader in world health issues, its human resources become a key source of competitive advantage. The successful leadership role of WHO in providing high quality technical support to meet health development goals of its member countries essentially depends on its ability to attract, develop, motivate, retain the best talents and maintain a deep bench. To support the overall WHO mission, the Organization should continue its major HR reforms as well as focus on continuous improvements in HR business processes. These will require development or adaptation of strategies, policies and systems in the major HR areas. The Organization must continue to (a) hire the right people with the right skills and expertise at the right time, ensuring gender parity and meeting geographical consideration; (b) develop organizational capacity and drive individual performance; (c) nurture talents and provide enabling and supportive environment to retain committed staff; and (d) develop norms, procedures and guidelines that are less bureaucratic in supporting technical programmes. A continuing challenge is inspiring commitment among staff members to enhance their efficiency. Many of the support staff, who have long years of WHO service, feel stagnated in their careers as there is not only a limited career path, but also limited staff development activities. A needs-based approach to staff development must be put in place and a systematic staff development plan be made available to all staff. Career aspirations of staff should also be addressed and career planning be made part of human resource management. The Competency Model presents a set of success factors and key behaviors that will support and enable performance. All staff members must understand and appreciate how the Competency Model will help the work of WHO and how it can be applied to develop a performance culture. It must be integrated in key HR processes such as recruitment, performance management and staff development. Efficient and highly systematic storage, processing, retrieval of human resources information and reporting is vital to today’s organizations. Accurate information and their timely availability are crucial for decision-making. An integrated human resources information system that efficiently automates some HR operational functions will contribute to more staff efficiency and allow quality time for more value-added activities. Documentation of business processes not only provide consistency in dealing with HR issues but also facilitates cross-training of staff members and enhance staff versatility and broaden their skills set and knowledge. The Region will continue to endeavor to meet the gender and geographical representation targets. Recruitment strategies should be continuously reviewed and evolved and be more creative to meet these targets. To support implementation of Rotation and Mobility Policy, there will be a need to develop guidelines that strike a balance between Organizational needs and individual circumstances. Goal To identify or develop and implement best human resources practices to support technical programmes to effectively assist member countries in implementing health development programmes.

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WHO Objectives To provide efficient client-oriented operational support through effective human resource planning, development and/or continuous improvement of HR policies and programmes adapted to regional context, and timely provision of HR services to the Organization. Indicator Level of satisfaction of clients (staff members and management) in the quality of delivery of HR services. Strategic Approaches Development, continuous review and improvement, and consistent implementation of HR policies and programmes adapted to regional context. 32. BUDGET AND FINANCIAL MANAGEMENT Regional Issues and Challenges A major challenge is to improve budget and financial management while WHO is decentralizing by giving additional resources and responsibilities to regions and countries. This requires development of appropriate policies, procedures and guidance, as well as support from new information technology systems that respond efficiently to both changing programme requirements and the needs of Member States. Budget and financial management are ongoing functions that must be efficient and allow for sound internal control to support the work of WHO in the Region. Flexibility is required in order to accommodate varying circumstances and needs in different locations, and consistency is necessary to ensure that the correct balance is struck between service and control. Timely, accurate and relevant management information is vital to support the delivery of work across the Region. Integrated reporting across all fund sources is necessary to meet the requirements of Member States in the Region. Financial information is one of the measures by which Member States and donors can judge the Region’s success in achieving its objectives. The new Global Management System must be developed to easily deliver the financial information and services to improve programme planning and monitoring and to meet the statutory and other information that will be required. The growth of extrabudgetary resources and increasing complexity of donor agreements stretches the capacity of the Organization. Therefore, an investment in training – particularly in countries – is necessary to ensure staff in financial management and managers who control and monitor funds have the skills, expertise and capability necessary to handle the increased volume and complexity of financial resources. Goal To provide timely and accurate financial information and services within a sound internal control framework that enable management and program staff to achieve results that improve heath in the region. WHO Objectives Provide effective, efficient and transparent budget and financial administrative support across the Region for all sources of funds, including timely and accurate financial reports to internal and external customers.

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Indicators • Timely financial information and accessible analytical tools which allow managers in countries and the regional office to make well informed decisions on planning operational matters. Budget presentation, implementation and monitoring that enables management, staff, Member States in the Region and external donors to judge financial performance. Acceptance by WHO headquarters and governing bodies of the Region’s biennial financial report, audited financial statements (including an unqualified audit opinion) and the interim financial report and statements. Response to internal and external audit report recommendations that add value and lead to enhanced accountability and internal control.

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Strategic Approaches Formulation and dissemination of relevant policies within a framework of financial integrity and continuous process improvement in order to assure a seamless budgetary and financial process, along with efficient and effective operations within a sound accountability framework, for all sources of funds and throughout the Region; provision of a balanced response to the different, but equally important, requirements of Member States and donors as providers of funds, and of the Organization, at all levels. 33. INFRASTRUCTURE AND LOGISTICS Regional Issues and Challenges Infrastructure and logistics management enables the Organization to deliver, effectively, its technical support to Member States. It provides appropriate administrative support and security at reasonable cost, ensuring that resources are not diverted from other essential programme activities. It is necessary to constantly review essential utilities and initiate innovative cost-reduction measures. Infrastructure services cover a range of infrastructure and logistic support functions essential for all WHO sites: accommodation, office supplies and all matters related to office services; general building management and maintenance, including provision of utilities; servicing of conferences and meetings; archives, mail and security; information on travel and travel policy, and contracting and procurement. A review and evaluation of filing systems and records management in the Regional Office was undertaken. In this context, an electronic records management system (IRIMS) would be introduced. Security measures in the Regional Office and country offices have been strengthened and will be further developed. Efficient procurement and logistical support function forms an integral part of the infrastructure services to facilitate implementation of technical programmes. In view of the revolution in informatics technology, the supply function has assumed increased importance, as timely supply of latest and modern high-tech equipment is a key factor in the successful implementation of IT. Goal To provide appropriate administrative support and security of WHO personnel and property at economical cost, ensuring timely supplies of the highest quality at affordable prices to facilitate technical programme delivery.

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Strategic approaches • Application of the best practices in respect of appropriateness, timeliness, costeffectiveness and reliability in all aspects of infrastructure support at all organizational levels Procurement services should be not only efficient, prompt and cost-effective, but also responsive to market dynamics and adapt to technological advancements and changes due to globalization, etc With the installation of WHO Web Buy System, greater emphasis will be laid on procurement through WHO catalogue, resulting in standardization of supplies and equipment. It will also encourage procurement of items which are technically approved and negotiated for global contracts to take advantage of economies of scales.

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34. GOVERNING BODIES Regional issues and challenges The formal contribution of Member States of WHO/SEARO to its work takes place within a series of Regional Committee meetings. The fifty-seventh and fifty-eighth sessions of the Regional Committee were held during 2004-2005 biennium in which high-ranking officials from SEAR Member Countries participated. The challenge is to provide apt documentation and timely input to the governing bodies to facilitate informed decision-making at the Regional level. The use of new IT-based technologies to prepare and disseminate documentation for the RC is to be recognized. In a bid to make WHO more responsive to needs of Member States and providing appropriate technical assistance in a timely manner, channels of communication between the countries and WHO secretariat need to be improved. At the same time, wider participation from Member States is necessary for broad-based consultations. Goal To jointly plan, formulate and evaluate health policies with all Member Countries so as to respond to their needs more effectively and efficiently. WHO Objectives To assure efficient management in preparing and conducting consultations on health policymaking involving all Member States. Indicator Scheduled consultations on health policy making and evaluation, involving participation of all SEAR countries. Strategic Approaches • • • Improvement of coordination between Member States, Regional governing body and WHO Secretariat. Develop methods to encourage participation of Member States, UN and other intergovernmental bodies in the work of Governing bodies. Concise and accurate documentation by using latest technologies available.

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35. EXTERNAL RELATIONS Regional issues and challenges Building and reinforcing its alliance with external partners is the core function of the Organization for health development in the Region. To fulfil this function, the programme for External Relations needs to contribute to the creation of an enabling environment for the Organization to effectively deliver its technical support to Member States through resource mobilization and interagency collaboration. Other sources are becoming a more essential component of WHO’s integrated programme budget for collaboration with Member States due to the zero growth in its regular budget for the last several biennia. These sources are increasingly important for WHO’s ever-expanding technical work for the achievement of globally agreed health goals, targets and initiatives. Many Member States of the Region rely on the external resources, given that the shortage of national health budget continues to be a major constraint in the pursuit of national health development goals, and the demand for WHO’s technical assistance is also increasing. To meet these requirements, WHO’s work for resource mobilization in the region and countries needs to be strengthened and expanded through various regional and country initiatives and strategies. Collaboration with development partners working at global, regional and country levels is the prerequisite for the integration of a health dimension in a broad social, economic and environmental development policies and for better health outcome with effective and efficient synergy. To achieve this multi-sectoral collaboration, the institutional and operational linkages of WHO with other development partners need to be developed, maintained and further strengthened, especially, with UN system and other intergovernmental organizations, multilateral financial institutions, regional agencies, such as, ESCAP, ASEAN and SAARC and civil society organizations and private sectors. Goal To ensure that health goals are incorporated in overall development policies of other partner agencies at regional and country levels and external resources for WHO programmes and health development in the Member States are increased. WHO Objectives To negotiate, sustain and expand partnership for better health outcome in the Region and its Member States through collaboration with intergovernmental and regional agencies, civil society organizations and private sectors and to secure the Organization’s resource base to increase other sources. Strategic Approaches • • Enhanced collaboration with current donors and outreach potential donors to expand resource base. Develop, maintain and strengthen operational mechanism for collaboration with external partners working for health.

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36. DIRECTION Regional Issues and Challenges Member States of the South-East Asia Region are faced with double burden of communicable and non-communicable diseases and there is a need to close disparities in health to ensure that health development contributes maximally to poverty reduction. Most countries in our Region are finding it increasingly difficult to meet their health care needs. Increasing flow of resources and ensuring their equitable distribution and timely allocation is necessary to provide prompt and effective support to Member States for meeting health challenges. The complementary strengths of WHO Headquarters, SEARO and Country offices have to be drawn upon to continue making efforts for achievement of Millenium Development Goals. As the number and types of organizations involved in public health in the Region continues to increase, SEARO must provide the political and technical leadership in the area of health development. In order to do this, SEARO has to improve technical capability and capacity and move technical expertise closer to the countries to respond more effectively to the needs of the MS. It has to strengthen external relations, partnerships and resource mobilization efforts and promote collaboration with other Regions. SEARO will further strive to decentralize Regional and intercountry activities and make work-plans more effective by strengthening monitoring and evaluation systems including technical auditing. Administrative and budgetary aspects of WHO programmes need to be managed efficiently to meet health challenges effectively. Goal To arrive at a more compact, efficient, transparent, fair and relevant WHO, better able to respond effectively to the needs of its Member States and maintain the strong tradition of solidarity and close collaboration with and among the Member States. WHO Objectives To direct the work of the Organization within the overall framework of WHO’s Constitution, so as to maximize region-wide contribution to the work of Member States in achieving significant gains in health status. Indicator Extent of achievements in all areas of work as reflected in the end-of-biennium performance assessments. Strategic Approaches • • Strengthen country presence and offices. Improve core functions at the Regional Office – external relations and resource mobilization, advocacy and communications, governance, administrative support, including human resource development, knowledge management including IT, joint programme planning, monitoring and evaluation, including technical audits, coordination of technical networks and technical panels. Increase transparency and strengthen communication across the Organization.

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WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR SOUTH-EAST ASIA

Forty-first Meeting of the Consultative Committee for Programme Development and Management, WHO/SEARO, New Delhi, 19-21 July 2004

Agenda Item 3.3

SEA/PDM/Meet.41/6.3 16 July 2004

REVIEW OF MAJOR DEVELOPMENTS AND ISSUES CONCERNING PROGRAMME BUDGET 2006-2007

CONTENTS PAGE 1. 2. 3. 4. Budget Policy Directions .................................................................................1 Summary of Proposed Programme Budget 2006-2007 .................................1 Next Steps in Planning.....................................................................................5 Outstanding Issues Related to Programme Budget 2006-2007....................5

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BUDGET POLICY DIRECTIONS

During the past year, there have been some changes in the direction of programme budgeting, based on new policies of the Organization, both in headquarters and the regions, and the availability of funds to the Organization. This paper will review the key changes and discuss how these will affect the work of WHO in the SEA Region. The Director-General has continually stressed that work in countries should be the highest priority of the Organization. He has stated that 70% of WHO’s resources should be shifted to regions and countries; this will increase to 75% during the 2006-2007 biennium. Regions too have been advised to shift more funds to the countries to implement the work of WHO. This is likely to affect the implementation of ICP II in the future even though South-East Asia has the highest proportion of funds allocated to the country offices as compared to other regions. The second development is World Health Assembly Resolution WHA 51.31 involving the redistribution of the WHO budget to regions. For the last three biennia, ending in 2004-2005, the distribution of funds has been adjusted between regions with South-East Asia experiencing a net decrease in Regular Budget (Assessed Contributions) funds (Table 2). The Fifty-seventh session World Health Assembly (2004) decided that the Director-General will work closely with Member States to determine broad guidelines for the distribution of WHO’s funds by regions and countries. The result of this work will be reported to the 115th session of the Executive Board in January 2005. The third issue is the greater financial dependence of WHO on Voluntary Contributions 1 compared to Assessed Contributions of all Member States 2. The SEA Region itself is now in the position where Voluntary Contributions exceed those from Assessed Contributions. Analysing the trends, it is projected that Voluntary Contributions will represent over two-thirds of WHO funding in 2006-2007 (Table 2). This high dependence on donor funds makes it difficult to plan a budget for the biennium since funds are not secured until the biennium is under way. Nonetheless, the Proposed Budget represents the overall resource requirements of the entire Organization and assumes securing Voluntary Contributions based on previous biennia. The final change in preparing the budget for 2006-2007 is that there is no General Programme of Work (GPW) to guide the priorities of the Organization. As will be explained in another agenda item, the 11th GPW will cover the period of 2006-2015. However, the formulation of the document has been delayed and this will not be completed until well after the 2006-2007 budget is finalized. Therefore, there is no GPW to guide the development of PB 2006-2007. However, six Areas of Work (Epidemic alert and response, Surveillance, Prevention and management of chronic non-communicable diseases, Tobacco, Making pregnancy safer, Child and adolescent health, and Planning, resource coordination and oversight) have been identified as Organization-wide priorities for the 2006-2007 budget.

SUMMARY OF PROPOSED PROGRAMME BUDGET 2006-2007

In early July 2004, headquarters released the first draft of the Proposed Programme Budget 2006-2007. In this budget there are now 36 Areas of Work (AoW), as opposed to 35 AoWs for the 2004-2005 biennium. Most of the significant changes in these areas of work involved Health Systems and Policy Areas of Work. This was caused by changes in the emphasis and structure of work organized in headquarters, discussed extensively with the regions.

1 2

These were formerly called EB (Extra-budgetary) funds or OS (Other Sources). Assessed Contributions were called the Regular Budget in previous WHO budgets.

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Overall, the proposed budget (Table 1) shows a 12.8% increase over the budget for 2004-2005, with an 8.1% increase in Assessed Contributions and 14.9% increase in Voluntary Contributions. It should be noted that if these proposed changes are realized, over 70% of WHO’s budget will be financed by Voluntary Contributions. Table 1: Organization-wide proposed budget for 2006-2007 2004-2005 Office AC* AFRO AMRO SEARO EURO EMRO WPRO HQ Total 192 73 93 55 82 72 313 880 VC** 553 94 192 104 202 121 678 1,944 Total 745 167 285 159 284 193 991 2,824 AC* 216 82 105 62 93 81 312 951 VC** 672 115 229 139 259 152 668 2,234 Total 888 197 334 201 352 233 980 3,185 AC* 12.5% 12.5% 12.5% 12.5% 12.5% 12.5% 0% 8.1% VC** 21.5% 21.9% 19.8% 34.2% 28.6% 25.0% -1.6% 14.9% Total 19.2% 17.8% 17.4% 26.7% 24.0% 20.3% -1.2% 12.8% 2006-2007 Change

All amounts rounded to millions of USD * AC – Assessed Contributions and Miscellaneous Income ** VC – Voluntary Contributions

All regions would receive a 12.5% increase in the budget financed by Assessed Contributions while headquarters would receive no increase. This is in line with the DirectorGeneral’s policy to ensure that 75% of the Organization’s resources is used in regions and countries. As for Voluntary Contributions, each region has different increases depending on an estimate of resource needs and past trends in Voluntary Contributions. The SEA Region’s 19.8% increase in Voluntary Contributions is large, but still less than other regions. Nonetheless, the trend over five biennia has shown a large increase in Voluntary Contributions (Table 2). During the 1998-1999 biennium, Voluntary Contributions financed 42% of the budget. This increased to 59% in 2002-2003 and is projected to be about 69% in the 2006-2007 budget. Table 2: SEARO funding by Assessed and Voluntary Contributions Biennium 1998-1999 2000-2001 2002-2003 2004-2005 2006-2007 AC 96.4 95.4 91.1 93.5 105.1 VC 70.5 114.4 129.4 191.5 229.3 Total 166.9 209.8 220.5 285.0 334.4 Percent VC 42% 54% 59% 67% 69%

Note: Amounts in millions of US$; amounts for the first three biennia are actuals while those for 2004-2005 and 2006-2007 are budgeted and proposed respectively.

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At present, the budget for the SEA Region is broken down by 36 Areas of Work (Table 3). The proposed budget for each is the total including both Assessed and Voluntary Contributions, covering the total for the Regional Office and countries. Although these figures were finalized by headquarters, they were based on extensive consultations with the Regional Office. In addition, country offices were consulted during the process to determine the resources required for each Area of Work. Later in the year, the budget will be presented by each Area of Work breaking it down by Assessed and Voluntary Contributions. Each AOW will also show the amount of funds budgeted for the Regional Office and the sum for the country offices. In looking at Table 3 with the proposed regional budget by Area of Work, the per cent change from the 2004-2005 budget may not be representative of the actual change between these two biennia. This is because the total amounts of Voluntary Contributions for each AOW in 2004-2005 are not yet known. Actual amounts may be lower or higher depending on donor funds received. A better comparison is with the actual expenditures (Assessed and Voluntary Contributions) during the 2002-2003 biennium. These amounts are shown in the last column in Table 3. The proposed budget for the Region shows an increased commitment to certain Areas of Work. As a result of the 3 by 5 initiative, the amount budgeted for HIV/AIDS has expanded considerably, especially compared to 2002-2003 levels. In addition, there is an increased emphasis on Epidemic alert and response as well as Surveillance, prevention and management of noncommunicable diseases. Making pregnancy safer and Child and Adolescent health have also planned large increases in funding. These four areas are all Organization-wide priorities as is Planning, resource coordination and oversight which also received a large budget increase. It is also noted that the budget for Immunization and vaccine development dropped from its previous high levels, anticipating reduced polio eradication activities.

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Table 3: Proposed SEAR budget 2006-2007 for assessed and voluntary funds (thousands of US$) Obligated 2002/2003 $7,197 $81 $5,550 $5,907 $17,918 $4,789 $3,963 $1,750 $1,851 $2,580 $1,122 $5,787 $889 $2,141 $1,869 $2,372 $834 $3,933 $58,789 $3,494 $1,992 $2,450 $22,638 ? ? ? $9,684 $16,362 $6,967 $868 $996 $1,162 $0 $289 $0 $1,827 Planned 2004/2005 $19,637 $631 $8,353 $10,720 $33,939 $20,664 $4,004 $2,866 $2,217 $3,845 $1,395 $6,568 $2,734 $1,821 $3,681 $4,478 $1,187 $5,903 $66,741 $3,174 $2,183 $3,407 $30,635 ? ? ? $7,387 $20,334 $4,337 $1,197 $1,212 $1,342 $5,513 $298 $1,144 $1,385 Proposed 2006/2007 $26,000 $1,405 $14,000 $9,434 $28,000 $28,000 $8,500 $2,866 $3,000 $3,430 $2,000 $7,533 $1,840 $2,202 $3,037 $9,000 $1,186 $12,000 $60,000 $5,500 $2,504 $3,373 $10,080 $10,156 $5,176 $8,225 $10,601 $27,695 $9,000 $4,075 $1,600 $1,575 $6,665 $300 $2,000 $1,700 $816 $334,474

2006-2007 Areas of Work 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Communicable disease prevention and control Communicable disease research Epidemic alert and response Malaria Tuberculosis HIV/AIDS Surveillance, prevention and management of chronic, non-communicable diseases Health promotion Mental health and substance abuse Tobacco Nutrition Health and environment Food safety Violence, injuries and disabilities Reproductive health Making pregnancy safer Gender, equity, women and health Child and adolescent health Immunization and vaccine development Essential drugs and medicine policy Essential health technologies Policy making for health in development Health system policies and service delivery Human resources for health Health financing and social protection Health information, evidence and research policy Emergency preparedness and response WHO's core presence in countries Knowledge management and Information technology Planning, resource coordination and oversight Human resources development in WHO Budget and financial management Infrastructure and logistics Governing bodies External relations Direction Exchange rate hedging and IT fund TOTAL

$198,049

$284,934

Note: Shaded AOW represent organization-wide priorities

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NEXT STEPS IN PLANNING

Now that the proposed budget has been prepared, efforts are under way to start developing the 2006-2007 work plans for the countries and the Regional Office. The objective of the efforts is to improve the quality of work plans, emphasizing results-based planning, leading to better implementation and more effective WHO programmes in the Region. The end-of-biennium assessment of 2002-2003 showed that the Region and countries had too many diverse expected results, making it difficult to manage programme and spreading WHO resources over too many areas. An innovation introduced this year in the planning process is Regional Expected Results (RER). Each Area of Work (AOW) will work to identify a group of similar expected results from countries and add on a Regional Office expected result to support country work. By focusing regional work on results that are important to countries, Regional Office support will be more effective. In addition, a group of countries working on similar results will facilitate horizontal support and the exchange of relevant experience between countries of the Region. The process of developing RER has already started with a retreat for Regional Advisers and an orientation meeting for the planning staff of each country office. It is planned that these RER will be finalized by the end of 2004. In the beginning of 2005, work will begin on developing the detailed workplans for all offices in the Region. It is planned that the first drafts of the workplans will be completed by May 2005 and discussed at the next CCPDM meeting for formal presentation to the Regional Committee at its fifty-eighth session in September 2005. For the first time, the 2004-2005 workplans were finalized before the beginning of the first year of the biennium. They were also uploaded in AMS so that obligations could start in the beginning of January. For the next biennium, it is planned to move this completion date to November 30 in order to allow even more time to prepare for implementation in the new biennium.

OUTSTANDING ISSUES RELATED TO PROGRAMME BUDGET 2006-2007

The process to prepare the budget for 2006-2007 has proceeded without any major problems. Nonetheless, there are still some outstanding issues related to the budget that are likely to affect the development of the workplans for the Region. These are briefly discussed below. 1. The part of the budget from Assessed Contributions, formerly called the Regular Budget, is proposed to increase by 12.5% for the Region. If approved, this would require an 89% increase in Assessed Contributions from all Member States. However, this will mean an increase of about $12 million for the regional and country offices. Based on the current distribution of funds, 25% (US$ 3 million) would be used in the Regional Office. However, there must be guidance on the distribution of the remaining 75% (about US$ 9 million) to the countries of the Region. In principle, this should be based on the technical needs of the countries and agreement that all countries would receive additions to their budgets to offset the increase in Assessed Contributions. Furthermore, the final budget will not be approved until May 2005, the same time as the first draft of workplans are completed. This uncertainty may disrupt the timing of workplan development. It is proposed that the Regional Director establish a group, with representation from Member States, to determine the basis for the distribution of these additional funds. There are still some discussions about the distribution of organizational resources as a result of resolution WHA 51.31. Although this resolution only covered three biennia (2000-2001 through 2004-2005), work is under way to determine the criteria for the distribution of the Organization’s funds in the future. The report of this work will be presented to the 115th session of the Executive Board in January 2005. The results of this work may also affect the funds available for the 2006-2007 biennium. It is proposed

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that the SEA Region be actively involved with this work in order to ensure that there is an equitable distribution of resources to the Region. 3. As discussed above, it may not be possible to continue the ICP II mechanism since this is seen to reduce the availability of funds at the country level. This is despite the fact that South-East Asia leads all other regions in the proportion of funds at the country level. At present, the Regional Office budget from Assessed Contributions only covers staff salaries and essential activities such as the meetings of CCPDM, the Regional Committee and the SEA Advisory Committee on Health Research (ACHR). Technical support and meetings were supported by the ICP II funding mechanism. Consideration should be given as to how appropriate technical support and meetings can be continued in the next biennium. It may also be useful to earmark some of the ICP II funds for horizontal collaboration between countries of the Region and with neighbouring countries of other regions. The objective of this is to unify WHO activities in the Region and ensure that the regional programme budget is implemented in a unified fashion, keeping in mind regional solidarity, intercountry cooperation and strengthening the work of Health Ministers. Voluntary Contributions are expected to cover almost 70% of the regional budget for 2006-2007. This may change the work of the Region unless there are strong resource mobilization policies and initiatives promoting the urgent work of the countries. More must be done to increase the capacity of the countries and the Regional Office in mobilizing resources for priority programmes.

The CCPDM is requested to provide guidance to the Regional Director concerning these issues. Based on this, the Regional Director may propose specific resolutions for the Regional Committee meeting in September 2004.

Key facts

Organisation World Health Organization (WHO)

Document type Governing Bodies documents

Adoption date August 6, 2004

Source World Health Organization