AFR/RC56/4 24 July 2006
REGIONAL COMMITTEE FOR AFRICA Fifty-sixth session Addis Ababa, Ethiopia, 28 August–1 September 2006 Provisional agenda item 7.1
ORIGINAL: ENGLISH
WAYS AND MEANS OF IMPLEMENTING RESOLUTIONS OF REGIONAL INTEREST ADOPTED BY THE WORLD HEALTH ASSEMBLY AND THE EXECUTIVE BOARD Report of the Regional Director Executive Summary 1. The Fifty-ninth World Health Assembly and the one-hundred-and-eighteenth session of the Executive Board adopted resolutions on certain issues of regional interest as set out below: (a) (b) (c) (d) Eradication of poliomyelitis (WHA59.1) Application of the International Health Regulations (WHA59.2) Nutrition and HIV/AIDS (WHA59.11) Implementation by WHO of the recommendations of the Global Task Team on Improving AIDS Coordination among Multilateral Institutions and International Donors (WHA59.12) (e) Prevention and control of sexually transmitted infections: draft global strategy (WHA59.19) (f) Sickle-cell anaemia (WHA59.20) (g) Infant and young child nutrition 2006 (WHA59.21) (h) Emergency preparedness and response (WHA59.22) (i) Rapid scaling up of heath workforce production (WHA59.23) (j) Public health, innovation, essential health research and intellectual property rights: towards a global strategy and plan of action (WHA59.24) (k) Prevention of avoidable blindness and visual impairment (WHA59.25) (l) International trade and health (WHA59.26) (m) Strengthening nursing and midwifery (WHA59.29) (n) Consideration of the acceleration of the procedure to elect the next Director-General of the World Health Organization (EB 118.R2) (o) Strengthening of health information systems (EB 118/R4)
2. The ways and means of implementing these resolutions of regional interest have been set out for consideration by the Regional Committee. Each resolution is followed by the measures already taken or planned to be taken. 3. The Committee is invited to examine and comment on the proposed strategies for implementing the resolutions of interest to the African Region and to provide guidance for their implementation.
CONTENTS Paragraphs INTRODUCTION .......................................................................................................................1–3 WHA59.1: WHA59.2: Eradication of poliomyelitis ..................................................................................4–5 Application of the International Health Regulations .............................................6–7
WHA59.11: Nutrition and HIV/AIDS........................................................................................8–9 WHA59.12: Implementation by WHO of the recommendations of the Global Task Team on Improving AIDS Coordination among Multilateral Institutions and International Donors....................................................................................10–11 WHA59.19: Prevention and control of sexually transmitted infections: draft global strategy ..............................................................................................................12–13 WHA59.20: Sickle-cell anaemia ............................................................................................14–15 WHA59.21: Infant and young child nutrition 2006................................................................16–17 WHA59.22: Emergency preparedness and response .............................................................18–19 WHA59.23: Rapid scaling up of health workforce production .............................................20–21 WHA59.24: Public health, innovation, essential health research and intellectual property rights: towards a global strategy and plan of action ............................22–23 WHA59.25: Prevention of avoidable blindness and visual impairment.................................24–25 WHA59.26: International trade and health.............................................................................26–27 WHA59.29: Strengthening nursing and midwifery................................................................28–29 EB 118.R2: Consideration of the acceleration of the procedure to elect the next Director-General of the World Health Organization .........................................30–31 EB 118/R4: Strengthening of health information systems.....................................................32–33
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INTRODUCTION 1. The Fifty-ninth World Health Assembly and the one-hundred-and-eighteenth session of the Executive Board adopted a number of resolutions of regional interest. The ways and means of implementing the resolutions of interest to the African Region are contained in this document referenced AFR/RC56/4 which the Regional Director hereby submits to the fifty-sixth session of the Regional Committee for consideration and guidance, in pursuance of operative paragraph 5 of resolution AFR/RC30/R12. 2. The document contains only the titles of the relevant resolutions and action planned or already undertaken to address issues directed at the Secretariat in support of countries. In conformity with World Health Assembly Resolution WHA33.17, the Regional Committee is invited to examine in detail the proposals of the Regional Director as contained in this document and provide clear guidelines for optimal use of resources, taking into account the related managerial implications. 3. Following the Regional Committee’s decisions, guidelines and resolutions, a plan of work will be prepared to facilitate the monitoring of the implementation of the resolutions as part of the WHO regional programme of technical cooperation. The resolutions of regional interest and the ways and means of implementing them are presented below. WHA59.1: ERADICATION OF POLIOMYELITIS 4. Operative paragraphs requirements: In support of countries, provide technical expertise during emergencies to deal with outbreaks; mobilize funds for emergencies and ensure adequate supply of monovalent oral polio vaccine; provide advice based on risk assessment; and pursue a polio-free initiative in the short-to-long term. 5. Action taken or planned by the Regional Office: The Polio Eradication Programme will carry out the following interventions in support of countries: improve coverage of vaccination activities in remaining states in northern Nigeria using the Immunization Plus Days approach; implement high quality polio outbreak response activities in polio-free countries experiencing importations as endorsed by the Fifty-ninth World Health Assembly; strengthen routine immunization and polio surveillance activities through the Reach Every District approach; and intensify advocacy and resource mobilization efforts at global, regional and national levels. WHA59.2: APPLICATION OF THE INTERNATIONAL HEALTH REGULATIONS 6. Operative paragraphs requirements: Designate immediately WHO IHR contact points; further accelerate steps to establish a roster of experts; and working in support of countries, provide technical guidance in mobilizing international assistance for programme design, reasonable stockpiling, comprehensive training and capacity building, including regional networking of laboratories and voluntary compliance by Member States. 7. Action taken or planned by the Regional Office: The Regional Office’s divisional director for communicable disease prevention and control and the WHO technical officers responsible for disease control in the country offices are the WHO-designated contact points for IHR in the African Region. Invitation of inputs into the roster of experts to be compiled by the Director-General is being initiated. The roster is to reflect fair representation of African professionals for the purpose of implementing the IHRs. A programme for the training of personnel and capacity building of identified laboratories has started. The programme will be
AFR/RC56/4 Page 2 scaled up to ensure that the African Region has an adequate network of facilities and human resources to respond to international health challenges. Increased advocacy to create awareness among couriers for transportation of specimens has also been initiated, and a purposeful targeting approach to communicating information on handling and reassurance has been planned for airlines in regional routes and their management. In addition, an information document has been prepared for attention at the fifty-sixth session of the Regional Committee for Africa. WHA59.11: NUTRITION AND HIV/AIDS 8. Operative paragraphs requirements: Working in support of Member States, strengthen technical guidance; provide support for developing advocacy tools; build capacity for incorporating HIV and AIDS issues in national nutrition policies, training and programmes development; disseminate science-based recommendations, guidelines and tools on nutritional care and support for people living with HIV/AIDS; promote and foster establishment of guidelines for research, including appropriate food and nutrition interventions in HIV/AIDS funding proposals. 9. Action taken or planned by the Regional Office: Nutrition and HIV/AIDS is a priority as reflected in the Strategic orientations for WHO action in the Africa Region, 2005-2009. A draft framework for the development of food and nutrition activities and interventions and for their integration into HIV policies, programmes and funding proposals has been prepared. This will be finalized, disseminated and used as an advocacy tool to support countries to integrate food and nutrition activities and interventions into HIV policies, programmes and funding proposals. Further research will be carried out to examine how best to incorporate appropriate food and nutrition interventions into HIV/AIDS and community and home-based care curricula. To monitor and evaluate progress, support will also be provided to Member States to develop appropriate indicators for measuring actual integration of nutrition into HIV programmes and the impact of nutrition interventions. Collaboration with key stakeholders, including United Nations agencies such as UNAIDS, UNICEF, FAO, WFP, at all levels through active sharing of information, expertise and other resources will continue. WHA59.12: IMPLEMENTATION BY WHO OF THE RECOMMENDATIONS OF THE GLOBAL TASK TEAM ON IMPROVING AIDS COORDINATION AMONG MULTILATERAL INSTITUTIONS AND INTERNATIONAL DONORS 10. Operative paragraphs requirements: Working in collaboration with UNAIDS Secretariat, other UN agencies, the AU and all partners, develop strategic orientations, give normative guidance, build capacity and provide technical assistance to Member States in the context of national road maps towards universal access to HIV prevention, treatment, care and support. 11. Action taken or planned by the Regional Office: WHO has established and chaired the first Global Joint Problem-Solving and Implementation Support Team. The Team’s work at regional level was directed at identifying bottlenecks in the implementation of Global Fund grants and providing technical support to countries. Technical assistance is being provided for the development of proposals for the sixth round of the Global Fund and for the continuation of its funding from previous rounds. A guidance document is being produced for WHO staff, particularly at country level in interpreting and implementing the Team recommendations. The view that Division of Labour means that a UN organization takes the lead in a specific area according to its strengths should be understood as a way to present multiple entry points for coordinated response to HIV/AIDS. That view has been shared with countries and with other UN
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agencies in particular during the Joint WHO/UNAIDS meeting in Brazzaville (March 2006). A joint UN plan for acceleration of HIV prevention was developed in collaboration with six UN agencies under the auspices of the Regional Office. Discussions were held with UNAIDS Secretariat and UN agencies on Joint UN Teams on HIV/AIDS. WHO country representatives were briefed on the need to coordinate HIV programmes across UN agencies. Assessment of the work related to the UN Joint Team was included in WHO staff members’ evaluation. Regional United Nations HIV/AIDS Teams are being put in place in collaboration with UNAIDS Secretariat, other UN agencies, World Bank and the AU to provide quality technical and programming support to countries. WHA59.19: PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED INFECTIONS: DRAFT GLOBAL STRATEGY 12. Operative paragraphs requirements: Consistent with the global strategy and at the regional level, prepare action plans for sexually transmitted infections. In support of countries, raise awareness for the development and funding of the implementation of appropriate legislation, plans and strategies. Provide support to countries to reflect local epidemiology of sexually transmitted infections. 13. Action taken or planned by the Regional Office: The Regional Office developed a regional strategy on acceleration of HIV prevention in which STIs control and prevention constitute one of the key strategic approaches. The Regional Office will develop a framework for the implementation of the global strategy in Member States, taking into account the specificities of the region and the Regional strategy for acceleration of HIV prevention. Advocacy to Member States for maintaining STI control and prevention as an important strategy for prevention of HIV transmission needs to be sustained, in particular, building the capacity of health workers to provide quality syndromic management, ensure availability of drugs, improve tracing and treatment of partners, promote correct and consistent use of condoms, and strengthen STI surveillance systems. WHA59.20: SICKLE-CELL ANAEMIA 14. Operative paragraphs requirements: Working in support of Member States, increase awareness of the international community of the global burden of sickle-cell anaemia; promote equitable access to health services for prevention and management of the disease; provide technical support and advice to national programmes; promote and support intercountry collaboration to develop personnel training and expertise; ensure further transfer of advanced technologies and expertise, and the construction and equipment of referral centres for care, training and research. 15. Action taken or planned by the Regional Office: As proposed in the document “Sicklecell disease in the African Region: current situation and the way forward” prepared for the fiftysixth session of the Regional Committee, a Regional Expert Advisory Committee on Sickle-cell Disease will be set up to advise the Regional Director on how best to deal with the disease. WHO will work with other development partners on the mobilization of resources to create subregional centres of excellence and support countries to increase their capacity to screen for and manage sickle-cell disease. These centres will be part of the health care infrastructure of the countries selected. Three countries will also be supported to undertake studies on the cost of key interventions for sickle-cell disease surveillance, prevention and control. The findings will be widely disseminated and used to support policy formulation and programmes development and to obtain technical equipment and infrastructure development assistance for Member States.
AFR/RC56/4 Page 4 WHA59.21: INFANT AND YOUNG CHILD NUTRITION 2006 16. Operative paragraphs requirements: Working in support of Member States, mobilize technical support for the implementation and independent monitoring of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant Health Assembly resolutions. 17. Action taken or planned by the Regional Office: Member States will be assisted to monitor, evaluate and, where appropriate, review or strengthen existing national laws on the International Code of Marketing of Breastmilk Substitutes and subsequent Health Assembly resolutions. Capacity to apply these laws consistent with broader national legislation will be developed in collaboration with relevant partners, including UNICEF and the World Trade Organization. WHA59.22: EMERGENCY PREPAREDNESS AND RESPONSE 18. Operative paragraphs requirements: Working in support of countries, assess the resilience and risk management capability of hospitals; emphasize community preparedness and resilience in actions of national health emergency preparedness and response programmes; maintain joint work with other UN agencies and partners, including the UN system-wide mechanisms for logistics supply and management; establish a mortality tracking service and compile a global database of technical health references. 19. Action taken or planned by the Regional Office: Based on a combination of needs assessments, coordination for gaps filling and restoration of public health functions and capacity building, the Regional Office will intensify support to countries affected by crises and disasters. The overall goal will be to reduce avoidable mortality and suffering (malnutrition, morbidity) by introducing appropriate health and nutrition interventions. The Regional Office will set up coordination groups at regional, country and local levels for coordination, especially in health cluster pilot countries (Democratic Republic of Congo, Liberia, Uganda) for risk and vulnerability mapping. Technical services and operational support will be provided to partners for addressing life-threatening gaps. A programme for building community-based, civil societyengaged emergency preparedness and resilient response capacity in collaboration with other UN agencies and development partners will be developed. The lessons learnt in strengthening emergency preparedness, and building systems and capacities in Member States will be harnessed and disseminated. WHA59.23: RAPID SCALING UP OF HEALTH WORKFORCE PRODUCTION 20. Operative paragraphs requirements: Working in support of Member States, provide technical support needed to revitalize health training institutions; encourage global health partners to support health training institutions; engage in training partnerships to improve capacity and quality of health-professional education; and encourage planning and use of innovative approaches to teaching and continuing education. 21. Action taken or planned by the Regional Office: The issue of inadequacy of the health workforce was extensively discussed at the Fifty-ninth World Health Assembly and in The world health report 2006. All activities to strengthen the health workforce will be implemented within the broad context of The world health report 2006 and WHO strategies for human resources for health. The initiative to establish a human resources for health observatory has started and the initial building blocks have been put in place. The Regional Office is helping with the
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establishment of the Global Alliance for Health Workforce which has been launched this year with the aim of increasing investment in health workforce development, including training and education. New guidelines and tools for assessment, targeting strategy development, sensitivity modeling and implementation of HRH in countries are being developed. As a back-up, the Regional Office will support Member States to evaluate and strengthen health sciences training institutions and programmes; mobilize and allocate more resources to training of health workers; broker partnerships in health worker education; promote distance learning; and assist countries in exploring innovative ways of motivating and retaining staff. The target year for completion of most of these activities is 2007, with definite scaling up and full implementation starting in 2009 and considering the outcomes of the nursing and midwifery mapping exercise scheduled to be completed in 2008. WHA59.24: PUBLIC HEALTH, INNOVATION, ESSENTIAL HEALTH RESEARCH AND INTELLECTUAL PROPERTY RIGHTS: TOWARDS A GLOBAL STRATEGY AND PLAN OF ACTION
22. Operative paragraphs requirements: Continue to issue public health-based research and development report; identify, from a public health perspective, gaps and needs related to pharmaceuticals and report thereon periodically; continue to monitor in consultation with other international organizations, the impact of intellectual property rights and other issues addressed in the report of the WHO Commission on Intellectual Property Rights, Innovations and Public Health on the development of, and access to, health care products and report thereon to the Health Assembly. 23. Action taken or planned by the Regional Office: WHO will consider the recommendations of the report of the WHO Commission on Intellectual Property Rights, Innovation and Public Health and actively participate in the development of a global strategy and action plan. Based on the flexibilities built into the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), especially for patent laws, national medicine policies and legislation, the Regional Office will assist Member States to access appropriate technical assistance and support regional and subregional economic groups to develop essential capacity for research and production of both generic and franchised medicines at cost-benefit to the poor in the African Region. A monitoring system to assess the impact of TRIPS on access to medicines will also be established in the Region. WHA59.25: PREVENTION OF AVOIDABLE BLINDNESS AND VISUAL IMPAIRMENT 24. Operative paragraphs requirements: As a commitment in support to countries, give priority to prevention of avoidable blindness and visual impairment through the provision of technical support; facilitation of cross-country collaboration for training; and monitoring of progress in the Global Initiative for the Elimination of Avoidable Blindness in collaboration with international partners. The planned actions should be reflected in WHO’s Medium-term Strategic Plan 2008-2013 and Proposed Programme Budget 2008-2009. 25. Action taken or planned by the Regional Office: WHO in collaboration with the International Agency for the Prevention of Blindness provided technical support to Cape Verde, Guinea-Bissau and Mauritania to develop national or district programmes for the prevention of blindness. The support will be extended to Algeria, Angola, Comoros, Republic of Congo, Equatorial Guinea, Ethiopia, Madagascar, Mali, Mauritius, Mozambique, Nigeria, Sao Tome and Principe, Seychelles and Tanzania. A blindness prevention focal point has been recruited to focus
AFR/RC56/4 Page 6 on interventions. A regional expert meeting will be organized to discuss and finalize the Regional strategy for prevention of blindness. The main issues and strategies will be presented to the Regional Committee in 2007. Two representatives for the African Region were nominated to serve on the Avoidable Blindness Monitoring Committee and give regional perspectives in monitoring progress in the Global Initiative for Elimination of Avoidable Blindness. WHO collaborating centres, the Kilimanjaro Centre for Community Ophthalmology, Lions Aravind Institute of Community Ophthalmology and the International Centre for Eye Health will continue to be used as partners for training, particularly of middle-level eye care workers. The Programme Budget 2008-2009 will have prevention of blindness as one of its priorities in line with the prominence it has been given in the WHO Medium-term Strategic Plan 2008-2013. WHA59.26: INTERNATIONAL TRADE AND HEALTH 26. Operative paragraph requirements: Working in support of Member States and in collaboration with various international organizations, through evidence-based information, assist countries in the development of policies and legislation to address the relationship between trade and health, as well as take advantage of the opportunities that trade agreements provide for health services provision. 27. Action taken or planned by the Regional Office: A working document entitled “Poverty, trade and health: an emerging health development issue” has been prepared for the fifty-sixth session of the Regional Committee. Twenty-two (22) countries have been supported to prepare background documents focusing on the existence or non-existence of functional national policies and regulatory mechanisms related to trade in health services, magnitude of trade in health services, and the positive and negative consequences of trade in health services on various national health and health-related objectives. Fifteen (15) countries have completed their reports. A regional workshop on trade in health services has also been planned for 2006 to expose senior policy-makers in the ministries of health to the General Agreement on Trade in Services and its implications for trade in health. WHA59.29: STRENGTHENING NURSING AND MIDWIFERY 28. Operative paragraph requirements: Working in support of countries, involve nurses and midwives in the integrated planning of human resources for health; recruit nurses and midwives in all relevant WHO programmes, including the application of ethical recruitment guidelines; optimize the contribution of nurses and midwives to meeting national health policy objectives and internationally agreed health-related development goals, including those contained in the United Nations Millennium Declaration. 29. Action taken or planned by the Regional Office: The basis for activities aimed at strengthening nursing and midwifery services in countries derives from the WHO “Strategic directions for strengthening nursing and midwifery services”. The Regional Office has developed guidelines to support countries in the implementation of the strategic directions, including fair and ethical engagement of the services of nurses in WHO and national programmes. Representatives of 19 countries with high maternal mortality rates have been supported to draw up action plans to strengthen education, regulation and practice of midwifery in the African Region. To improve the quality of nursing and midwifery training and education, guidelines for the evaluation of nursing and midwifery programmes have been drafted and are currently field tested in Malawi, Nigeria and Tanzania. Based on the findings, Malawi has been supported to revise its nursing and midwifery curriculum. A regional consultation was also organized to build consensus on the essential competencies of skilled birth attendants. Increased involvement of
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nurses and midwives in the provision of HIV care has also increased access to antiretroviral therapy. Work is ongoing to develop the core competencies for HIV/AIDS care, prevention and treatment. Continuing support will be given to countries to evaluate and review the nursing and midwifery education and training curricula in line with the regional midwifery competencies and the competencies of other priority programmes to make nurses and midwives more multi-skilled; strengthen the regulatory environment to support the expanded role of nurses and midwives; and ensure safe practice. Efforts will continue to be directed at strengthening the role of chief nursing officers and enhancing the work of the network of collaborating centres on nursing and midwifery development with a view to increasing their capacity to engage with policy and overall national health development issues. The Regional Office will continue its contribution for establishing baseline information to be included in the 2008 report, including the global mapping of mental health and midwifery services. EB 118.R2: CONSIDERATION OF THE ACCELERATION OF THE PROCEDURE TO ELECT THE NEXT DIRECTOR-GENERAL OF THE WORLD HEALTH ORGANIZATION 30. Operative paragraph requirements: Convene a special session of the Health Assembly on 9 November 2006 in Geneva, and include on the provisional agenda of the special session only one item entitled “Director-General”, comprising two parts entitled, respectively, “appointment” and “approval of contract”. 31. Action taken or planned by the Regional Office: The Acting Director-General has sent an invitation for candidatures directly to Member States. In addition, the Regional Director is organizing a related meeting at the request of Member States. EB 118/R4: STRENGTHENING OF HEALTH INFORMATION SYSTEMS 32. Operative paragraphs requirements: Working in support of Member States, provide technical support needed to reform national health information systems through the global partnership of the Health Metrics Network; develop national partnerships that bring together technical and development partners around a coherent and coordinated country-led strategy; and plan for strengthening health information systems, policies and programmes and for building statistical capacity and a culture of evidence-based information. 33. Action taken or planned by the Regional Office: Regional Committee resolution AFR/RC54/R3 puts emphasis on priority interventions for strengthening national health information systems. In this context, the Health Metrics Network framework and assessment tools are already in use in 20 countries in the Region. Financial and technical support from the Network will be expanded to all countries requesting that support. A regional database is being set up to ensure the use of accurate and timely health statistics to generate evidence for major policy decisions. Emphasis will continue to be put on the creation of observatories and regional health information resource centres to promote better access to health statistics and foster transparency in data analysis, synthesis and evaluation, including peer review. All activities to strengthen national health information systems will be implemented within the broad context of the framework of the Health Metrics Network. A Regional strategic plan 2006-2015 for strengthening national health information systems is being developed to focus on increasing activities in health statistics at regional and country levels; provide support to Member States; build capacities for the development of health information systems; and generate, analyse, disseminate and use data in developing and implementing national policies, programmes and strategies, thereby contributing to the health development of the populations.