Fifty-sixth Meeting of the Regional Director with the WHO Representatives Phuket, Thailand, 2-3 May 2005

SEA-WRM-56 Distribution: Restricted Fifty-sixth Meeting of the Regional Director with the WHO Representatives Phuket, Thailand, 2-3 May 2005 Report of the Meeting WHO Project: 000 GBS 001 Regional Office for South-East Asia New Delhi, October 2005 © World Health Organization The contents of this restricted document may not be divulged to persons other than those to whom it has been originally addressed. It may not be further distributed nor reproduced in any manner and should not be referenced in bibliographical matter or cited. Page iii CONTENTS Page 1. BACKGROUND.................................................................................................1 2. BUSINESS SESSION...........................................................................................2 2.1 Regional Director’s Opening Remarks........................................................2 2.2 Review of Recommendations of the 55th WRs’ Meeting (agenda item 2) ............................................................................................5 2.3 Arrangements for ICP-II Successor Mechanism (agenda item 3) ............................................................................................7 2.4 Preparing for 42nd CCPDM: Issues beyond ICP-II (agenda item 4) ............................................................................................9 2.5 Review of Progress in Delegation of Authority (agenda item 5) ..........................................................................................11 2.6 Preparedness of Country Offices for Emergency Situations: Lessons Learnt from the Tsunami, SARS, and Avian Flu Experiences (agenda item 6) ..........................................................................................15 3. CLOSING SESSION .........................................................................................20 Annexes 1. Agenda............................................................................................................21 2. Programme......................................................................................................22 3. List of Participants............................................................................................23 Page 1 1. BACKGROUND The Fifty-sixth Meeting of the Regional Director with the WHO Representatives (WRs) was held in Phuket, Thailand, from 2 to 3 May 2005 in conjunction with the Tsunami Health Conference, which was held from 4-6 May 2005. The Agenda, Programme and the List of Participants are at Annexes 1, 2 and 3 respectively. This report presents the highlights of discussions under each agenda item along with recommendations of WRs. It documents the important issues discussed at the meeting, and shall be the basis for follow-up action in countries and in the Regional Office. This meeting represented a significant change in the way that WRs meetings have been conducted in the past. All the WRs were fully involved in the deliberations of the meeting. Selected WRs acted as moderators and chaired the different sessions of the meeting. A drafting group comprising Dr Kan Tun (WR Sri Lanka) as Chairperson, and Dr Adik Wibowo (Ag.WR Nepal), Dr Ei Kubota (WR Bhutan) and Dr J.M. Luna (WR Maldives), as members was formed to prepare the report and recommendations of the meeting. Report of the Meeting Page 2 2. BUSINESS SESSION 2.1 Regional Director’s Opening Remarks The Regional Director welcomed the WHO Representatives (WRs) and said that in the past year, a strategy on decentralization had been launched in a big way to realize the country focus and country-specific approach in the Region whereby more authority was delegated to the WHO Representatives. The WHO Representatives had been allowed to work horizontally among themselves. Now that more than a year had passed, it was appropriate to assess the performance in implementing this strategy in order to identify the strengths and weakness in such a process to rectify the shortcomings. Dr Samlee stressed that while pursuing the WHO mission, it should be kept in mind that the biennial programme budget was the most important managerial tool for collaboration with Member States. Particularly in the regional context, the decentralization strategy was the managerial instrument for enhancing effectiveness of the biennial programme budget at country level. In this context, delegation of authority and horizontal collaboration were the key approaches to efficient and effective implementation of the biennial workplans. The Regional Director stated that ICP-II would cease to exist at the end of the 2004-2005 biennium so as to reflect the real picture of budgetary decentralization where 75% of the Regular Budgetwas allocated to the WHO country programmes. At the same time, maximum benefit would be derived from the use of Voluntary Contributions, especially for strengthening WHO’s normative functions as well as the basic infrastructure of national systems. The planning process was reoriented in order to ensure full and active involvement of the Regional Office in the development and implementation of WHO country programmes. Appropriate modalities were being explored for promoting intercountry activities within the context of WHO country-level operations, especially the country programme budget. Dr Samlee stressed the need to reorient the strategy for development and implementation of intercountry programmes. The successor arrangement of ICP-II needed to be worked out. However, this would depend on the spirit, Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 3 sense of solidarity and willingness on the part of Member States. WHO should encourage the countries and provide them with practical and convincing advice on this issue in the process of preparing biennial workplans. At the same time, particular attention needed to be drawn to the role of Voluntary Contributions in the development and implementation of regional and intercountry programmes. Voluntary Contributions would play an important role in WHO’s work under these programmes. The role of CCPDM in future would be exclusively to serve as an executive arm of the Regional Committee, especially in matters relating to programme development and management, and it would be always convened at the Regional Office. Starting from its 42nd meeting, a considerable amount of time of the Committee would be devoted to a detailed review of the strategic biennial programme budget and biennial workplans, for both countries and the Regional Office. The review of country workplans would be done country by country, between the country team, which consists of the WHO Representative with a senior national health official at the decision-making level and the panel of senior staff members in the Regional Office, under the chairmanship of DPM. Regional workplans would be reviewed at a plenary session of the meeting. The Regional Director stated that in regard to distribution of additional funds from the Regular budget, the Regional Working Group on Programme Budget Development had yet to submit its final recommendations. Distribution of resources among the countries was a very sensitive issue and had to be handled with utmost care. Recognizing this, WHO was moving towards integrated budget planning. Integrating Voluntary Contributions with the Regular Budget in the process of budget planning required particular attention and had to be done in parallel with strategy development for resource mobilization and fund raising. The issue would be discussed in detail at the meeting. There had been a revision of the financial regulations and rules. To this effect, from the biennium 2006-2007 onwards, there would be no carryover of unliquidated obligations to the subsequent biennium. This implied that all obligated funds from the Regular Budgetmust be liquidated within the biennium concerned. This would end the practice followed until now, whereby unliquidated obligations could be carried over to the first year of the next biennium. By setting the end target clearly within the biennium, financial discipline would be strengthened and ultimately both the output as well as the Report of the Meeting Page 4 quality of programme implementation improved. Therefore, from the next financial period, there would be no regional implementation targets as currently practised. There would be no requirement of 75% budgetary obligation by the end of the first year of the biennium and 100% by the end of August of the second year. With this change, the Regional Office and the country offices would have to pay particular attention to ensure full implementation of country workplans with high quality outputs and outcomes. The Regional Director wished to have feedback from WRs as to how useful the increased delegation had been in implementing country workplans. He recognized that there were deficiencies in this delegation which needed rectification. The process and its practice needed to be reviewed and corrective action taken to improve the situation. The Region had learnt a lot from the experiences in dealing with SARS, avian influenza and the tsunami disaster. The lessons learnt needed to be reviewed with a view to improving the Emergency Preparedness and Response Programme (EPR) in order to ensure that relevant practical approaches in relief and restoration operations were in place. In this context, the Regional Director emphasized the need to have a robust EPR plan for each WHO country office. The Regional Office should work closely with WHO headquarters and other partners in supporting the development of such a plan. The WHO country EPR plan would be designed to fully support national disaster preparedness and response operations. The Regional Office and WHO headquarters would readily provide back-up in a most efficient and effective manner to implement the country workplan during an emergency. Dr Samlee referred to the earlier practice where each WR prepared a concise report on the country health situation reflecting current issues and the work of WHO in the country during the preceding year, which was presented at the plenary session. In addition to following up on the implementation of new initiatives, such as horizontal collaboration, there would also be discussions on selected technical subjects at the next meetings. The meeting was informed that in future the RD’s meeting with WRs in November would always be held at the Regional Office. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 5 2.2 Review of Recommendations of the 55th WRs’ Meeting (agenda item 2) Highlights of the presentation The presentation highlighted the action taken on major recommendations of the 55th WRs’ Meeting as follows: � Key Policy Directions in Decentralization: − A policy paper on “Decentralization Strategy in SEAR” was issued to all WRs in February 2005. It was followed by discussions during special missions to six countries. Countries have discussed this with the respective governments and continue to explain this in different forums. − The staff needs of the WHO country offices are being reflected in the updated Country Cooperation Strategy (CCS) documents. − WHO country offices are providing support to governments in priority areas by engaging new staff and through SSAs, as required. � Horizontal Collaboration: − The Regional Office is in the process of preparing guidelines for horizontal collaboration and multi-country activities. − Horizontal collaboration with countries of other regions (notably WPR) are periodically reviewed at bi-regional meetings. � 11th General Programme of Work: − WRs periodically informed. − At country level, consultations have been held by some countries with government and experts. − Based on country inputs, regional inputs will be provided to HQ. � Concept for Future Planning in WHO: − WHO headquarters should take further action for realization of the voluntary contributions now shown in the budget. It is necessary to motivate countries and the Regional Office to prepare realistic and integrated budgets. � Concept and Practice of New Ways of Working with Countries: − The role of the Regional Office in supporting activities at country level is gradually being expanded at various levels. Report of the Meeting Page 6 � Programme Budget and Planning for 2006-2007: − The Regional Office has conducted “country days” for seven countries to strengthen joint planning for PB 2006-2007. All country offices are in the process of developing the PB 2006-2007 in close coordination with the concerned governments. � Government-WHO Coordination Mechanism: − Mechanisms vary substantially from country to country but should be formalized as soon as feasible. The experience to date should be reviewed. � Resource Mobilization and Partnerships in Countries: − WHO headquarters hopes to finalize the Organization-wide Resource Mobilization Strategy by January 2006. The Regional Office and country offices will follow these guidelines. � Monitoring, Evaluation and Technical Assessment: − Efforts were focused on ensuring adherence to procedures and processes. − Review meetings were undertaken in several technical programme areas. � Programme Support Cost: − The matter is under consideration at the Regional Office. Discussion points � Core presence of country offices must be reviewed as early as possible. The review should first look at the efficiency of existing staff and then determine the appropriate quantity. SEARO should make a detailed country-by-country review of core presence in WHO country offices depending on the country situation. Sufficient training for A&F staff at WHO country offices is required to strengthen WHO’s core presence. � Technical Units in the Regional Office should facilitate the implementation of country workplans. Requirements of technical support from the Regional Office professional staff shall be reflected in the country workplans. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 7 Comments by the Regional Director � While strengthening WHO county offices, the quality of implementation should be reviewed. Competence of the staff to cope with the workload has to be improved. EB or global funds may be used for the additional staff to be recruited. While preparing workplans, the number of staff required should be indicated. � At the request of country offices, the Regional Office should be able to provide the necessary technical support. � Country days are important to strengthen country offices in the preparation of workplans and quality implementation of Programme Budget. Recommendations (1) Horizontal collaboration is a managerial tool for WRs to use in implementing activities; it should be flexible enough to accommodate ad hoc events between two or more countries. (2) WHO’s core presence should be determined by CCS and should reflect specific country needs, WHO country office capacity and efficiency. (3) With increased delegation of authority to WRs, the Regional Office should strengthen internal reviews and technical assessments for evidence-based outcomes which should be fact-finding rather than fault- finding. This would complement WHO internal and external audits. (4) Well-planned national consultative process should take place in most countries, involving senior government officials, WHO staff and other stakeholders, preferably prior to the CCPDM meeting in July 2005. 2.3 Arrangements for ICP-II Successor Mechanism (agenda item 3) Highlights of the presentation � ICP-II mechanism will cease to exist at the end of the current biennium. � A Regional Working Group on Programme Budget has provided policy guidelines for ICP-II successor arrangements and recommended that multi-country activities (MCAs) be continued. Such activities should be determined by the WRs in order to provide clear benefits to the respective countries and they should be in-charge of MCA joint planning Report of the Meeting Page 8 and free to use technical services from various sources. Funds for MCAs should be at least equal to ICP-II levels (5.35%). � Implementation of MCAs could be managed by the WRs depending on their willingness and capacity; alternatively, it should be managed by the Regional Office. � MCAs should benefit two or more countries. � WRs could collaborate with other WRs concerned to identify and propose MCAs. � Alternatively, the WRs could identify MCAs suggested by RAs based on the RER matrix. � MCAs should be indicated in workplans at the activity, product or OSER level and funds budgeted based on the agreement of the countries concerned. � Issues such as fund distribution, planning (Country Office vs. Regional Office), eligible MCAs, priority setting and conduct of future regional meetings were presented for discussions. Discussion points � ICP-II has generally been seen by Member States as conducting intercountry meetings. Very often, it was difficult to identify and nominate suitable nationals to such meetings. In some cases, countries had to regret participation due to non-availability of staff. � Collaborative efforts should be in place between the Regional Office and country offices for implementation of MCAs. Technical units in the Regional Office are in the best position to coordinate with country offices in identifying MCAs. � As recommended by the Regional Working Group, the funding of MCAs should be maintained at the ICP-II level (5.35%) of the country’s Regular budget. � A forum such as High Level Task Force could be used to prioritize MCAs. � The RER matrix was very useful in visualizing clear linkages between country expected results (OSERs) to RERs and OWERs. � A number of MCAs for DPR Korea have to be done in close collaboration with PR China. Although PR China is outside the SEA Region, the Regional Director agreed that WR DPR Korea could maintain direct contact with WR China for this purpose. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 9 Comments by the Regional Director � The Region had successfully implemented technical collaboration without the ICP-II mechanism for 25 years. It was only in the past 10 years or so that the ICP-II mechanism had been in operation. Therefore, it was worthwhile to analyse the role of ICP-II in the last few biennia. � Phasing out ICP-II funds from the regional to the country level should not be seen as a loss of credibility. Instead, the Regional Office would now be in a better position to provide more country-focused technical support through MCAs. � Technical unit(s) should develop “regional training programmes” and inform Member States to “buy-into” the relevant programmes. It is one of the ways to provide suggestions for MCAs. � MCAs should be identified from practical and real situations. Emerging diseases such as avian flu, DHF and kala-azar are good examples to be considered for MCAs. Recommendations (1) MCAs should be country-driven. Areas of common interest should be identified in consultation with ministries of health and implemented in collaboration with SEARO. (2) The RER matrix could be an entry point for determining MCAs. Detailed guidelines for MCAs should be made available as soon as possible. 2.4 Preparing for 42nd CCPDM: Issues beyond ICP-II (agenda item 4) Highlights of presentations � For the first time in a decade, the South-East Asia Region will receive an increase (of US$ 5.797 million) in WHO’s Regular Budget in 2006-2007 if approved by the World Health Assembly. This represents a 6.2% increase over the 2004-2005 biennium. � The increase to the countries would be US$ 4.719 million while the Regional Office would receive a little more than US$ one million. The ratio of 75% to countries and 25% to the Regional Office, explicit in our Region, will be maintained. � In determining modalities in the the distribution of additional Regular Budget among Member States, the 56th WRs’ meeting would discuss Report of the Meeting Page 10 the options for presentation to the CCPDM meeting in July 2005. This will also be an occasion for presenting options to Member States, obtaining their reaction and gaining support for the final decision to be made by the Regional Director for submission to the Regional Committee in September 2005. � A simulation was presented for discussion. In this, the criteria for allocating additional Regular Budget were: (1) Existing RB funds should in no case be reduced. Charges would involve additional funds only. (2) Ensure that the countries in greatest need are protected. (3) Recommendations of RWG should be considered at the Regional Committee meeting in September 2005. � Work is continuing on the identification of a global formula for allocating funds to regions. However, the results of this work will be too late for establishing the 2006-2007 country budget allocations as it will only be completed prior to the EB session in January 2006. Therefore, some interim calculations are needed to enable the Regional Director to determine how the additional RB funds will be distributed. Discussion points � Resource allocation of RB funds to the countries should be based on their size and needs. It is noted that RB distribution among the countries has been without significant changes over the past several biennia. This is an opportune time to consider a revision of the criteria for allocation as the Region will be receiving some increased RB allocation. The substantial increase in country RB would make a great impact and make a difference at country level. � The cost of security and ICT should be borne by SEARO/HQ budgets rather than having reflected in the country budget, and then used for regional costs. WHO pays 9% to UNCT of the total cost of UN Field Security services at country level. In addition, WHO country offices are also contributing to SEARO for WHO’s own Field Security Officer. This practice of “double payment” should be discontinued in the coming biennium. IT cost for Member States has to be on actual cost basis rather than an equal fixed amount. � OSLO report on determining WHO country offices could be referred to, since it mentioned about the minimum requirement for each WCO for its core presence. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 11 � If the countries do not identify MCAs by 31 May 2005, there should be a mechanism to protect this allocation so that it is not used for other in- country activities (already agreed at RWG). � The workplan is not the only means for resource mobilization. The updated CCS document and tailor-made proposals are other useful tools. � Reassignment of WRs Nepal, Sri Lanka and Myanmar would take place with effect from 1 July 2005. Therefore, the WRs concerned should represent the current country of assignment as well as the country of reassignment during the CCPDM meeting in July 2005. Comments by the Regional Director � It is important to tackle the issue of resource distribution tactfully. Various models need to be considered for distribution of increased RB funds to the countries. � Among all WHO regions, SEAR allocates the highest proportion (75%) of its RB to countries. Some anomalies in the distribution of RB funds to the countries had been rectified in the past (e.g. Bhutan and Maldives). There should not be any difficulty in arriving at a consensus between WHO and SEAR Member States to further address the issue of budget imbalances. � The cost of Field Security Officer and IT should be absorbed by HQ. DAF should pursue this with HQ. Recommendation Any increase in Regular Budget funds in PB 2006-2007 should be considered as an opportunity to correct imbalances in resource allocations to countries. 2.5 Review of Progress in Delegation of Authority (agenda item 5) Highlights of presentations Presentation by WR Indonesia � Delegation of authority (DoA) was extensively used for routine as well as tsunami operations. The experience was good. � Staff recruitment is easier and requires less follow-up with SEARO. However, SEARO support is required for building up a roster of experts for STCs/STPs as the roster in the country office is not comprehensive. Report of the Meeting Page 12 � Travel authorization was convenient and required less time. This has been used mostly for travel of national staff within SEAR. However, this increases the workload for country office. There is a need to monitor staff travel from the country office. � For purchase orders, bidding processes are done once in a biennium. � There is a need to clarify the adjudication report format and definition of APWs. � Monitoring and follow-up contracts need to be improved. Compared with the LCS mechanism, APW is preferred. Concerning the Statement of Expenditure for LCS, there was reluctance on the part of some Professional staff in WRO to pursue the expenditure documentation from national programme managers. � Conclusion: − Greatly improved and speeded up implementation − Workload shifted from SEARO to WCO − Training needed for both GS and P staff in WCO − WRs must rely on CO staff and therefore high quality staff is necessary − SEARO must closely monitor the performance of WCOs and report on insufficiencies − Further delegation could be considered. Presentation by DAF � The Regional Director delegated the authority – administrative and financial – to WRs and Directors for various programmes. � With the increased delegation of authority, there are some issues in the country offices like unfamiliarity with administrative procedures and guidelines; difficulty in appropriate grading of STCs/STPs; travel authorization for recruitment sometimes issued after commencement of travel; delayed updating of personnel database, and reluctance in some cases to undertake delegation of authority for recruitment. � Additional delegation comes with increased accountability as WRs are responsible for quality and compliance of obligations under delegated authority. Review of obligations has revealed some shortcomings. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 13 � The existing delegation in respect of programme changes may be broadened. � Local cost subsidy limit has been raised from the current US$ 30,000 to US$ 50,000 Discussion points � It was felt that increased delegation to WRs has been positive as it accelerated the implementation process requiring minimal follow-up with the Regional Office. � The delegation was generally compatible with the delegation levels of country offices of other UN agencies. � The workload has gradually shifted from the Regional Office to country offices but is offset by increased motivation of country office staff. However, smaller country offices may have difficulties in managing the increased workload. � Further delegation by WRs to Ag WRs and other P staff requires more guidelines and training. At the same time, accountability must be ensured. � Training of country office staff is essential and should be continual. A combination of CD ROM training kits and “face-to-face” training would be beneficial. � Regular visits of DAF and other A&F officers to the country offices are beneficial. Also, regular visits of auditors to country offices should be encouraged to minimize cases of fraud. The Regional Office must closely monitor performance in the country offices, identify shortcomings and advise on improvements. � New financial regulations starting from 2006-2007 will require close monitoring of implementation. It is therefore important that S&E requests be planned earlier as the supply process requires a long lead time. Efforts should be made to purchase items in first year of the biennium. � Administrative Officers should be strict and comply with rules and regulations such as bidding procedures, payments against APW and LCS instalments. � 100% payment against LCS should be discouraged and the new procedure of 20% balance after final statement of accounts should be seen as a motivation to get further payment. Report of the Meeting Page 14 � The limiting factor of appointing STCs/STPs was the lack of an updated and complete roster. This is a SEARO responsibility and technical units in the Regional Office have been directed to take appropriate action. � Another limiting factor was the lead time in medical clearance of STCs/STPs. All efforts should be made to speed up medical clearance. � It was emphasized that contract extensions could be expedited if the performance report of the previous contract was duly signed by the supervisor before extending a contract. � Programme changes need to be reviewed to allow for shifting of funds from products within the same AoW. Comments by the Regional Director � The rationale for increased delegation of authority is to improve efficiency. It could have been stratified according to the capacity of the country office but it was delegated equally. Some country offices use the authority only partially. Such cases should be referred to SEARO. � Training of country staff was vital and several means can be used: (i) self- learning kits and materials (ii) recruitment of STPs as trainers in A&F areas and sending them to country offices (iii) specific briefing to Ag WRs (iv) further delegation to WCO staff, but not STCs and SSAs, and (v) sending country office staff to higher offices for on-the-spot training. � Further delegation to countries was limited to the extent of DG’s delegation to RD. If the country offices have capacities to implement more and ensuring compliance with manual provisions, this would be welcome. In regard to special delegation during emergencies, announced in 1998 by EHA/HQ, the relevant document be reviewed to see if this is possible. � SEARO should concentrate more on Monitoring and Evaluation and Internal Review and Assessment. � It has been agreed by WHO headquarters in principle to replace the LCS mechanism with APW since the latter provides for clarity of the product and output that has to be achieved. � For increased Programme Changes, DPM and PLN should review the current delegation. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 15 Recommendations (1) Expert Roster: Technical Units should maintain an up-to-date roster of experts. IRA will make a technical assessment of the quality of roster and how they are made available to country offices. (2) Training: CD-ROM training kits should be developed in the A&F area for use by staff at country offices to complement other types of training. (3) Contracts (APW/LCS/TSA): New staff especially needs to be briefed on obligation types and their appropriate use. APWs should be used for WHO-initiated activities that have a clearly-defined product and output. WCO staff to select the most appropriate mechanism for implementing the workplan. (4) Internal Review and Assessment: DAF, BFO and IRA should periodically visit country offices to support proper implementation of delegation of authority. (5) Programme Change: SEARO should review the possibility of extending delegation to WRs to make PC within AoW. It should, however, be within the framework of OWERs. 2.6 Preparedness of Country Offices for Emergency Situations: Lessons Learnt from the Tsunami, SARS, and Avian Flu Experiences (agenda item 6) Highlights of the presentation � As a rule, WHO’s role in any emergency is to work very closely with the government concerned in responding to any major disaster, as quickly and effectively as possible, through mobilization of technical, human and financial resources. � The response to tsunami was the first major event jointly managed by the Regional Office and WHO headquarters, with the centre of operations in the Regional Office. This disaster management has brought out positive and negative results. � The post-tsunami operations at the Regional Office demonstrated that coordination and management of a major disaster could be carried out from the Regional Office. � There was rapid response to establish an operational platform. Report of the Meeting Page 16 � There was close communication and coordination among senior management at the Regional Office, country offices and WHO headquarters. � Staff from WHO headquarters were utilized to address specific gaps at the Regional Office (e.g. flash appeal management). � However, more could have been done effectively as there was a lack of standard operating procedures and pre-arrangements for surge capacity. Multiple sources of commands were issued from WHO headquarters, the Regional Office and country offices to the field where the response was taking place. Real country needs were not taken into account at the early stage. � In spite of constraints, the post-tsunami emergency situations were handled effectively in a coordinated manner. There was no outbreak of disease despite unfavourable conditions in camps. � The important question now is if we have another major disaster, whether a natural event, a complex man-made crisis or a biological, chemical or a radionuclear emergency, are the WHO country offices ready to respond alone or do they need assistance from the Regional Office? � There are many common areas to be addressed, such as availability of WCO multi-hazard preparedness plans including outbreaks; clear roles and backstopping of HQ-Regional Office-WCO; use of common operational platforms (SEARO and country operations room), building a “cadre” of SEAR emergency staff in specific technical and administrative areas. � There is a need to build on information management that was in place: in-house technical coordination mechanisms; administrative guidelines; use of experiences of other countries. Presentation by DAF � Delegation of authority has been increased in view of tsunami � WRO authorized to make purchases up to US$ 100 000 � Local CRC required for purchases over US$ 20 000 � Purchases involving US$ 1000 to US$ 20 000 subject to competitive bidding process Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 17 � Local cost subsidies up to US$ 100 000 � Recruitment of STCs/STPs up to 5-1/2 months already delegated by RD to WRs prior to tsunami � Approval of recruitments delegated to tsunami operations room � Administrative posts to be cleared through DAF. Discussion points � Lack of standard operating procedures (SOPs) and lack of coordination was evident in field operations during the initial phases, but there were initial teething problems. � Global Outbreak Alert and Response Network (GOARN) has a rapid response team (RRT) mechanism which has been functioning well and was coordinated by CDS/SEAR. � SEARO has created a task force to review “event management” such as tsunami and is now developing SOP specifically for the Regional Office and country offices. � Sharing of local experiences with national disasters management departments is very helpful. � Coordination at all levels – internally and externally – is a must. Networking with partners is critical. � Operations Room in the Regional Office and affected country offices is a must. Emergency operations rooms established at sub-offices are very helpful. � It is important to clarify WHO’s role of “operations” in the field as against focusing on “strategic planning”. Also, there is need to review deliverables of contributions made by WHO in emergency. � Tsunami was a test for WHO in disaster management. Lessons learnt – positive or negative – should be incorporated. � Better emergency preparedness plans should be developed and incorporated in country workplans. Priority to EPR must be increased. � Many agencies were involved in the field. It was important to improve WHO visibility through “WHO tents” and “WHO jackets”. � Some emergency supplies were undelivered. It was observed that best use of national capacity to distribute should be utilized. A mechanism should be established to track delivery and distribution. Report of the Meeting Page 18 � An updated roster of experienced and trained staff for emergency situations should be developed. Making use of other agencies and INGOs is beneficial. � There is a need to work out an emergency recruitment system. At the same time, requirements of WHO consultants should be rationalized and shared with governments. Comments by the Regional Director � SOP and guidelines should be seen as a prerequisite. However, training and drill exercises are still required. � EPR programme should be seen as an inter-programme and not in isolation. At the country office level, there needs to be a lot of coordination with other stakeholders. � Disaster management, such as tsunami, should be treated differently. Rapid response is required by using flexibility of rules and regulations and risk-taking initiatives. � At the country level, WHO’s role should be part of UNCT. WHO should take the lead in the health sector in coordination with other sectors. Furthermore, WHO should emphasize public health measures and disease surveillance. � If required by the government, WHO may act as an agency for mission- critical commodities. � WRs represent RD and DG and have capabilities to manage emergencies. They should assert their full authority. All initiatives in the field must be cleared through the WRs. Recommendations (1) WCO EPR plan should be in place as soon as possible in close consultation with other partners and UNCT. (2) There is need for a mechanism to mobilize, maximise and synergise the efforts of all groups (particularly CDS, EPR and Polio) involved in managing crises. The Regional Office could develop an action plan for a “common platform” for event management. (3) An “Operational Management Package” for emergency should be developed as a management tool. In emergencies, WHO may have to Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 19 go beyond its technical advisory role and provide assistance for ensuring health and well-being of the affected population. (4) Draft SOPs should be reviewed and operationalised through appropriate training and simulation exercises, taking into account the tsunami and SARS experience. (5) SEARO should develop a more effective mechanism for deployment of WHO staff including establishment of virtual teams. Report of the Meeting Page 20 3. CLOSING SESSION Concluding Remarks by the Regional Director In his concluding remarks, the Regional Director stated that the meeting had been very productive and that he was looking forward to the next meeting in November 2005. He assured that careful planning would be ensured for the next meeting. He hoped that timely action would be taken on the recommendations/action points of the meeting before the next meeting so that the progress could be visible. He assured that the Regional Office would intensify its efforts to strengthen the capacity of country offices through training of staff, particularly general service staff. The Regional Office staff, particularly in Administration and Finance, would visit countries more often to help in these areas. Fact-finding by IRA for decision-making by executive management would be launched soon. There is a will and strong intention to pursue a decentralization strategy, horizontal collaboration and multicountry activities. The Regional Director was glad to note that WRs had found delegation of authority helpful to their work and hoped that deficiencies therein would be rectified. The Regional Office and country office staff have to work together more harmoniously. He felt that the Regional Office needed strengthening in order to support country offices efficiently and effectively. He stated that he was planning to use the next part of 2005 to effect more changes to improve efficiency. He would like to have a new agenda to talk about in the next meeting. In conclusion, the Regional Director thanked the WRs for their active participation and wished them productive discussions during the Tsunami Health Conference which would follow this meeting. Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 21 Annex 1 AGENDA (1) Opening (2) Review of Recommendations of 55th WRs’ Meeting (3) Arrangements for ICP-II Successor Mechanism (4) Preparing for 42nd CCPDM: Issues beyond ICP-II (5) Review of Progress in Delegation of Authority (6) Preparedness of Country Offices for Emergency Situations: Lessons learnt from the Tsunami, SARS and Avian Flu Experiences (7) Recommendations by WRs and Closing Report of the Meeting Page 22 Annex 2 PROGRAMME Monday, 2 May 2005 0900-0930 hrs Opening 0945-1030 hrs Review of Recommendations of 55th WRs’ Meeting (agenda item 2) Moderator: WR Timor-Leste � Presentation by PLN 1030-1230 hrs Arrangements for ICP-II Successor Mechanism (agenda item 3) Moderator: WR India � Presentation by DPM � Discussions 1400-1630 hrs Preparing for 42nd CCPDM: Issues beyond ICP-II (agenda Item 4) Moderator: WR Myanmar � Discussions on Workplans for PB 2006-2007 � Distribution of any Additional AC Funds � Resource Mobilization Strategies and Voluntary Contribution (VC) in Workplans − Presentation by PLN − Discussions Tuesday, 3 May 2005 0900-1030 hrs Review of Progress in Delegation of Authority (agenda Item 5) Moderator: WR Thailand � Presentation by DAF � Presentation by WR Indonesia � Discussions 1100-1300 hrs Preparedness of Country Offices for Emergency Situations: Lessons Learnt from the Tsunami, SARS and Avian Flu Experiences (agenda item 6) Moderator: WR DPR Korea � Presentations by Dr Luis Perez, EPR/SEARO, Dr Jai Narain, CDS/SEARO and Ms Ann T Van Hulle-Colbert, DAF/SEARO 1430-1530 hrs Recommendations by WRs and Closing (agenda item 7) Moderator: WR Bangladesh Drafting Committee for Recommendations: WR Sri Lanka (Chairperson), Ag. WR Nepal, WR Bhutan and WR Maldives (Members) Fifty-sixth Meeting of the Regional Director with the WHO Representatives Page 23 Annex 3 LIST OF PARTICIPANTS WHO Representatives Dr Duangvadee Sungkhobol Bangladesh Dr Ei Kubota Bhutan Dr Eigil Sorensen DPR Korea Dr Salim J. Habayeb India Dr Georg Petersen Indonesia Dr Jorge M. Luna Maldives Dr Agostino Borra Myanmar Dr Adik Wibowo Nepal Dr Kan Tun Sri Lanka Dr William L. Aldis Thailand Dr A.G. Andjaparidze Timor-Leste Secretariat Secretary Dr Bjorn Melgaard Director, Programme Management Members Dr Poonam Khetrapal Singh Deputy Regional Director Ms Ann T. Van Hulle-Colbert Director Administration and Finance Dr Abdul Sattar Yoosuf Director Department of Sustainable Development & Healthy Environment Dr Jai P. Narain Director Department of Communicable Diseases Dr P.T. Jayawickramarajah Ag. Director Department of Family & Community Health Dr Sangay Thinley Temporary Adviser to the Regional Director Dr Myint Htwe Chief Internal Review & Technical Assessment Dr Brent Burkholder RA-in charge Immunization & Vaccine Development Dr R.M. Brooks Planning Officer Dr Lin Aung Programme Development Officer Dr Luis J Perez Emergency Preparedness and Response Mr Daniel Walter Budget and Finance Officer Mr R.K. Arora Programme Planning and Coordination Unit