Part I draft proposed programme budget 2012-2013

REGIONAL COMMITTEE Provisional Agenda item 7.3 Sixty-third Session SEA/RC63/5 Bangkok, Thailand 7–10 September 2010 22 June 2010 Part I Draft Proposed Programme Budget 2012-2013

PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 1 DRAFT Programme Budget 2012-13 Introduction This first draft of the proposed programme budget 2012-13 is for review at the six regional committees. It is drafted eighteen months in advance of its implementation. The normal consultative process of Regional Committees and the Executive Board is known to shape the final biennial budget in terms of content emphasis as well as addressing the overall financial envelope. As in the past the programme budget is by nature ambitious and developed with a degree of aspiration. The unfolding of the global economic downturn over the next year might introduce greater realism with regard to the over overall budget level. At this point in the process, a proposed budget is that is similar to that of the approved programme budget 2010-11 for the base programme segment. The biennial budget 20012-13 is the last in the current Medium term strategic plan (MTSP). While the unchanged structure of the MTSP - with its 13 strategic objectives -over several biennia has the advantages of stability and comparability, the importance of integration of WHO's action across programmes and levels of the Organization has become increasingly clear. The strategic objectives in the MTSP aim to provide an overall sense of direction and priority. The real challenge is to ensure that strategic objectives do not function as artificial silos. Examples are numerous. Work on AIDS, tuberculosis and malaria impacts on child and maternal health. Better nutritional status is an outcome of work under several strategic objectives. Better capacity to manage outbreaks of emerging and epidemic-prone diseases means better capacity to manage the health dimensions of humanitarian crises. Similarly, WHO's core functions are not the exclusive priority of any one level of the Organization. Rather, they describe how different levels of WHO interact in the interest of achieving better outcomes. The process of fostering a better integration and continuously seeking to find synergies across all departments, clusters, headquarters, regions and country offices is ongoing and will continue to be the preferred way of working. Another key theme for this budget is continuity. This translates into using lessons learned from the Programme budget performance assessment 2008-2009 and scaling-up interventions that have proven their relevance and effectiveness. Such an approach is particularly important for interventions aimed at improving maternal and child health. The third theme is change in those areas where new directions have been provided as new priorities from country need articulated through the Country cooperation strategies and agreements are established through WHA resolutions. Examples of such changes include the increasing focus and number of intergovernmental processes, shifting from policy to action, as in the programme on health systems strengthening, and from research to implementation, as in the programme for non- communicable diseases. The proposed programme budget 2012-13 will be presented after the last major UN review of progress against the Millennium Development Goals (MDGs) in September 2010. As this budget opens, there will be just three years left before 2015. The MDG review will provide direction and identify where progress is lacking and thus where WHO's priorities must lie. For maternal, newborn and child health, WHO's work will have particular focus in high-burden countries and the method of operation will be based on agreed collaboration and division of labour with other UN agencies. The work will be placed in the context of national development plans as well as national health policies and strategies. Success in improving the health of women, newborns, and young children will require an integrated continuum of technical interventions across the life course, but with concomitant efforts to strengthen health delivery systems and address the broader social and economic determinants of women's health. The work will follow the evidence provided in the report "Women and Health - today's evidence, tomorrow's agenda ", which outlines the consequences and costs of failing to address health issues at the appropriate point in the lives of girls and women. One of the key lessons learned from previous biennia is that the achievement of health goals depends on equitable access to a health system that delivers quality services. The exact configuration of services will depend on country context, but will in all cases require adequate financing of health care with PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 2 pooling of risk; a well-trained and adequately remunerated workforce; information on which to base policy and management decisions; infrastructure and logistics to get medicines and vaccines to where they are needed; well-maintained facilities organized as part of a referral network; and leadership that provides clear direction and harnesses the potential of all stakeholders - including communities. A robust national health policy and strategy can ensure complementarities between all the elements needed to improve health outcomes, and thus accelerate progress towards the MDGs. In countries that receive significant levels of external aid, robust national strategies provide the best means of ensuring alignment between external inputs and national priorities. Facilitating the development and implementation of national policies, strategies and plans is now a priority for WHO. Support for this process at the national level requires coordinated action across the Organization in collaboration with partnerships, but also improved competencies of WHO staff, particularly in countries. The MDG's focus on quantitative, time-bound goals has been a stimulus to measure results and track progress. But this focus has also revealed serious shortcomings in the capacity of countries to generate statistics and other health information. Some 85 countries, representing 65% of the world’s population, do not have reliable cause-of-death statistics. This means that causes of death are neither known nor recorded, and health programmes are left to base their strategies on crude and imprecise estimates. WHO will continue to help countries to strengthen information systems and build national analytic capacity. The past decade has seen notable achievements in reducing deaths from AIDS, tuberculosis, malaria and the vaccine-preventable diseases of childhood. But this is progress, and not a victory, and this progress is fragile. Sustaining these gains must be done in tandem with efforts to tackle other health priorities, including non-communicable diseases and mental health. Sustained advocacy has paid dividends by securing high-level political support for the non- communicable disease agenda, recently reflected in the UNGA special session on these diseases. The proposed programme budget 2012-13 budget reflects the need to shift the focus to surveillance, measurement and the strengthening of actions with partnerships that will result in improvements in non-communicable diseases. Such action will only be effective if the health sector collaborates with other sectors that influence the main risk factors for these diseases. In doing so, ongoing work to implement the recommendations of the Commission on Social Determinants of Health will have particular relevance. The H1N1 influenza pandemic was the first major test of the revised International Health Regulations. By the time the budget 2012-13 starts to be implemented, the Review Committee will have completed its assessment of the performance of the WHO Secretariat, Member States and the network of national and international institutions involved in tackling this pandemic. Should the Committee’s report identify components of the system that work well, it will be important to protect and reinforce them. The report is also likely to identify areas of WHO performance that need to be improved.. Such recommendations will be reflected in the emphasis of the 2012-13 budget. A key message coming from both internal and external discussions is that WHO should be of demonstrable value to all countries, with the level of support adjusted to the particular needs and circumstances of individual countries. In some countries, support is provided through a physical presence and a WHO country office, but in others it is not. A key concern during the biennium will be to develop and implement clear criteria to be used to ensure a good match between the level of WHO support and country development needs. In countries where WHO has a physical presence, the level and skill mix of WHO staff will have to be developed to match programme implementation. This is particularly critical in priority areas such as the development of national policies and strategies as mentioned above. WHO's budget and financing cannot be considered in isolation from questions about priorities and the changing nature of WHO's core business. Discussions among Member States around the strategic issues raised at the initial consultation on the future of financing for WHO, held in January 2010, are continuing in parallel with this budget preparation. At the initial consultation, normative and standard setting work and technical cooperation with countries was generally seen as being core business and central to maintaining WHO's role as the world's technical authority on health issues. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 3 Further input on these important issues for the profile of WHO in the more immediate and also longer term future will be forthcoming during the continuing debate on this issue. The final programme budget 2012-13 that will be presented to the 64th World Health Assembly in May 2011 will continue to be modified as we receive input and guidance from Member States. This version of the PB 2012 reflects the initial conclusions of this exercise, particularly in relation to the need for consolidation of key areas of work and a tight focus. Budget overview The Proposed programme budget for 2012-2013 reflects an assessment of the financial environment and the resources likely to be available as well as the actual implementation capacity of the Organization. It reinforces the Secretariat's commitment to better alignment of resources management to planned delivery across strategic objectives and major offices, especially with regard to the under- funded priority strategic objectives. It also maintains the commitment to the Organization’s strategy to strengthen the first-line support provided to countries with adequate back-up at regional and global levels. The “70%–30%” principle continues to guide the overall distribution of resources between regions and headquarters, with the understanding that there will be variations between the strategic objectives and their underlying programmes depending on the nature of the programmes concerned. The Organization-wide baselines and targets have been established for each expected result. Within the overall framework of the Proposed programme budget 2012-2013, the detailed work of identifying the specific targets and actual resource requirements at the Organization-wide expected result level will be undertaken during an integrated operational planning and budgeting process to be conducted in 2011. This will enable a better alignment with country priorities, collaboration across the Organization and a more accurate estimate of resource requirements. Unlike in the past, where the assessed contributions were managed as a budget parallel with but separate from the budget of voluntary contributions, it is proposed to take the next step to achieve a fully integrated budget. In a fully unified budget, assessed contributions can play an important role in ensuring better alignment and protection of the core activities of WHO where these will not be funded from less flexible resources. The allocation of assessed contribution resources by major office is proposed to remain the same as for 2010-2011. However, within each major office the assessed contributions will be managed to ensure optimal alignment between budget, resources and results within its programme portfolio. During the biennium 2008-2009, a segmentation of the budget was proposed to provide greater transparency on the Programme budget, its funding and implementation. This was formalized in the Programme budget 2010-2011 by presenting the budget broken down into three segments: Base programme (Base), Special programmes and collaborative arrangements (SPA) and Outbreak and Crisis response (OCR).This segmentation has proven useful in improving transparency, e.g., as shown in the discussions on partnerships during WHA63 and in facilitating budget management. Further refinements have been made during the 2008-2009 biennium in terms of shifting some programmes from Base to SPA, moving out five partnerships 1 from the WHO Programme budget altogether, as well as improving the tracking mechanisms. The total proposed Programme budget for 2012-2013 is $4,804 million. The increase of $264 million compared to the approved budget for 2010-2011 relates mainly to adjusting the SPA and OCR budgets to the realities of their funding and implementation (table 1). - Base programmes: WHO has exclusive strategic and operational control over the the activities concerned, and over the choice of means, location and timing of implementation. The Organization can ensure both a balanced growth across the different strategic objectives, reflecting overall health priorities and an even distribution across major offices. This segment is proposed at US$3,419 million, which represents an increase over the approved budget for 2010-2011 of 51 million. It should be noted that the totality of 1 The five partnerships which has moved out of WHO’s programme budget are: the Health Metrics Network (HMN), Roll Back Malaria Partnership (RBM), Water Supply and Sanitation Collaborative Council (WSSCC), Partnership for maternal, Newborn and Child Health (PMNCH), and United Nations Standing Committee on Nutrition (SCN) PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 4 SO12 and 13 is included as part of Base programmes although these strategic objectives serve all budget segments. - Special programmes and collaborative arrangements: activities that are fully within WHO’s results hierarchy and for which WHO has executive authority. However, the activities in this segment are undertaken in collaboration with others and thus the magnitude of associated operations is determined by the special nature of the activity and the joint strategic decisions of the collaboration. The budget for this segment has been set at $922 million, i.e., similar to the expenditure level in 2008-2009 but $100 million above the Approved budget for 2010-2011. For a full list of the special programmes and collaborative arrangements for 2012-2013, see summary table 4. - Outbreak and crisis response: relates to activities governed by acute external events. The resource requirements are normally significant and difficult to predict; for this reason, budgeting can only be done with great uncertainty and the requirements for the 2012- 2013 has been estimated at US$462 million, i.e., about the same as the expenditures in 2008-2009. US$147 million relate to outbreak response in SO1 and US$315 million to crisis response in SO5 (table 2). Table 1: Implementation for 2008-2009 2 , Approved programme budget for 2010-2011 and proposed Programme budget 2012-13 budget by budget segment (in US dollars million) 2008‐2009 2010‐2011 2012‐2013 Budget Impl. App. PB Proposed PB Base 3,742 2,451 3,368 3,419 51 SPA 370 934 822 922 100 OCR 116 469 350 462 112 Total 4,227 3,854 4,540 4,804 264 Change over 2010‐ 2011 Over the past several bienniums, the WHO programme budget has grown. However, funding and implementation has not always kept pace with the growth in the budget. There have been large funding gaps across strategic objectives and major offices. This has caused some challenges in implementation of the programme budget. For 2012-2013 biennium, having a closer alignment between results, budget, available resources and programme implementation is sought. Organization-wide, it has particularly been ensured in the budgeting process that strategic objectives 3, 4, 6, 7, and 9 will have sufficient room for growth compared to their levels of expenditures in the 2008- 2009 biennium. It is an expressed desire of the Director-General and the Secretariat as a whole to continuously increase efficiency in strategic objective 12 and 13 and limit the growth in their costs below the growth in the overall level of operation. To this effect, an organization-wide effort is ongoing to contain costs, through applying bench-marking, standard setting and introduction of cost-reduction targets 3 . However, at the same time the number and complexity of intergovernmental processes are putting a strain on SO12 and 13. 2 . Compared to the expenditures reported in the Programme budget 2008-2009 performance assessment report, US$151 million has been shifted from Base to the SPA segment and US$46 million has been shifted from the SPA segment out of the Programme budget altogether. 3 The result of this process will be reflected in the Proposed programme budget version to be presented to the Executive Board in January 2011. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 5 Table 2: Proposed programme budget 2012-2013 by strategic objective and segment and compared with implementation in 2008-2009 and the approved budget for 2010-2011 (US$ millions). Baselines Proposed Programme Budget 2012‐2013 Approved PB 2010‐2011 SO All segm. Base 1 407 1,268 542 581 43% 710 147 1,438 30% 2 386 634 556 551 43% 97 0 649 14% 3 89 146 146 146 64% 0 0 146 3% 4 153 333 292 287 88% 34 0 320 7% 5 55 364 109 101 84% 1 315 418 9% 6 89 162 149 143 60% 12 0 155 3% 7 3563 636173% 1 6 1% 8 80 114 113 110 37% 1 0 111 2% 9 42 120 116 96 132% 4 0 100 2% 10 265 474 420 410 54% 45 0 455 9% 11 114 115 115 135 19% 17 0 152 3% Subtotal 1‐11 1,715 3,793 2,621 2,620 53% 922 462 4,005 83% 12 260 223 223 290 12% 290 6% 13 476 524 524 509 7% 509 11% Subtotal 12‐13 736 747 747 799 9% 799 17% Grand total 2,451 4,540 3,368 3,419 40% 4,804 100% Base % change over Exp 2008‐2009 SPA OCR Total % of Grand total Impl. 2008‐ 2009 (Base In line with the aim for consolidation of the growth in the programme budget and in order to facilitate a better alignment, the overall budget of base programme for the regions was the approved budgets for 2010-2011. This, for all regions provides a considerable challenges for growth from the level of 2008- 09 expenditures, ranging from 35% for European region to 92 and 98% for the Americas and the Eastern Mediterranean regions (table 3). Table 3: Budget breakdown of the Proposed programme budget 2012-20133 by Major Office and budget segment with comparison to 2008-09 implementation and the Approved budget for 2010-2011 (US$ millions). Major office Approved PB2010‐2011 Proposed Programme budget 2012‐2013 SPA OCR Total AFRO 522 1,263 926 926 27% 77% 402 81 1,409 AMRO 127 256 245 245 7% 92% 6 7 257 SEARO 252 545 394 394 12% 56% 80 32 505 EURO 176 262 239 239 7% 35% 16 11 266 EMRO 197 515 391 391 11% 98% 163 171 725 WPRO 205 310 293 293 9% 42% 11 13 316 HQ 970 1,389 881 932 27% ‐4% 246 148 1,325 Total 2,451 4,540 3,368 3,419 100% 40% 922 462 4,804 % of total (vali'tion) % o. 2008‐2009 exp. Impl. 2008‐ 2009 (Base) All segments Base, incl SO12 and 13 Base, incl SO12 & 13 For Headquarters, implementation in 2008-2009 was already above the approved budget for 2010-2011. Containing the growth of this major office and moving towards the 30-70 alignment between headquarters and the regions requires firm action and has significant implications: • The proposed Headquarters budget for 2012-2013 is established 4% below the 2008-2009 implementation. • With cost increases and enforcement of budget discipline, this will restrict the level of Headquarters operations in 2012-2013 considerably below that of 2008-2009 and create the impetus for devolving functions and resources to the regions and countries as is required to more towards the 30-70 alignment. • However, for this to materialize, efforts to adjust will already have to start during the 2010- 2011 biennium PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 6 Financing the programme budget The current financial situation in general and in several of the main donor Member States in particular suggests a slow down in the historical increase of resources for WHO or a direct decrease in the coming year or two. Although it is difficult to predict the future financial situation, it is prudent to show greater caution with respect to at all times having sufficient resources to meet obligations to staff salaries and other costs that represent longer-term commitments and are slow in adjusting. The full proposed programme budget is anticipated to be funded 20% from assessed contributions and 80% from voluntary contributions with most of the latter being highly specified. This continues the trend of an increasing proportion of the programme of WHO being funded from voluntary resources (table 4). The high proportion of the total budget funded from specified voluntary contributions poses serious challenges to WHO as was expressed in the January 2010 discussions on the future of financing for WHO: “In the absence of change, greater alignment with agreed priorities will be unattainable. Participants agreed that improving performance is intimately linked to the way WHO is financed 4 ”. Table 4: Proposed programme budget 2012-2013 financing compared with actual implementation in the biennium 2008-2009 5 and the Approved programme budget 2010-2011 across major offices (US$ millions). Source of funding US$ millions % US$ millions % US$ millions % Assessed contributions 909 929 929 Member states non‐assessed inco 30 15 15 Total Assessed contributions 939 24% 944 21% 944 20% 111 300 400 196 400 400 2,654 2,896 3,060 Total voluntary contributions 2,961 76% 3,596 79% 3,860 80% Total financing 3,900 100% 4,540 100% 4,804 100% Fully and highly flexible Medium flexible voluntary Specified voluntary contributions Actual Approved Proposed Assessed contributions It is proposed that the level of assessed contributions remain unchanged from the biennium 2010-2011. Miscellaneous income may continue to provide support to the budget in line with assessed contributions. Miscellaneous income is derived mainly from interest earnings on assessed contributions, collection of arrears of assessed contributions, and unspent assessed contributions at the end of a biennium. It is proposed that the budget be presented as a fully unified budget which is financed from both assessed and voluntary contributions. The assessed contributions can play an important and integral role in ensuring better alignment and protection of the core activities of WHO where these cannot be funded from less flexible resources. This will not only ensure better alignment but also greatly enhance efficiency and budget management acceptance. The allocation of assessed contribution resources by major offices is proposed to remain the same as for 2010-2011 (table 5). Within each major office, the assessed contributions will be managed to ensure optimal alignment between budget, resources and results across the programme portfolio. If the proposal is endorsed by the EB/WHA, it would mean that there would be appropriation sections corresponding to major offices rather than strategic objectives which is the current practice. This would also mean bringing the control of the distribution of assessed contribution more in line with previous discussions and concerns of the governing bodies. 4 “The future of financing for WHO – Report of an informal consultation convened by the Director- General” Geneva, Switzerland, 12-13 January 2010 5 The implementation figures for 2008-2009 include the $46 million relating to partnerships that has moved out of the Programme budget. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 7 Table 5: Proposed financing of the unified programme budget with assessed contributions by Major office compared with actual implementation 6 in 2008-2009 and the approved programme budget 2010- 2011 (US$ millions). Major office Total AC Total AC Total AC Africa 1,007 211 1,263 210 1,409 210 The Americas 140 81 256 81 257 81 South‐East Asia 363 103 545 102 505 102 Europe 203 63 262 62 266 62 Eastern Mediterranean 531 91 515 91 725 91 Western Pacific 230 79 310 79 316 79 Headquarters 1,426 322 1,389 320 1,325 320 Total 3,900 949 4,540 944 4,804 944 Actual Approved Proposed Core voluntary contributions The core voluntary contributions account (CVCA), comprising fully and highly flexible funds, is becoming an important component of WHO’s financing model. The contributors to the CVCA as well as WHO – are learning how to get maximum benefit of this new financing instrument. For 2008-2009, US$195 millions were received to the CVCA from 14 different donor countries. The CVCA promotes better flow of resources towards less well-funded strategic objectives and offices and within these to bottlenecks of implementation due to lack of immediate financing, thus contributing to both greater alignment and efficiency. The CVCA is still new and relatively small, however, now that the CVCA has been established, including the required rolling working capital, the full benefit is expected to begin showing during the course of 2010-2011. Despite or due to the current adverse general financial environment, it is anticipated that donors will find it attractive to shift all or some of their contributions to the CVCA from more specified contributions. Core voluntary contributions that are flexible at the OWER, major office or organization-wide theme level are termed medium-flexible and provide an option for contributors who for one reason or the other cannot provide highly or fully flexible funds to increase the flexibility and thereby quality of their funding. It is foreseen that specified voluntary contributions will continue to constitute the majority of the funding for the Organization also in the 2012-2013 biennium. However, the combination of the global financial crisis and the institutionalization of the CVCA will likely make it more attractive for donors to shift some of their specified funding into the CVCA, which, thus is projected to grow at a relatively faster pace compared to the specified contributions. Cost recovery The combined costs of strategic objectives 12 and 13 for 2012-2013 are estimated to be $799 million plus about $60 million, which in the Approved programme budget for 2010-2011 were listed as funded through a separate mechanism. Member States have over the years requested WHO to ensure full cost recovery from activities funded from voluntary contributions. Ensuring cost-recovery of both direct and indirect costs is a challenge across the UN system. During 2009, WHO has undertaken an Organization-wide exercise to analyse the constraints in ensuring full cost recovery and investigated alternative solutions. As a result of this work, a post occupancy charge was introduced from January 1, 2010 to recover those costs most closely associated with the level of staffing of programmes and projects. Examples of such costs 6 Note that the implementation of $3,900 million includes $46 million relating to the partnerships that were moved out of the Programme Budget 2010-11 (see also summary table 4). PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 8 include: staff development and learning, IT infrastructure, HR administration, UN common security charges, office accommodation. The post occupancy charge is an appropriate solution to ensure cost recovery when the staff intensity and thus the support costs vary considerably across activities as is the case for WHO. The introduction of the post occupancy charge is expected to close the financing gap for strategic objectives 12 and 13 which was projected in the Approved programme budget 2010-2011. The post occupancy charge is included as a programme direct cost within all strategic objectives and appears in work plans as an integral component of the standard staff cost. In order to avoid double counting, these costs will be separated out and explicitly shown in the Executive Board version of the Proposed programme budget 2012-2013 as fuller information become available with respect to the actual earnings. Financing safety and security of staff The security situation has continued to deteriorate significantly in certain countries and the cost of providing security for the Organization’s staff and operations has escalated. WHO has put in place four financing mechanisms: a) set-up costs to allow for a minimum standard of security staffing and infrastructure will be financed through assessed contributions and other direct funding of SO13 in the Programme Budget; b) costs due to unforeseen circumstances such as emergency evacuation will be financed through a Security Fund; c) costs directly driven by the number of staff alone such as WHO contribution to UN Security Management System will be covered by the newly introduced post occupancy charge; and d) cost of doing business at a particular field location as a consequence of programme implementation will be covered from the work plans of each programme and project. In Resolution WHA63.6, Member States’ agreed to release US$ 10 million in Member States’ non- assessed income in 2010 to the Security Fund Financing the Capital Master Plan Financing the capital master plan has for many years a significant challenge for the Organization. Further to decisions taken at the 63rd WHA, a sustainable financing approach has been agreed. The 2012-2013 budget includes an amount of 22m for the capital master plan, which is outside of the operational expenditures in SOs 1 to 13. This planned amount of 22m will be directed towards priority capital projects as defined in the capital master plan, and for which annual updates are to be provided to the WHA. Financing is via a capital charge of 6 million per annum, together with 10 million from other member states non assessed income, the latter subject to available income. Carry forward The Organization routinely carries forward a balance on specified voluntary contributions to meet future commitments for planned salary and activity costs against these projects. At the start of 2012 it is expected that this carry forward will be approximately 1.5 billion. Depending on the ease, if any, with which this carry forward can be re-distributed to other planned costs, which in turn depends on the degree of specification, it is possible that this carry forward may be slightly reduced by the end 2013. Any such reduction would thus contribute towards financing of the 2012-13 budget. Operational planning and budgeting The detailed resource allocation is determined closer the time of implementation of the Programme budget, on the basis of specifically planned results and precise estimate of resource requirements for agreed programme delivery. An integrated operational planning and budgeting process will be conducted in 2011. During this process the expected accomplishments of each entity across the Organization will be agreed, reflecting their respective functions and desirable staffing. Estimated staff and non-staff resource requirements will be determined. On the basis of the agreed operational plans, detailed budget allocations will be done. A key feature of the operational planning and budgeting process is alignment of the commitments for results and budget allocations with agreed priorities at the country level. This will allow for target countries for the Organization-wide expected results to be identified on the basis of country priorities, PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 9 as will the latter thus ensure greater co-ordination and alignment of the delivery of planned results across the Organization. Emphasis will also be placed on ensuring the expected results and resource requirements are based on realistic assumptions of resource availability and are cost effective. Monitoring the programme budget Performance monitoring and assessment are essential for the proper management of the programme budget and to inform the revision of policies and strategies. Monitoring and assessment of the implementation of the programme budget are conducted at the 12-month period (the mid-term review) and upon completion of the biennium (the programme budget performance assessment). The mid-term review serves to track and appraise progress towards the achievement of the expected results. It facilitates corrective action, and the reprogramming and reallocation of resources during implementation. For each Organization-wide expected result, an appraisal is made as to the progress made towards achieving the expected results at the mid-term. also It is basically a process for the secretariat to identify and analyse the impediments and risks encountered, together with the actions required to ensure that the expected results are achieved. The end-of-biennium programme budget performance assessment is a comprehensive judgment of the performance of each organizational entity and of the Organization as a whole, including the achievement of the targets set for the expected result indicators. The assessment focuses on achievements as compared against planned results, and on lessons learnt, in order to inform planning for the next biennium. The performance assessment for the biennium 2008–2009 has noted the lessons learnt and these have informed the formulation of this Proposed programme budget 2012–2013. The set of indicators for all Organization-wide expected results in the Amended Medium-term strategic plan 2008–2013 has been further reviewed in the light of the PBPA 2008-2009. Further improvement has been considered where appropriate with the aim of facilitating measurement and reporting. The refinement and tracking of indicators and targets across all levels of the Organization represents an incremental effort and work undertaken in the current biennium will also lead to continuous improvements as part of the preparation of the next Medium-term strategic plan. The mid-term review and the programme budget performance assessment processes each generate a report; both documents are submitted to the governing bodies for their consideration. The timeline for production of these documents established for the biennium 2008–2009 will be maintained: the mid- review report will be made available for the PBAC, EB, Health Assembly and Regional Committee sessions following the first year of the biennium; the assessment report will be submitted to the same bodies at their session following the second year of the biennium. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 10 Strategic objective 1 To reduce the health, social and economic burden of communicable diseases Scope The work under this strategic objective focuses on prevention, early detection, diagnosis, treatment, control, elimination and eradication measures to combat communicable diseases that disproportionately affect poor and marginalized populations. The targeted diseases include but are not limited to: vaccine- preventable, tropical, zoonotic and epidemic-prone diseases, excluding HIV/AIDS, tuberculosis and malaria. Achievements to date The pandemic of influenza A(H1N1) 2009 dominated the Organization's activities and led to the fine tuning of national preparedness plans across all Member States and the establishment of national rapid response teams, including at sub-national level. WHO and Member States responded by collaborating more closely in accordance with the International Health Regulations (2005), and by stepping up information sharing, consultation and decision making. From the replies submitted by 119 Member States to the Secretariat's 2008 and 2009 questionnaires on the Regulations, it appeared that cross- sectoral links continued to be created, and that awareness of their requirements was increasing among health-sector personnel. By the end of 2009, contributions from Member States and other donors, through the pandemic vaccine development initiative, allowed WHO to establish a logistical and legal framework to provide 95 developing countries with access to vaccines against influenza A(H1N1) 2009. The positive trends in global vaccination coverage continued, with an estimated global coverage of 82% in 2009. Approximately five million deaths in all age groups were averted by immunization during the biennium. During 2000–2008, measles deaths worldwide fell by 78% from an estimated 733 000 deaths in 2000 to 164 000 in 2008. By late 2008, pneumococcal and rotavirus vaccines had been introduced in 31 and 19 Member States respectively. Despite continuing indigenous wild poliovirus transmission in Afghanistan, India, Nigeria and Pakistan, progress was made towards eradication in these four countries. The recurrent re-introduction or persistence of the viruses in 19 countries that had previously been free of poliomyelitis further complicated the situation. WHO's work in controlling neglected tropical diseases, including leprosy, human African trypanosomiasis and onchocerciasis, attracted wider attention and recognition as a result of regional plans associated with the Global Plan to Combat Neglected Tropical Diseases 2008–2015. Dracunculiasis is on the verge of eradication. Countries were increasingly leading research through networks such as the African network for drugs and diagnostics innovation. Four regional reference research training centres were established in Colombia, Indonesia, Kazakhstan and Rwanda. The high-level political commitment demonstrated at the Ministerial Conference on Research for Health in the African Region, held in Algiers, on 23–26 June 2008 and the Global Ministerial Forum on Research for Health, held in Bamako, on 17–19 November 2008, served to raise the priority given to health research. Key challenges Achieving or making progress towards eradication of numerous neglected tropical diseases and communicable diseases, including poliomyelitis, will involve overcoming impediments, such as weak delivery systems. Building the capacity of health systems to implement planned activities in conflict areas pose a particular challenge. In general, interventions to prevent and control vaccine preventable diseases and respiratory, diarrhoeal and vector-borne diseases, will need to be scaled up, including expanding vaccination coverage to include children who have not been immunized and introducing new vaccines. Action will be required to support the integration of the Global Plan to Combat Neglected Tropical Diseases 2008–2015 in national plans, and to strengthen capacity and address emerging and re-emerging and vector-borne diseases that pose a risk to global health security. In addition to ensuring full implementation of the International Health Regulations (2005), research and PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 11 advocacy will need strengthening in order to engage governments and civil society in preventing, controlling and treating communicable diseases. Priorities and emphasis for 2012–2013 There has been considerable progress made towards the regional elimination of some major vaccine preventable diseases, such as polio, measles and rubella, which affect millions of children every year. It is anticipated that fewer supplementary immunization activities will be needed as eradication or elimination of these diseases is achieved There has also been some progress made towards reducing the impact of diseases like hepatitis B. At the same time, some vaccine preventable diseases such as influenza remain poorly controlled. It is clear that immunization campaigns work but equally clear Member States and WHO cannot afford to sit back. The primary emphasis in this area will include progressing towards the regional eradication and elimination of certain diseases such as measles, rubella, and hepatitis B and to strengthen immunization against other diseases such as influenza; working with partners to build on the success of campaigns until targets are reached and control and prevention interventions are adequately scaled up; strengthening the availability of information necessary to assess and document the progress being made by immunization programmes; expanding vaccination efforts to cover unimmunized children and age groups older than infancy. Immunization of older age groups will expand groups protected by immunization and will ensure that immunizations initiated in infancy are completed; more effectively addressing the expectations and needs of Low and Middle-Income Countries in mounting successful immunization campaigns; and developing new and effective ways to support immunization efforts through activities such as establishing regional pooled vaccine procurement systems, building new partnerships, developing new financing arrangements, introducing new vaccines, supporting transfer of vaccine production technologies and increasing access to vaccines. The endemic persistence of polio in four countries, and the spread of polio from these countries to other countries, continue to delay the eradication of Polio and increases the risk of re-infection in otherwise polio-free countries The primary emphasis in this area will be: mobilizing political, technical and financial backing needed to complete polio eradication; working with the Global Polio Eradication Initiative partners to build upon implementation of the new Global Polio Eradication Initiative (GPEI) Plan 2010-2012; continuing with ongoing implementation of critical activities such as vigorous outbreak control measures and migrant population strategies; continuing planning for the post eradication period including the handling of complex issues such as the destruction or safe storage and handling of residual stocks of wild poliovirus infectious materials, certification of the interruption of wild poliovirus transmission and final containment of wild poliovirus stocks and resolving issues about the technical and operational feasibility of replacing OPV by IPV to eliminate the occurrence of vaccine associated paralytic polio (VAPP) and circulation of vaccine-derived polioviruses (cVDPVs), and verification of the elimination of vaccine derived polio viruses. Following the launch of the eight year Global Plan to Combat Neglected Tropical Diseases considerable progress has been made in the treatment and elimination of leprosy, Chagas Disease, rabies, lymphatic filariasis, and Guinea worm. There has also been significant progress made towards reducing the impact of a wide range of other diseases like, schistosomiasis, human African trypanosomiasis, and Yaws, which affect huge numbers of people. .Breakthroughs were achieved by integrating national plans under the new Global Plan and by harmonizing multi-sector collaboration; strengthening surveillance, preparing elimination plans, and global strategies to cater to many of the aspects of neglected tropical and zoonotic diseases. In addition integrated vector management and pesticide management strategies have been developed. WHO supported various endemic countries through training and education programmes and facilitating access to vital information, specimen banks and databanks. WHO has also strengthened its collaboration with Member States, UN Agencies, the Foundation for Innovative new Diagnostics to design new diagnostic tools and the pharmaceutical industry, which have provided large scale drug donations. The primary emphasis in this area will include achieving the global eradication of Guinea worm and the regional eradication and elimination of lymphatic filariasis, schistosomiasis, human African trypanosomiasis and yaws; supporting integrated national plans to combat neglected tropical diseases under the Global Plan; supporting making more drugs available, particularly for schistosomiasis and soil transmitted helminthiasis and supporting the implementation of a new strategic plan for dengue that commits to integrated vector management and provides a road map for national plan development. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 12 The Implementation of the International Health Regulations as the framework for preparedness, surveillance, alert, assessment and networks is essential for strengthening global public health security. Implementation of the IHR will help countries to respond to emerging and re-emerging epidemic and pandemic diseases, vector borne disease, and disease related to the human animal interface and environmental change. Implementation of the IHR is particularly complex in fragile states and areas affected by conflict and security issues. The primary emphasis in this area will be: strengthening advocacy, political commitment and engagement of communities, civil society and the non-state sectors in the implementation of IHR; assisting countries strengthen their preparedness and capacities, including planning, health systems, tools and networks for surveillance, preparedness, risk assessment and risk response to handle public health issues of local, national and international importance; facilitating research, and the capacities such as regional innovative systems, to conduct research, needed to acquire the evidence and vital knowledge necessary to strengthen public health disease control and prevention efforts and to disseminate the results so knowledge results in implementation; supporting Member States to resolve public health issues related to the sharing if viruses and benefits; enhancing communication, advocacy tools and strategies by providing more support at community levels, by supporting health systems and integration of services in underserved urban and rural communities, and at country level, by supporting development of regional platforms for surveillance, epidemiology, monitoring, alert and response, laboratory capacity, "events-based surveillance", vaccine preventable diseases and evaluation of immunization programmes. Links with other strategic objectives - Strategic objectives 2, 3, 4, 6 and 9: in relation to integrated disease control, surveillance and harmonized research initiatives. - Strategic objective 5: in relation to mutual support in field operations and health security. - Strategic objective 8: in relation to the adoption of adequate solutions for management of health-care waste. - Strategic objective 9: in relation to water and sanitation aspects of zoonotic diseases. - Strategic objective 10: in relation to the implementation of programmes through financially sustainable health-system approaches. - Strategic objective 11: in relation to access to safe and effective vaccines, medicines and interventions, as well as quality assurance of diagnostics and laboratory services. Major WHO special programmes and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope - Effective collaboration with GAVI Alliance partners - Global Poliomyelitis Eradication Initiative - Partnership for the control of neglected tropical diseases - Special Programme for Research and Training in Tropical Diseases - Vaccine research partnerships - Tri-partite Agreement WHO-FAO-OIE on avian influenza management and other emerging diseases Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 155.2 24.0 76.0 21.3 88.1 52.0 164.5 581 Special programmes and collaborative arrangements 710 Outbreak and crisis response 147 Grand Total 1 438 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 13 Organization-wide expected results and indicators Indicators 1.1.1 Number of Member States with at least 90% national vaccination coverage (DTP3) 1.1.2 Number of Member States that have introduced Haemophilus influenzae type b vaccine in their national immunization schedule Baseline 2012 135 160 Targets to be achieved by 2013 1.1 Policy and technical support provided to Member States in order to maximize equitable access of all people to vaccines of assured quality, including new immunization products and technologies, and to integrate other essential child- health interventions with immunization. 145 170 Indicators 1.2.1 Percentage of final country reports demonstrating interruption of wild poliovirus transmission and containment of wild poliovirus stocks accepted by the relevant regional commission for the certification of poliomyelitis eradication 1.2.2 Percentage of Member States using trivalent oral poliovirus vaccine that have a timeline and strategy for eventually stopping its use in routine immunization programmes Baseline 2012 90% 50% Targets to be achieved by 2013 1.2 Effective coordination and support provided in order to achieve certification of poliomyelitis eradication, and destruction, or appropriate containment, of polioviruses, leading to a simultaneous cessation of oral poliomyelitis vaccination globally. 100% 75% Indicators 1.3.1 Number of Member States certified for eradication of dracunculiasis 1.3.2 Number of Member States that have eliminated leprosy at subnational levels 1.3.3 Number of reported cases of human African trypanosomiasis for all endemic countries 1.3.4 Number of Member States having achieved the recommended target coverage of population at risk of lymphatic filariasis, schistosomiasis and soil-transmitted helminthiases through regular anthelminthic preventive chemotherapy Baseline 2012 190 95 8 500 20 Targets to be achieved by 2013 1.3 Effective coordination and support provided to Member States in order to provide access for all populations to interventions for the prevention, control, elimination and eradication of neglected tropical diseases, including zoonotic diseases. 193 145 7 500 25 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 14 Indicators 1.4.1 Number of Member States with surveillance systems and training for all communicable diseases of public health importance for the country 1.4.2 Number of Member States for which WHO/UNICEF joint reporting forms on immunization surveillance and monitoring are received on time at global level in accordance with established time-lines Baseline 2012 150 155 Targets to be achieved by 2013 1.4 Policy and technical support provided to Member States in order to enhance their capacity to carry out surveillance and monitoring of all communicable diseases of public health importance 193 165 Indicators 1.5.1 Number of new and improved tools or implementation strategies, developed with significant contribution from WHO, introduced by the public sector in at least one developing country 1.5.2 Proportion of peer-reviewed publications based on WHO-supported research where the main author’s institution is in a developing country Baseline 2012 9 55% Targets to be achieved by 2013 1.5 New knowledge, intervention tools and strategies that meet priority needs for the prevention and control of communicable diseases developed and validated, with scientists from developing countries increasingly taking the lead in this research. 14 60% Indicators 1.6.1 Number of Member States that have completed the assessment and developed a national action plan to achieve core capacities for surveillance and response in line with their obligations under the International Health Regulations (2005) 1.6.2 Number of Member States whose national laboratory system is engaged in at least one external quality-control programme for epidemic-prone communicable diseases Baseline 2012 160 150 Targets to be achieved by 2013 1.6 Support provided to Member States in order to achieve the minimum core capacities required by the International Health Regulations (2005) for the establishment and strengthening of alert and response systems for use in epidemics and other public health emergencies of international concern. 193 193 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 15 Indicators 1.7.1 Number of Member States having national preparedness plans and standard operating procedures in place for readiness and response to major epidemic-prone diseases 1.7.2 Number of international coordination mechanisms for supplying essential vaccines, medicines and equipment for use in mass interventions against major epidemic and pandemic-prone diseases 1.7.3 Number of severe emerging and re-emerging diseases for which prevention, surveillance and control strategies have been developed Baseline 2012 165 8 8 Targets to be achieved by 2013 1.7 Member States and the international community equipped to detect, assess, respond to and cope with major epidemic and pandemic-prone diseases (e.g. influenza, meningitis, yellow fever, haemorrhagic fevers, plague and smallpox) through the development and implementation of tools, methodologies, practices, networks and partnerships for prevention, detection, preparedness and intervention. 193 9 10 Indicators 1.8.1 Number of WHO locations with the global event-management system in place to support coordination of risk assessment, communications and field operations for headquarters, regional and country offices Baseline 2012 90 Targets to be achieved by 2013 1.8 Regional and global capacity coordinated and made rapidly available to Member States for detection, verification, risk assessment and response to epidemics and other public health emergencies of international concern. 120 Indicators 1.9.1 Proportion of Member States’ requests for assistance that have lead to effective and timely interventions by WHO, delivered using a global team approach, in order to prevent, contain and control epidemic and other public health emergencies. Baseline 2012 99% Targets to be achieved by 2013 1.9 Effective operations and response by Member States and the international community to declared emergencies situations due to epidemic and pandemic prone diseases. 99% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 16 Strategic objective 2 To combat HIV/AIDS, tuberculosis and malaria Scope Work under this strategic objective will focus on: scaling up and improving prevention, treatment, care and support interventions for HIV/AIDS, tuberculosis and malaria so as to achieve universal access, in particular for seriously affected populations and vulnerable groups; advancing related research; removing obstacles that block access to interventions and impediments to their use and quality; and contributing to the broader strengthening of health systems. Key achievements to date Member States facing a high burden of HIV, tuberculosis and/or malaria have made progress in tackling the diseases by focusing on medium-term plans linked to United Nations Millennium Development Goals targets, and responding to the specific needs of at-risk and highly vulnerable populations, including women, children, the very poor and marginalized groups. Innovation, increased financing and technical assistance, and closer collaboration among global partners have contributed to the result. Efforts were stepped up to measure, and respond to emerging drug-resistance. Antiretroviral therapy had been made available to more than four million people worldwide, and health systems strengthened to effectively deliver HIV programmes by addressing, inter alia, human resources capacity, information systems for managing procurement and supply of HIV-related medicines and diagnostics, laboratory diagnostic capacity for HIV and tuberculosis, and treatment monitoring and prevention of mother-to-child transmission of HIV. Coverage of the latter in low- and middle income countries increased; and HIV prevention methods for most-at-risk populations, inter alia, through expansion of male circumcision programmes, were promoted in high burden countries in sub- Saharan Africa. There has been a slow decline in tuberculosis incidence, to the point where the 2015 Millennium Development Goals target 6 has been met and progress is sustainable. DOTS services and application of the Stop TB Strategy were expanded worldwide. International commitment to funding malaria control increased. Member States also scaled up their response by distributing long lasting insecticide treated nets, and, to some extent, rapid diagnostics tests and artemisinin based combination therapy. Implementation and its impact have been greatest in less populated countries with high per capita investment in malaria elimination. Strong political support for elimination from low-endemic countries was emerging, triggered by evidence showing the link between malaria and slower development. Innovation and improved technologies have been the subject of greater attention and strategic attention, triggered by investments by many key partners. Harmonization and coordination of technical support to Member States, particularly in accessing and managing grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, was enhanced. By engaging communities and civil society, partnerships were expanded in the areas of disease prevention, treatment and care, and donor financing of disease control. Member States participated more actively in monitoring and evaluating performance and the impact of HIV, tuberculosis and malaria activities. Analysis and reporting by WHO was also used more widely to help guide global, regional and local responses. Key challenges Although much progress has been made , major challenges remain to expanding universal access to care, including weak health systems, uneven political commitment and resources constraints. Only an estimated 3% of multidrug-resistant tuberculosis cases annually are known to be receiving quality care and extensively drug-resistant tuberculosis is widespread. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 17 A major shift in policies on universal health-care coverage is, therefore, urgently needed in order to increase access to modern diagnostics and proper treatment, and to improve drug quality regulation and promote their rational use within strengthened health systems. Ensuring synergies and complementarily among the increasingly diverse array of partners involved in fighting all three diseases has represented a continual challenge. WHO’s active support for countries in their efforts to leverage funding from global mechanisms for combating HIV/AIDS, tuberculosis and malaria has resulted in increased resources, but also in a corresponding demand for technical assistance. However, the increases in country-level funding from global mechanisms were not always matched by adequate resources to undertake normative work and support member states. Priorities and emphasis for 2012–2013 The demand for technical assistance would require more careful prioritization and identification of areas for particular emphasis, such as, empowering country offices and building their capacity, particularly in human resources increasing investment in countries' routine health information systems to monitor progress in implementation of interventions, monitoring drug and insecticide resistance and assessing the impact of interventions; guaranteeing standards of care and the quality of commodities, collaborating with health services and systems to develop an integrated response and a primary health care approach. Further areas for emphasis include promoting innovation and support to integrated services; prevention of and containment of drug-resistant disease; strengthening of programme monitoring and evaluation including improved measurement of impact; development of integrated policies and operational guidelines for the 3 diseases, child, adolescent, maternal and reproductive health; and full harmonization with existing partnerships hosted by WHO that cover HIV, TB and Malaria, and further strategic engagement on Global Fund-related efforts. Links with other strategic objectives - Strategic objective 1: particularly work related to delivery of interventions; strengthening research capacity and expanding access to new strategies and tools, such as vaccines; and strengthening systems for monitoring and surveillance of communicable diseases. - Strategic objective 3: particularly work relating to HIV and mental health - Strategic objective 4: particularly efforts related to supporting research and development of new tools and interventions; meeting specific needs of children, adolescents and women of child-bearing age; formulation and implementation of gender-sensitive interventions; and tackling sexually transmitted infections. - Strategic objective 6: specifically relating to prevention of tobacco use and its relationship with tuberculosis; and prevention of unsafe sex. - Strategic objective 7: specifically work relating to approaches that enhance equity and are pro- poor, gender-responsive, ethical and human rights based. - Strategic objective 8: particularly relating to environmental health and its relationship with malaria - Strategic objective 9: particularly work in the area of nutrition and its relationship to HIV/AIDS - Strategic objective 10: particularly efforts related to organization, management and delivery of health services; areas of human resource capacity strengthening, integrated training and widening of service provider networks; work related to minimizing the potential of financial catastrophe and impoverishment due to out-of-pocket health expenses. - Strategic objective 11: specifically work related to essential medicines, medical products and technologies for the prevention and treatment of HIV/AIDS, tuberculosis and malaria. - Strategic objective 12: specifically work related to health knowledge and advocacy material made accessible to Member States. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 18 Major WHO special programmes and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope - HIV Vaccine Initiative (including AAVP) - Special Programme for Research, Development and Research Training in Human Reproduction - Special Programme for Research and Training in Tropical Diseases Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 208.2 40.4 90.0 25.5 32.9 55.5 98.8 551 Special programmes and collaborative arrangements 97 Outbreak and crisis response 0 Grand Total 649 Organization-wide expected results and indicators Indicators 2.1.1 Number of low- and middle- income countries that have achieved 80% coverage for (a) antiretroviral therapy and (b) the prevention of mother-to- child transmission services 2.1.2 Proportion of endemic countries that have achieved their national intervention targets for preventing malaria 2.1.3 Number of Member States that have achieved the targets of at least 70% case detection and 85% treatment success rate for tuberculosis 2.1.4 Number of countries among the 27 priority ones with a high burden of multidrug- resistant tuberculosis that have detected and initiated treatment, under the WHO- recommended programmatic management approach, for at least 70% of estimated cases of multidrug- resistant tuberculosis 2.1.5 Proportion of high burden Member States that have achieved the target of 70% of persons with sexually transmitted infections diagnosed, treated and counselled at primary point- of-care sites Baseline 2012 a) 15 B)20 46 15 70% Targets to be achieved by 2013 2.1 Guidelines, policy, strategy and other tools developed for prevention of, and treatment and care for patients with, HIV/AIDS, tuberculosis and malaria, including innovative approaches for increasing coverage of the interventions among poor people, and hard- to-reach and vulnerable populations. a) 35 b) 45 60% 50 27 90% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 19 Indicators 2.2.1 Number of targeted Member States with comprehensive WHO recommended policies and medium-term plans in response to HIV, tuberculosis and malaria 2.2.2 Proportion of high burden countries monitoring provider initiated HIV testing and counselling in sexually transmitted infection and family planning services 2.2.3 Number of countries among the 63 ones with a high burden of HIV/AIDS and tuberculosis that are implementing the WHO 12-point policy package for collaborative activities against HIV/AIDS and tuberculosis Baseline 2012 HIV/AIDS:115/131 Tuberculosis: 118/118 Malaria 70/70 60% 30 Targets to be achieved by 2013 2.2 Policy and technical support provided to countries towards expanded gender- sensitive delivery of prevention, treatment and care interventions for HIV/AIDS, tuberculosis and malaria, including integrated training and service delivery; wider service-provider networks; and strengthened laboratory capacities and better linkages with other health services, such as those for sexual and reproductive health, maternal, newborn and child health, sexually transmitted infections, nutrition, drug- dependence treatment services, respiratory care, neglected diseases and environmental health. HIV/AIDS: 131/131 Tuberculosis: 148 Malaria: 70/70 75% 45 Indicators 2.3 Global guidance and technical support provided on policies and programmes in order to promote equitable access to essential medicines, diagnostic tools and health technologies of assured quality for the prevention and treatment of HIV/AIDS, 2.3.1 Number of new or updated global norms and quality standards for medicines and diagnostic tools for HIV/AIDS, tuberculosis and malaria 2.3.2 Number of new priority medicines and diagnostic tools for HIV/AIDS, tuberculosis and malaria that have been assessed and pre-qualified for United Nations procurement 2.3.3 Number of targeted countries receiving support to increase access to affordable essential medicines for HIV/AIDS, tuberculosis and malaria whose supply is integrated into national pharmaceutical 2.3.4 Number of Member States implementi ng quality- assured HIV/AIDS screening of all donated blood 2.3.5 Number of Member States administering all medical injections using sterile single use syringes PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 20 systems (the number of targeted countries is determined for the six-year period) Baseline 2012 Medicines: 95 300 HIV/AIDS: 38 188 170 Targets to be achieved by 2013 tuberculosis and malaria, and their rational use by prescribers and consumers, and, in order to ensure uninterrupted supplies of diagnostics, safe blood and blood products, injections and other essential health technologies and commodities. Medicines: 105 400 HIV/AIDS: All 50 tageted countries 193 193 Indicators 2.4.1 Number of Member States providing WHO with annual data on surveillance, monitoring or financial allocation data for inclusion in the annual global reports on control of HIV/AIDS, tuberculosis or malaria and the achievement of targets 2.4.2 Number of Member States reporting drug resistance surveillance data to WHO for HIV/AIDS, tuberculosis or malaria Baseline 2012 HIV/AIDS: 120 Tuberculosis: 198 Malaria: 107 HIV/AIDS: 65 Tuberculosis: 125 Malaria: 107 Targets to be achieved by 2013 2.4 Global, regional and national systems for surveillance, evaluation and monitoring strengthened and expanded to keep track of progress towards targets and allocation of resources for HIV/AIDS, tuberculosis and malaria control and to determine the impact of control efforts and the evolution of drug resistance. HIV/AIDS: 130 Tuberculosis: 198 Malaria: 107 HIV/AIDS: 75 Tuberculosis: 130 Malaria: 107 Indicators 2.5.1 Number of Member States with functional coordination mechanisms for HIV/AIDS, tuberculosis and malaria control 2.5.2 Number of Member States involving communities, persons affected by the diseases, civil-society organizations and the private sector in planning, design, implementation and evaluation of HIV/AIDS, tuberculosis and malaria programmes Baseline 2012 HIV/AIDS: 118 Tuberculosis: 110 Malaria: HIV/AIDS: 120 Tuberculosis: 87 Malaria: Targets to be achieved by 2013 2.5 Political commitment sustained and mobilization of resources ensured through advocacy and nurturing of partnerships on HIV/AIDS, tuberculosis and malaria at country, regional and global levels; support provided to countries as appropriate to develop or strengthen and implement mechanisms for resource HIV/AIDS: 131 Tuberculosis: 120 Malaria: HIV/AIDS: 131 Tuberculosis: 87 Malaria: PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 21 mobilization and utilization and increase the absorption capacity of available resources; and engagement of communities and affected persons increased to maximize the reach and performance of HIV/AIDS, tuberculosis and malaria control programmes. Indicators 2.6.1 Number of new and improved tools or implementation strategies for the prevention and control of HIV/AIDS, tuberculosis or malaria implemented by the public sector in at least one developing country 2.6.2 Proportion of peer- reviewed publications arising from WHO-supported research on HIV/AIDS, tuberculosis or malaria and for which the main author’s institution is based in a developing country Baseline 2012 6 70% Targets to be achieved by 2013 2.6 New knowledge, intervention tools and strategies developed and validated to meet priority needs for the prevention and control of HIV/AIDS, tuberculosis and malaria, with scientists from developing countries increasingly taking the lead in this research. 13 70% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 22 Strategic objective 3 To prevent and reduce disease, disability and premature death from chronic noncommunicable diseases, mental disorders, violence and injuries and visual impairment Scope The work under this strategic objective focuses on the following activities: policy development; programme implementation; monitoring and evaluation; strengthening of health and rehabilitation systems and services; implementation of prevention programmes and capacity building in the area of noncommunicable diseases, including genetic disorders, visual and hearing impairment, mental, behavioral and neurological disorders, including those related to psychoactive substance use; injuries due to road traffic crashes, drowning, burns, poisoning, falls, violence in the family and the community, and disabilities from all causes. Key achievements to date The commitment of Member States was demonstrated by the adoption of World Health Assembly and UN General Assembly resolutions on prevention and control of noncommunicable diseases: , on violence prevention, road traffic injury prevention, emergency trauma care, disability and rehabilitation and on prevention of avoidable blindness and visual impairment, as well as numerous regional committee resolutions, for example, on road traffic injury prevention in the Eastern Mediterranean Region, on a regional cancer control strategy in the African Region, and on a regional noncommunicable diseases prevention plan in the Western Pacific Region, the resolution of PAHO's Directing Council to endorse the Strategy and Plan of Action on Mental Health and of a regional Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment in the Region of the Americas. A regional framework for injury prevention in the Western Pacific Region was agreed and an assessment of the progress made in implementing a resolution on the prevention of injuries in the European Region completed. The First Global Ministerial Conference on Road Safety, held in 2009, resulted in the adoption of the Moscow Declaration which in turn lead to the Declaration of a Decade of Action on Road Safety 2011- 20 by the UN General Assembly. WHO's mental health Gap Action Programme was launched to scale up health services for people suffering from mental, neurological and substance use disorders. Technical assistance provided by WHO to Member States covered the preparation and implementation of: strategies and policies for violence and injury prevention and prevention and control of noncommunicable diseases; strategies and regulations to improve the life of people living with disabilities; and mental health policy and legislation based on human rights principles and best practice. Progress was made in the implementation of cost-effective interventions and national policies and plans, as well as in developing a stronger evidence base for interventions. Advocacy activities helped to raise the profile of noncommunicable diseases and injuries prevention and increase the prominence of noncommunicable diseases, mental disorders, violence and injuries and visual impairment on national health and global development agendas. New key partnerships were established and existing ones strengthened. Key challenges The availability of resources in several areas remains inadequate in relation to the magnitude of the problems and the potential for action. This seriously constrains implementation of WHO’s recommendations and guidelines in many low- and middle-income countries. Triggering intersectoral action, which is essential for implementing Health in All policies, has also proved difficult. Priorities and emphasis for 2012–2013 The primary emphasis for the biennium is to capitalize on the broad based advocacy efforts that have led to an increase on the awareness and commitment to the prevention and control of noncommunicable conditions by strengthening national programmes and building technical as well as managerial capacity with special focus on low and middle income countries. Fundable country programmes will be developed to focus on the priorities including: support to Member States to adapt, PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 23 implement and evaluate primary prevention measures; integrating the prevention of noncommunicable conditions into the national development agendas; strengthening implementation of existing resolutions, frameworks, action plans and normative guidance; and integrating essential interventions for preventing and managing noncommunicable conditions including mental and neurological disorders, injuries and disabilities into health system strengthening initiatives. In doing this it is essential to support the development and effective use of multisectoral partnerships, internationally and within countries, reaching out to additional government and civil society stakeholders, and strengthen the contribution of the private sector to the implementation of existing policies and plans while preventing any conflict of interest. Stronger emphasis will also be given to reliable data collection, strengthening surveillance of noncommunicable conditions, integrating such surveillance into national health information systems and improving capacity to measure accurately and report on key indicators. Emphasis will also be placed on careful development of evidence based recommendations to refine and strengthen existing interventions while continuing to integrate the prevention of noncommunicable conditions into the global development agenda. Links with other strategic objectives Achievement of this Strategic Objective requires strong links and effective collaboration with other strategic objectives, in particular: - Strategic Objective 5: in relation to strengthening emergency response for people with disabilities, psycho-social care and for managing injuries and noncommunicable diseases. - Strategic Objective 6: in relation to health promotion, surveillance, prevention and reduction of risk factors for health including population-wide approaches to combating tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity ; and in relation to urban health development. - Strategic Objective 7: in relation to enhancing human rights, health equity and integrating pro- poor, gender responsive approaches. - Strategic Objective 9: in relation to improved nutrition throughout the life course. - Strategic Objective 10: in relation to strengthening health services to respond more effectively to the health care needs of noncommunicable conditions. Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 21.9 11.2 18.1 18.0 22.6 18.0 36.2 146 Special programmes and collaborative arrangements 0 Outbreak and crisis response 0 Grand Total 146 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 24 Organization-wide expected results and indicators Indicators 3.1.1 Number of Member States whose health ministries have a focal point or a unit for injuries and violence prevention with its own budget 3.1.2 The world report on disability and rehabilitation published and launched, in response to resolution WHA58.23 3.1.3 Number of Member States with a mental health budget of more than 1% of the total health budget 3.1.4 Number of Member States with a unit in the ministry of health or equivalent national health authority, with dedicated staff and budget, for the prevention and control of chronic noncommunicable diseases Baseline 2012 162 Published in 6 languages 90 122 Targets to be achieved by 2013 3.1 Advocacy and support provided to increase political, financial and technical commitment in Member States in order to tackle chronic noncommunicable diseases, mental and behavioural disorders, violence, injuries and disabilities together with visual impairment, including blindness. 170 Report launched and implementation started in 40 countries 100 152 Indicators 3.2.1 Number of Member States that have national plans to prevent unintentional injuries or violence 3.2.2 Number of Member States that have initiated the process of developing a mental health policy or law 3.2.3 Number of Member States that have adopted a multisectoral national policy on chronic noncommunicabl e diseases 3.2.4 Number of Member States that are implementing comprehensive national plans for the prevention of hearing or visual impairment Baseline 2012 88 56 90 100 Targets to be achieved by 2013 3.2 Guidance and support provided to Member States for the development and implementation of policies, strategies and regulations in respect of chronic noncommunicable diseases, mental and neurological disorders, violence, injuries and disabilities together with visual impairment, including blindness. 94 64 105 130 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 25 Indicators 3.3.1 Number of Member States that have submitted a complete assessment of their national road traffic injury prevention status to WHO during the biennium 3.3.2 Number of Member States that have a published document containing national data on the prevalence and incidence of disabilities 3.3.3 Number of low- and middle-income Member States with basic mental health indicators annually reported 3.3.4 Number of Member States with a national health reporting system and annual reports that include indicators for the four major noncommunicab le diseases 3.3.5 Number of Member States documenting, according to population- based surveys, the burden of hearing or visual impairment Baseline 2012 175 163 110 136 38 Targets to be achieved by 2013 3.3 Improvements made in Member States’ capacity to collect, analyse, disseminate and use data on the magnitude, causes and consequences of chronic noncommunicable diseases, mental and neurological disorders, violence, injuries and disabilities together with visual impairment, including blindness. 180 168 120 155 50 Indicators 3.4.1 Availability of evidence-based guidance on the effectiveness of interventions for the management of selected mental, behavioural or neurological disorders including those due to use of psychoactive substances 3.4.2 Availability of evidence-based guidance or guidelines on the effectiveness or cost- effectiveness of interventions for the prevention and management of chronic noncommunicable diseases Baseline 2012 Published and disseminated for 12 interventions Published and disseminated for 5 interventions Targets to be achieved by 2013 3.4 Improved evidence compiled by WHO on the cost-effectiveness of interventions to tackle chronic noncommunicable diseases, mental and neurological and substance-use disorders, violence, injuries and disabilities together with visual impairment, including blindness. Published and disseminated for 16 interventions Published and disseminated for 8 interventions Indicators 3.5.1 Number of guidelines published and widely disseminated on multisectoral interventions to prevent violence and unintentional injuries 3.5.2 Number of Member States that have initiated community- based projects during the biennium to reduce suicides 3.5.3 Number of Member States implementing strategies recommended by WHO for the prevention of hearing or visual impairment Baseline 2012 14 21 100 Targets to be achieved by 2013 3.5 Guidance and support provided to Member States for the preparation and implementation of multisectoral, population-wide programmes to promote mental health, and to prevent mental and behavioural disorders, violence and injuries, together with hearing and visual impairment, including blindness. 18 25 130 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 26 Indicators 3.6.1 Number of Member States that have incorporated trauma-care services for victims of injuries or violence into their health- care systems using WHO trauma-care guidelines 3.6.2 Number of Member States implementing community- based rehabilitation programmes 3.6.3 Number of low- and middle-income Member States that have completed an assessment of their mental health systems using the WHO Assessment Instrument for Mental Health Systems (WHO- AIMS) 3.6.4 Number of low- and middle-income Member States implementing primary health-care strategies for screening of cardiovascular risk and integrated management of noncommunic able diseases using WHO guidelines 3.6.5 Number of Member States with tobacco cessation support incorporated into primary health care Baseline 2012 27 35 80 26 40 Targets to be achieved by 2013 3.6 Guidance and support provided to Member States to improve the ability of their health and social systems to prevent and manage chronic noncommunicable diseases, mental and behavioural disorders, violence, injuries and disabilities together with visual impairment, including blindness. 32 41 90 55 45 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 27 Strategic objective 4 To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and health ageing for all individuals Scope The work under this strategic objective seeks to improve and expand access to and use of effective public health interventions which will reduce morbidity and mortality related to pregnancy and childbirth and improve child survival and child and adolescent health and development. It also focuses on actions towards ensuring universal access to sexual and reproductive health services, with a particular emphasis on reducing barriers to use of services and reaching marginalized populations. This work can be achieved only in concert with strengthening health systems and ensuring integrated care, especially for children, adolescents, and women of reproductive age. It emphasizes the linkages between different points across the life course and includes healthy and active ageing. As the HIV pandemic continues, it is especially important that programmes and services intended to reach adolescents and women of reproductive age, including antenatal care, family planning services, and treatment for sexually transmitted infections, include systematically programmes and services for prevention and treatment of HIV infection, including prevention of mother-to-child transmission. It is recognized that the underlying gender inequities must be addressed to achieve the MDG health targets, including those covered under this strategic objective. In this context, violence against women is increasingly recognized as a major public health problem, including being linked to HIV infection, and requires greater attention among the public health community. Key achievements to date MDGs 4 and 5 are receiving greater attention by the global community, with indications of greater political commitment and potential for increased funding for these key MDGs. Within the UN system, the four key agencies working on MDGs 4 and 5 (UNICEF, UNFPA, and the World Bank in addition to WHO) have joined forces in an intensified and coherent joint effort for maternal and newborn health in the neediest countries. WHO has developed new tools and guidelines and assistance in their implementation in the areas of sexual and reproductive health, maternal, newborn and child health, and adolescent health. Globally, child mortality continues to decline. Under SO4, the focus has been on providing assistance to countries in accelerating scale up of IMCI, developing training packages for community health workers (CWH), and initiatives to bring services closer to children by implementing the CHWs programme to care for sick children in the community. The 63 rd WHA adopted a resolution on the prevention and treatment of pneumonia, a major cause of child mortality. Programmatic guidance to improve quality of and access to youth friendly services and school health services has been developed for adolescent health. Services for the prevention of mother-to-child transmission (PMTCT) of HIV infection have increased dramatically, which is a joint effort between SO2 and SO4. WHO's PMTCT strategic vision 2010- 2015 defines WHO's commitment to global and country support to scale up access to PMTCT of HIV services and integrate these services with maternal, newborn and child health programmes. Maternal mortality monitoring and surveillance systems have been strengthened, which has contributed to improved data reporting by countries, although significant gaps remain. The proportion of births attended by skilled health personnel has increased globally, with continued support from WHO for training of health care workers, complemented by an emphasis on greater access to emergency obstetric care and family planning services. Contraceptive prevalence in developing countries continues to rise, although unmet needs for family planning remain. Violence against women, especially intimate partner violence, is increasingly recognized as a major public health problem that must be addressed by the health sector, among others. WHO, together with UNAIDS, has begun to address the linkages between violence against women and HIV infection. In PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 28 addition, WHO held an expert meeting on Strengthening the Health Sector Response to Intimate Partner and Sexual Violence Against Women.. The WHO report on Women and Health, issued in late 2009, lays out for the first time the evidence available on the health issues that particularly affect girls and women throughout their life course, including older women. It also identifies areas where new data, analyses, and research are needed, and is intended to stimulate a much-needed policy dialogue at country, regional and global levels, to inform actions and to draw attention to innovative strategies that will lead to real improvements in the health and lives of girls and women around the world. Active ageing has been recognized by regional offices and countries as an increasingly important public health issue, as older people represent an increasing proportion of the population throughout most of the world. Key challenges Reducing child mortality increasingly depends on tackling neonatal mortality; globally, about 40% of deaths among children under five years of age are estimated to occur in the first month of life, most in the first week. The coverage of crucial interventions such as oral rehydration therapy for diarrhoea and case management with antibiotics for acute respiratory infections remains inadequate. Under-nutrition continues to play an unacceptably large role in child morbidity and mortality. Reducing maternal mortality remains a major challenge, and a much greater effort is needed to expand antenatal, childbirth and postpartum services to all women, especially the most poor and those living in rural or remote areas. Greater emphasis is needed on improving access to and the quality of services in facilities that can provide emergency obstetric care. Slow and uneven progress made in achieving universal access to sexual and reproductive health in countries is jeopardizing the achievement of the MDGs, especially MDG 5. Measuring progress in reducing maternal mortality continues to be a challenge, especially in parts of the world where vital registration systems are weak or nonexistent. Despite some progress in surveillance and monitoring, better ways are needed to measure progress, while strengthening health information systems in countries. The important role that HIV infection plays in maternal mortality in some parts of the world is becoming increasing clear; this calls for intensified efforts in HIV prevention among young people, including integration of HIV prevention and treatment services in family planning and antenatal care services. Violence against women, especially intimate partner violence, is an area that WHO recognizes as requiring a much more serious and comprehensive effort in the health sector. This is an issue that will benefit from working in partnership to gather more information on the extent of the problem and to identify effective interventions. With an increasingly ageing population globally, including in developing countries, the importance of active and healthy ageing takes on a greater importance. Although many of the disease-specific interventions are addressed in other strategic objectives, the context of ageing as part of the lifecourse, and the need for a holistic approach to health ageing, is included is strategic objective 4. Priorities and emphasis for 2012-2013 In light of the above, a key shift in emphasis will be on supporting countries to strengthen health systems to be able to deliver integrated services for: sexual and reproductive health services, including for adolescents; antenatal care; care for both the mother and newborn during childbirth and the postpartum/neonatal period; and in collaboration with SO 2, prevention, testing, counselling and treatment of HIV and other sexually transmitted infections, including congenital syphilis. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 29 Within this context, there will be greater emphasis placed on working in partnership with other UN system agencies, key donors and other stakeholders, to provide coherent support to countries in these areas. More emphasis will be given to supporting countries in scaling up effective child health interventions, and to extending care for newborns and children to the community level. Early childhood development will also receive greater emphasis, as evidence mounts for its importance later in life. Developing improved quality indicators for maternal health and better methods for measuring progress in reducing maternal mortality will receive greater emphasis - again, working together with partners active in this area, with an emphasis on strengthening health information systems in countries. Similarly, increased support will be given to Member States in setting national targets and indicators for achieving universal access to sexual and reproductive health; establishing monitoring systems of progress including availability of national sex and age disaggregated data on health outcomes and determinants; and monitoring and evaluation of interventions, including collection of indicators for maternal, newborn, child and adolescent health. Other priorities for reducing maternal mortality and morbidity include continuing to support countries to strengthen and expand their workforce of skilled birth attendants, and a greater emphasis on improving the quality of and access to facilities that can provide emergency obstetric care. Within the context of a life-course approach, adolescents are of special importance for health promotion interventions and access to services, given the behaviour patterns that are established during this phase of life. More attention will be given to reaching young adolescents in the context of school health. More emphasis will be given to the public health problem of violence against women. This is an issue that involves several strategic objectives, specifically SO3 and SO6. Health and active ageing will be a greater priority in 2012-2013. This reflects the global pattern of a growing population of older persons in most countries. A global action plan for ageing and health is planned, along with guidelines and training programmes for addressing the needs of older people, including in emergency situations. Research in many of the above areas will continue to be a priority with particular emphasis on implementation research to help integrate key evidence-based interventions at scale within health systems, towards the aim of universal access to reproductive, maternal, newborn and child health services. Links with other strategic objectives - Strategic objectives 1 and 2: in relation to ensuring the effective delivery, in an integrated manner, of immunization and other interventions for the control of major infectious diseases through services for maternal, newborn and child and adolescent health and sexual and reproductive health. - Strategic Objective 5: in relation to the response to the health needs of vulnerable populations, especially mothers and children in emergency situations - Strategic objectives 6 to 9, especially 6, 7 and 9: sufficient attention needs to be given to (a) social and economic determinants of ill-health that limit progress towards this strategic objective, (b) major risk factors, such as poor nutrition, and (c) human rights-based and gender-responsive approaches to ensure equitable access to key services at various stages of life. - Strategic objectives 10 and 11: with attention to specific actions required to strengthen health systems so that they can rapidly expand access to effective interventions for maternal, newborn, child, adolescent and sexual and reproductive health, while ensuring a continuum of care across the life course and across different levels of the health system, including the community. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 30 Major WHO special programmes and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope Special Programme of Research, Development and Research Training in Human Reproduction Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 107.7 25.4 36.0 12.9 36.1 18.0 50.5 286 Special programmes and collaborative arrangements 34 Outbreak and crisis response 0 Grand Total 320 Organization-wide expected results and indicators 7 Indicators 4.1.1 Number of targeted Member States that have an integrated policy on universal access to effective interventions for improving maternal, newborn and child health 4.1.2 Number of Member States that have developed, with WHO support, a policy on achieving universal access to sexual and reproductive health Baseline 2012 To be defined at the end of 2011 To be defined at the end of 2011 Targets to be achieved by 2013 4.1 Support provided to Member States to formulate a comprehensive policy, plan and strategy for scaling up towards universal access to effective interventions in collaboration with other programmes, paying attention to reducing gender inequality and health inequities, providing a continuum of care throughout the life course, integrating service delivery across different levels of the health system and strengthening coordination with civil society and the private sector. 28 above baseline 10 above baseline 7 All indicators are being reviewed to ensure harmonization of the measurements across offices; clear definitions for denominator and numerator will be applied at end of 2011 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 31 Indicators 4.2.1 Number of research centres that have received an initial grant for comprehensive institutional development and support 4.2.2 Number of completed studies on priority issues that have been supported by WHO 4.2.3 Number of new or updated systematic reviews on best practices, policies and standards of care for improving maternal, newborn, child and adolescent health, promoting active and healthy ageing or improving sexual and reproductive health Baseline 2012 To be defined at the end of 2011 To be defined at the end of 2011 To be defined at the end of 2011 Targets to be achieved by 2013 4.2 National research capacity strengthened as necessary and new evidence, products, technologies, interventions and delivery approaches of global and/or national relevance available to improve maternal, newborn, child and adolescent health, to promote active and healthy ageing, and to improve sexual and reproductive health. 4 above baseline 12 above baseline 20 above baseline Indicators 4.3.1 Number of Member States implementing strategies for increasing coverage with skilled care for childbirth Baseline 2012 To be defined at the end of 2011 Targets to be achieved by 2013 4.3 Guidelines, approaches and tools for improving maternal care applied at the country level, including technical support provided to Member States for intensified action to ensure skilled care for every pregnant woman and every newborn, through childbirth and the postpartum and postnatal periods, particularly for poor and disadvantaged populations, with progress monitored. 25 above baseline PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 32 Indicators 4.4.1 Number of Member States implementing strategies for increasing coverage with interventions for neonatal survival and health Baseline 2012 To be defined at the end of 2011 Targets to be achieved by 2013 4.4 Guidelines, approaches and tools for improving neonatal survival and health applied at country level, with technical support provided to Member States for intensified action towards universal coverage, effective interventions and monitoring of progress. 10 above baseline Indicators 4.5.1 Number of Member States implementing strategies for increasing coverage with child health and development interventions 4.5.2 Number of Member States that have expanded coverage of the integrated management of childhood illness to more than 75% of target districts Baseline 2012 To be defined at the end of 2011 To be defined at the end of 2011 Targets to be achieved by 2013 4.5 Guidelines, approaches and tools for improving child health and development applied at the country level, with technical support provided to Member States for intensified action towards universal coverage of the population with effective interventions and for monitoring progress, taking into consideration international and human-rights norms and standards, notably those stipulated in the Convention on the Rights of the Child. 10 above baseline 15 above baseline PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 33 Indicators 4.6.1 Number of Member States with a functioning adolescent health and development programme Baseline 2012 To be defined at the end of 2011 Targets to be achieved by 2013 4.6 Technical support provided to Member States for the implementation of evidence- based policies and strategies on adolescent health and development, and for the scaling up of a package of prevention, treatment and care interventions in accordance with established standards. 10 above baseline Indicators 4.7.1 Number of Member States implementing the WHO reproductive health strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health agreed at the 1994 International Conference on Population and Development (ICPD), its five-year review (ICPD+5), the Millennium Summit and the United Nations General Assembly in 2007 4.7.2 Number of targeted Member States having reviewed their existing national laws, regulations or policies relating to sexual and reproductive health Baseline 2012 To be defined at the end of 2011 To be defined at the end of 2011 Targets to be achieved by 2013 4.7 Guidelines, approaches and tools made available, with provision of technical support to Member States for accelerated action towards implementing the strategy to accelerate progress towards the attainment of international development goals and targets related to reproductive health, with particular emphasis on ensuring equitable access to good-quality sexual and reproductive health services, particularly in areas of unmet need, and with respect for human rights as they relate to sexual and reproductive health. 10 above baseline 3 above baseline PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 34 Indicators 4.8.1 Number of Member States with a functioning active healthy ageing programme consistent with resolution WHA58.16 “Strengthening active and healthy ageing” Baseline 2012 To be defined at the end of 2011 Targets to be achieved by 2013 4.8 Guidelines, approaches, tools, and technical assistance provided to Member States for increased advocacy for consideration of ageing as a public health issue, for the development and implementation of policies and programmes aiming at maintaining maximum functional capacity throughout the life course and for the training of health-care providers in approaches that ensure healthy ageing. 10 above baseline PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 35 Strategic objective 5 To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact Scope The joint efforts of the Member States and the Secretariat regarding this strategic objective involve the following: health-sector emergency preparedness; intersectoral action for reducing risk and vulnerability within the framework of the International Strategy for Disaster Reduction; responding to the health needs experienced during emergencies and crises (including nutrition-related needs as well as those concerning water and sanitation); assessing needs of affected populations; health actions during the transition and recovery phases following conflicts and disasters; health of migrants; gender within humanitarian action fulfilling WHO’s mandate within the framework of the reform process to enhance the United Nations humanitarian response; the global alert and response system for environmental and food-safety public health emergencies within the framework of the International Health Regulations (2005); risk reduction in respect of specific threats; and preparedness and response programmes for environmental and food-safety public health emergencies. In this way, WHO is making an important contribution to health security that also has critical implications for efforts to promote peace and responding to the Mandates of Member States contained in three relevant resolutions of recent World Health Assemblies (resolutions WHA58.1; WHA59.22 and WHA61.17). Key achievements to date An increasing number of Member States now have national emergency preparedness plans and programmes for disaster risk reduction, including for making health facilities safer. Institutional capacity has been developed through regular training courses, such as those targeted at WHO Representatives and Health Cluster Coordinators. Staff at global, regional and country levels have received training in WHO emergency standard operating procedures. A central logistics platform, with decentralized stocks in five regional warehouses, has been established to respond to humanitarian, as well as public health emergencies. WHO-led health clusters are supporting the efforts of most Member States facing protracted emergency situations in order to fill critical gaps in service provision and address priority health needs. Communicable disease control interventions have been systematically implemented during all acute natural disasters or conflict situations, and national communicable disease risk profiles have been developed to guide the response effort. Progress has been made in preparing guidelines and forming networks for food safety and environmental health emergencies, as well as for gender mainstreaming as part of the humanitarian response to crises and disasters. WHO has played an influential role in humanitarian policy setting through its involvement in numerous interagency bodies. Key challenges Member States and donors have shown increasing confidence in WHO by making generous contributions earmarked for specific protracted and sudden onset crises. However, such funding cannot be spent on core activities and staff. A lack of predictable, secure and flexible funding affects all three levels of the Organization, compromising its ability to effectively fulfil its commitments to Member States and their affected populations, as well as to humanitarian partners, donors and fellow members of the Inter-Agency Standing Committee. Having access to secure, flexible funding would ensure that enough trained, qualified and dedicated staff were permanently available: to help Member States introduce the policies, programmes, structures and systems needed for emergency preparedness and risk reduction, as well as monitor service delivery and gather and analyse health data; to lead the health cluster in support of national priorities and efforts, and provide technical expertise to Member States and partners in protracted and sudden onset crises; and to ensure that interagency humanitarian policies, guidance, tools and approaches were commonly implemented so that an increasing number of humanitarian health actors could provide coherent and coordinated support. In addition, a basic level of core funding from the Organization is needed to ensure that contributions to country Consolidated Appeals Process (CAP) and Flash appeals are effectively implemented. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 36 Priorities and emphasis for 2012–2013 During this biennium there are two priority areas. Firstly is to continue the work on emergency preparedness and disaster risk reduction by working on programmes that will aim to ensure: a) the health sector is fully integrated into community-based emergency risk management in countries most at risk; b) health emergency preparedness and risk reduction is established as a key element in primary health care; c) national all-hazards health emergency management programmes are an integral function of national health systems, health plans and strategies; including for environmental and food safety emergencies; d) global surveys of health emergency preparedness used by national authorities and other key actors to advocate for and build health emergency capacities; e) the reduction of the vulnerability of health facilities in case of natural disasters; and f) VRAM methodology accepted as the standard baseline data collection tool for vulnerability and risk analysis The second priority area is developing response and recovery capacities by ensuring: a) all Consolidated and Flash Appeals include a health component; b) the WHO activities within the health component of all Consolidated and Flash Appeals are effectively implemented in at least 30 countries per year and operate from a common WHO emergency training and logistics platform; c) there are an expanded range of emergency stocks available in regional depots; d) all WHO departments are familiar with standard operating procedures; e) health recovery strategies are developed and implemented; f) standard global and regional training programmes on public health in humanitarian settings take place regularly as part of a bigger programmes of staff development and institutional readiness; and g) communicable disease-control interventions are implemented; early-warning systems and diseases- surveillance for emergencies are put in place. Work will also continue with regard to leadership of the health cluster including ensuring the health cluster approach, guidance and tools accepted as standard and fully institutionalized and implemented in accordance with IASC policy, WHO representatives and staff in countries likely to have cluster approach are fully trained on health cluster issues and health cluster coordinators are trained in the relevant guidance and tools. Finally, emphasis will be given to health information and intelligence by working with all countries with EHA presence produce weekly Health Cluster Bulletin and implementing health Systems analysis for health recovery in at least 8 countries Links with other strategic objectives - Strategic objective 1: in relation to the International Health Regulations (2005) and responding to public health emergencies involving epidemics. - Strategic objective 3: in relation to gender inequalities and gender based violence, responding to psychosocial needs of most affected populations; responding to the health needs of the disabled; mass-casualty management; and health care for those suffering from chronic diseases. - Strategic objective 4: in relation to the response to the health needs of vulnerable populations, especially women and children in emergency situations. - Strategic objective 8: in relation to intersectoral action for emergency preparedness and risk reduction, and for dealing with environmental, chemical and radiological emergencies. - Strategic objective 9: in relation to nutrition in emergency situations. - Strategic objective 10: in relation to health of migrants, safe hospitals and health sector risk reduction measures Major WHO special programmes and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope Health and Nutrition Tracking Service PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 37 Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 31.5 13.5 14.0 5.8 10.3 6.4 20 101 Special programmes and collaborative arrangements 1 Outbreak and crisis response 315 Grand Total 417 Organization-wide expected results and indicators Indicators 5.1.1 Proportion of Member States with national emergency preparedness plans that cover multiple hazards 5.1.2 Number of Member States implementing programmes for reducing the vulnerability of health facilities to the effects of natural disasters Baseline 2012 65% 50 Targets to be achieved by 2013 5.1 Norms and standards developed, capacity built and technical support provided to Member States for the development and strengthening of national emergency preparedness plans and programmes. 70% 60 Indicators 5.2.1 Operational platforms for surge capacity in place in regions and headquarters ready to be activated in acute-onset emergencies 5.2.2 Number of global and regional training programmes on public health operations in emergency response Baseline 2012 100% 22 Targets to be achieved by 2013 5.2 Norms and standards developed and capacity built to enable Member States to provide timely response to disasters associated with natural hazards and conflict- related crises. 100% 22 Indicators 5.3.1 Number of humanitarian action plans with a health component formulated for ongoing emergencies 5.3.2 Number of countries in transition that have formulated a recovery strategy for health Baseline 2012 In all countries with humanitarian coordinators 18 5.3 Norms and standards developed and capacity built to enable Member States to assess needs and for planning interventions PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 38 Targets to be achieved by 2013 during the transition and recovery phases of conflicts and disasters. In all countries with humanitarian coordinators 20 Indicators 5.4.1 Proportion of acute natural disasters or conflicts where communicable disease- control interventions have been implemented, including activation of early-warning systems and diseases-surveillance for emergencies Baseline 2012 100% Targets to be achieved by 2013 5.4 Coordinated technical support provided to Member States for communicable disease control in natural disaster and conflict situations. 100% Indicators 5.5.1 Proportion of Member States with national plans for preparedness, and alert and response activities in respect of chemical, radiological and environmental health emergencies 5.5.2 Number of Member States with focal points for the International Food Safety Authorities Network and for the environmental health emergencies network Baseline 2012 65% In all Member States Targets to be achieved by 2013 5.5 Support provided to Member States for strengthening national preparedness and for establishing alert and response mechanisms for food-safety and environmental health emergencies. 70% In all Member States Indicators 5.6.1 Proportion of Member States affected by acute-onset emergencies and those with ongoing emergencies and a humanitarian coordinator in which the Inter-Agency Standing Committee Humanitarian Health Cluster is operational in line with IASC cluster standards 5.6.2 Proportion of Member States with ongoing emergencies and a humanitarian coordinator having a sustainable WHO technical presence covering emergency preparedness, response and recovery Baseline 2012 80% 75% Targets to be achieved by 2013 5.6 Effective communications issued, partnerships formed and coordination developed with other organizations in the United Nations system, governments, local and international nongovernmental organizations, academic institutions and professional associations at the country, regional and global levels. 100% 90% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 39 Indicators 5.7.1 Proportion of acute-onset emergencies for which WHO mobilizes coordinated national and international action 5.7.2 Proportion of interventions for chronic emergencies implemented in accordance with humanitarian action plans’ health components Baseline 2012 90% 100% Targets to be achieved by 2013 5.7 Acute, ongoing and recovery operations implemented in a timely and effective manner. 100% 100% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 40 Strategic objective 6 To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex Scope The work under this strategic objective focuses on integrated, comprehensive, multisectoral and multidisciplinary health-promotion and prevention strategies, approaches, tools and processes across all WHO’s relevant programmes; and on the prevention or reduction of the occurrence of six major risk factors: use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diet, physical inactivity and unsafe sex. The main activities involve the development of ethical and evidence-based policies, strategies, standards, guidelines, and interventions for health promotion, prevention and reduction of the occurrence of the major risk factors. Special emphasis is given to surveillance of risk factors and capacity building for health promotion across all relevant programmes. Key achievements to date The 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, adopted by WHA in 2008, provides the overarching road map for addressing the major modifiable risk factors for the major noncommunicable diseases that share the same risk factors (cardiovascular diseases, cancer, diabetes and chronic respiratory diseases). By late 2009, 167 Member States had become Parties to the WHO Framework Convention on Tobacco Control. The Global strategy to reduce the harmful use of alcohol was developed in collaboration with Member States and endorsed by the Sixty-third World Health Assembly in resolution WHA63.17. Global and regional information systems on alcohol and health have been introduced. Global surveys on alcohol and health and on assessment of the capacity of countries to address noncommunicable disease risk factors have been conducted. Evidence-based policies and interventions have assisted countries in preventing or reducing public health problems caused by alcohol and drug use. In all regions, mechanisms and tools have been prepared for adapting strategies to promote healthy diets and physical activity to suit national requirements, based on the WHO Global Strategy on Diet, Physical Activity and Health. Currently 66 countries have adopted multisectoral strategies based on the guidance provided in the WHO Global Strategy on Diet, Physical Activity and Health. The number of countries using innovative and sustainable sources of financing for health promotion, such as earmarked taxation on tobacco and alcohol, has increased. However, there is growing awareness of the “implementation gaps” between the evidence for health promotion and its translation into action. Key provisions of the WHO FCTC are being increasingly implemented by the end of 2009; however, despite widespread ratification of WHO FCTC, only 20 countries had approved comprehensive smoke- free legislation, and 26 a comprehensive ban on tobacco advertising, promotion and sponsorship. Of the 193 Member States, over 25% (49 countries) have experienced a relative reduction of at least 10% in their prevalence rate of tobacco use. A major achievement for the advancement of the intersectoral collaboration was the completion of tobacco tax assessment missions in 5 countries (Pakistan, Egypt, Indonesia, Ukraine, Maldives) Achievements have been made in the area of measurement and surveillance. Standrads for surveillance of risk factors and core indicators for global and national monitoring of trends have been developed in close coordination with the Information, Evidence and Research Cluster. The core indicators are being integrated into the Global Health Observatory. Both the WHO STEPwise approach to surveillance of noncommunicable disease risk factors and the Global School-based Student Health Survey (GSHS) are being more widely used. Currently 123 countries have been trained in STEPS and 80 countries have finished data collection, including 19 that have conducted more than one survey, and for the GSHS 103 countries have been trained, 54 countries have finished data collection, including 8 that have done repeat surveys. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 41 Evidence on the determinants and consequences of unsafe sex, was compiled and included in the WHO Women and Health report. Information on interventions to reduce risks has been collected, and surveillance tools have been developed. A systematic review and expert consultation was completed on effective interventions to address violence against women and HIV/AIDS, as the basis for programmatic and policy guidance. WHO participated in the finalization of the UNESCO International Technical Guidance on Sexuality Education. Key challenges While past advocacy efforts have been successful in raising the profile of NCDs and their common risk factors, resources - particularly in low and middle income countries - are insufficient in relation to the magnitude of the problem and the potential for action. This is a key challenge. Secondly, intersectoral action needs to be strengthened. This is a major challenge, particularly in addressing tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. Sectors like finance, transport, urban design, education, agriculture, and the food industry that either contribute to risk, or which could play a significant role in its reduction have few incentives to work together in the interests of better health. Careful design of and appropriate range of measurement strategies , organizational incentives including dialogue highlighting the co-benefits of action and/or regulations all have a role to play in developing new strategies and bringing in a wider range of actors into risk reduction, keeping in mind the importance of avoiding conflicts of interests. Surveillance of health risk is not a priority in a large proportion of countries. A major challenge is to strengthen measurement and surveillance of key risk factors and integrate them into the national health information system. Rules for engaging with the private sector need to be more precisely elaborated and intersectoral actions implemented through health-in-all policies and approaches. Health promotion actions should be mainstreamed in the work of priority public health conditions. The recommendations set out in resolution WHA60.24 (Health Promotion in a Globalized World) urge Member States to make the promotion of health a core responsibility of all governments. The challenge is to review and scale up the integration of evidence-based cost-effective health promotion interventions into health systems. Finally, addressing unsafe sex and risks related to sexuality remains a particularly sensitive topic; strong political will and close interagency collaboration are essential for success in this area. Priorities and emphasis for 2012–2013 A major priority is the continued work on advocacy and awareness and to ensure follow up to the General Assembly High Level Meeting on Noncommunicable Diseases. This will be key in raising awareness of the links of NCD risk factors, especially tobacco use, the harmful use of alcohol, and unhealthy diet particularly in relation to their contribution to withholding progress in MDGs. Additional components of this priority are the continued work of exploring and addressing the unmet needs of vulnerable groups, as well as mainstreaming of health promotion and disease prevention activities and reducing health and social inequities through the work undertaken on Social Determinants of Health and the revival of Primary Health Care. Special emphasis will be given to mainstreaming health health promotion across the various health programmes through the the development and implementation of an affordable and evidence-based package of health promotion interventions Another priority is the scale-up of national strategies and plans primarily through the development of and strengthening of country programmes. Examples of such programmes include: i) the global strategy to reduce the harmful use of alcohol, endorsed by WHA63, which will require strong implementation of an evidence-based, outcome-oriented set of interventions; ii) the development of internet based package of materials containing solutions and interventions to prevent or reduce major risk factors for health for use in the delivery of country support; iii) the development of operational models and good practices for the implementation of policies and programmes aimed at improving PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 42 diets, including nutrient profiling of foods, reformulation and nutrition labelling of food products, food procurement policies and economic tools to guide the demand of food products; iv) further strengthening of technical support, country capacity and intersectoral partnerships to low- and middle- income parties to the WHO FCTC to effectively implement the treaty.; and v) WHO's work in addressing risk factors such as unsafe sex. Links with other strategic objectives Strategic objectives 2, 3, 4, 7, 8 and 9: although these seek to deal with the determinants of poor health and strengthen service provision, this strategic objective seeks in particular, to create healthy environments in order to enable individuals to make healthy choices. The deliverables of Strategic objectives 6 complement those of Strategic objectives 3 which focus on the surveillance, prevention and health care to control NCDs, mental disorders, violence, injuries and visual impairment. Major WHO special programmes and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope - WHO Centre for Health Development (KOBE) - Special Programme of Research, Development and Research Training in Human Reproduction Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 23.9 13.9 17.5 17.0 22.1 18.0 30.1 143 Special programmes and collaborative arrangements 12 Outbreak and crisis response 0 Grand Total 155 Organization-wide expected results and indicators Indicators 6.1.1 Number of Member States that have evaluated and reported on at least one of the action areas and commitments of the Global Conferences on Health Promotion 6.1.2 Number of cities that have implemented healthy urbanization programmes aimed at reducing health inequities Baseline 2012 40 22 Targets to be achieved by 2013 6.1 Advice and support provided to Member States to build their capacity for health promotion across all relevant programmes, and to establish effective multisectoral and multidisciplinary collaborations for promoting health and preventing or reducing major risk factors. 50 46 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 43 Indicators 6.2.1 Number of Member States with a functioning national surveillance system for monitoring major risk factors to health among adults based on the WHO STEPwise approach to surveillance 6.2.2 Number of Member States with a functioning national surveillance system for monitoring major risk factors to health among youth based on the Global school- based student health survey methodology Baseline 2012 85 58 Targets to be achieved by 2013 6.2 Guidance and support provided in order to strengthen national systems for surveillance of major risk factors through development and validation of frameworks, tools and operating procedures and their dissemination to Member States where a high or increasing burden of death and disability is attributable to these risk factors. 90 73 Indicators 6.3.1 Number of Member States having comparable adult tobacco prevalence data available from recent national representative surveys, such as the Global Adult Tobacco Survey (GATS) or STEPS 6.3.2 Number of Member States with comprehensive bans on smoking in indoor public places and workplaces 6.3.3 Number of Member States with bans on tobacco advertising, promotion and sponsorship Baseline 2012 65 22 27 Targets to be achieved by 2013 6.3 Evidence-based and ethical policies, strategies, recommendations, standards and guidelines developed, and technical support provided to Member States with a high or increasing burden of disease and death associated with tobacco use, enabling them to strengthen institutions in order to tackle or prevent the public health problems concerned; support also provided to the Conference of the Parties to the WHO Framework Convention on Tobacco Control for implementation of the provisions of the Convention and development and implementation of protocols and guidelines. 75 26 29 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 44 Indicators 6.4.1 Number of Member States that have developed, with WHO support, strategies, plans and programmes for combating or preventing public health problems caused by alcohol, drugs and other psychoactive substance use 6.4.2 Number of WHO strategies, guidelines, standards and technical tools developed in order to provide support to Member States in preventing and reducing public health problems caused by alcohol, drugs and other psychoactive substance use Baseline 2012 50 14 Targets to be achieved by 2013 6.4 Evidence- based and ethical policies, strategies, recommendations , standards and guidelines developed, and technical support provided to Member States with a high or increasing burden of disease or death associated with alcohol, drugs and other psychoactive substance use, enabling them to strengthen institutions in order to combat or prevent the public health problems concerned. 60 17 Indicators 6.5.1 Number of Member States that have adopted multisectoral strategies and plans for healthy diets or physical activity, based on the WHO Global Strategy on Diet, Physical Activity and Health 6.5.2 Number of WHO technical tools that provide support to Member States in promoting healthy diets or physical activity Baseline 2012 65 20 Targets to be achieved by 2013 6.5 Evidence- based and ethical policies, strategies, recommendations , standards and guidelines developed and technical support provided to Member States with a high or increasing burden of disease or death associated with unhealthy diets and physical inactivity, enabling them to strengthen institutions in order to combat or prevent the public health problems concerned. 71 24 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 45 Indicators 6.6.1 Number of Member States generating evidence on the determinants and/or consequences of unsafe sex 6.6.2 Number of Member States generating comparable data on unsafe sex indicators using WHO STEPS surveillance tools Baseline 2012 10 5 Targets to be achieved by 2013 6.6 Evidence- based and ethical policies, strategies, interventions, recommendations , standards and guidelines developed and technical support provided to Member States to promote safer sex and strengthen institutions in order to tackle and manage the social and individual consequences of unsafe sex. 12 8 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 46 Strategic objective 7 To address the underlying social and economic determinants of health through policies and programmes that enhances health equity and integrates pro-poor, ethically sound, gender- responsive, and human rights-based approaches Scope The work under this strategic objective focuses on leadership in intersectoral action on the broad social and economic determinants of health; improvement of population health and health equity by better meeting the health needs of poor, vulnerable and excluded social groups; connections between health, poverty and various social and economic factors (labour, housing and educational circumstances; trade and macroeconomic factors; and the social status of various groups such as women, children, elderly people, displaced people and ethnic minorities); formulation of policies and programmes that are ethically sound, responsive to gender inequalities, sustainable, effective in meeting the needs of poor people and other vulnerable groups, and consistent with human-rights norms. Key achievements to date Member States recognize that health equity can best be achieved through policies and programmes that address the social determinants of health. A total of 18 country case studies on factors that encourage or hinder intersectoral action for health equity have been analysed, and tools and resources developed to facilitate country work. WHO and Member States have also enhanced their capacity to conduct disaggregated analysis of health equity by sex and ethnicity. It is now better understood by WHO and Member States that applying a human-rights based approach to health in a manner consistent with United Nations and regional human rights treaties and standards benefits both social and economic development. Ethical considerations and gender mainstreaming are being integrated in numerous WHO public health programmes at all levels, key cross-cutting normative work is continuing, capacity at regional and country levels is increasing, and a policy dialogue on women’s health has been initiated. Normative documents addressing ethics of public health and ethics of research have been disseminated; several hundreds of health professionals have been trained in all WHO regions; research ethics committees and national ethics committees have been strengthened to address emerging ethical issues at country level. The last World Health Assembly adopted guiding principles on Human organ and tissue transplantation. Key challenges The Strategic objective covers a spectrum of closely interrelated subjects that have been widely acknowledged as having the highest potential for equitable health outcomes. Consensus building and advocacy proved fruitful in creating an effective platform for promoting closer collaboration across concerned areas of work, pursuing mainstreaming efforts, for example, in gender, ethics and health and human rights, and developing partnerships with stakeholders outside WHO. In consequence, demand from Member States for technical assistance has increased. The expectations raised by the recent publication of several reports and guidance on ethics will need to be properly followed up. This will require technical cooperation particularly at country level for which it continues to be difficult to attract sufficient resources to implement effectively. In order to improve efficiency in the future, innovative solutions should be explored ways to use existing resources more effectively, development of fundable country cooperation programmes and working with partners to achieve the objectives. The expectation for ethical decision making processes within and outside WHO is extremely high. To ensure the transparency and fairness of these processes, an ethical framework is needed. Based on the close collaboration established between the Organization and the key players in the field of ethics, in particular the UN Interagency Committee on Bioethics, the Global Network of WHO Collaborating Centres for Bioethics and the Global Summit of National Ethics Committees, WHO and Members States will ensure that ethical requirements are included in public health programmes as well as research activities. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 47 Priorities and emphasis for 2012–2013 As the awareness on the need to address social determinants of health is quite high in Member States, we will focus our attention now less on the "what" and more on the "how" to implement this public health priority work by developing sufficient tools and fundable programs for the effective implementation of recommendations by the Commission on Social Determinants of Health, both within and outside the organization as mandated by resolution WHA.62.14 and the global plan of action on social determinants of health within a primary health care framework. The implementation will focus on two key areas. Firstly is to foster an all-of-Government approach to health through intersectoral action by engaging other sectors to integrate health related issues and policies into their sectoral programs. At a global level it is important to increase partnerships with stakeholders, UN agencies and donors to address and monitor inequities in health. The second key area is to strengthening the capacities of Member States in mainstreaming of gender, human rights and ethics based approaches within the health sector and beyond, and in the areas of trade and global health diplomacy, as well as taking into consideration and addressing the social determinants of health issues. It is also important to increase the health sector responsibility and action towards violence against women, especially at primary health care levels. Other priorities include the dissemination and implementation of ethical guidance for public health programmes, in particular for communicable diseases, organ transplantation, research and new technologies. To answer the requests expressed by many WHO departments, assessments on ethical aspects of programmes will be provided. Based on global consultations, ethical priority issues to be addressed by WHO will be identified. A review of the WHO strategy to date will identify WHO strengths and gaps in implementing the Gender Strategy. In women and health efforts to advance the women and health report will focus on providing policy, advocacy and programming directions in the response of Member States, partners and the various stakeholders in the report and equity analysis and monitoring, and evaluation of the effectiveness of SDH/HI policies in countries and share learning. Given the good response received from Member States to WHO efforts to strengthen capacity for disaggregated data generation, further efforts will focus more narrowly on the small number of countries requiring further assistance. Links with other strategic objectives Issues of health equity, ethical standards, gender, pro-poor approaches and human rights are relevant to all other strategic objectives. - Strategic objectives 1 to 5: notwithstanding the technical complexities, it is firmly established that health outcomes are powerfully influenced by social and economic determinants, as well as by the availability, quality and ethics of clinical services. - Strategic objectives 6, 8 and 9: the present strategic objective is primarily concerned with the underlying determinants and structural factors (such as labour markets, education system, and gender inequality) defining people’s different positions in social hierarchies, which affect intermediate determinants such as the environment, including food (strategic objectives 8 and 9) and individual factors such as behaviours (strategic objective 6). An ethical approach is required in particular in addressing individual behaviours and responsibilities, professional duties, health and research priorities. - Strategic objectives 10 and 11: health policies and systems need to include intersectoral action on health determinants and ethical analysis. Coherent action on health inequities also depends on the availability of appropriately disaggregated health data and the capacity to analyse and use such data to develop policies and services that respond to the needs of different social groups and address structural factors. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 48 Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 13.0 7.4 4.5 7.7 12.9 2.0 13 61 Special programmes and collaborative arrangements 1 Outbreak and crisis response 0 Grand Total 61 Organization-wide expected results and indicators Indicators 7.1.1 Number of WHO regions with a regional strategy for addressing social and economic determinants of health as identified in the Report of the Commission on the Social Determinants of Health endorsed by the Director-General Baseline 2012 6 Targets to be achieved by 2013 7.1 Significance of social and economic determinants of health recognized throughout the Organization and incorporated into normative work and technical collaboration with Member States and other partners. 6 Indicators 7.2.1 Number of published country experiences on tackling social determinants for health equity 7.2.2 Number of tools to support countries in analysing the implications of trade and trade agreements for health Baseline 2012 14 9 Targets to be achieved by 2013 7.2 Initiative taken by WHO in providing opportunities and means for intersectoral collaboration at national and international levels to address social and economic determinants of health, including understanding and acting upon the public health implications of trade and trade agreements, and to encourage poverty-reduction and sustainable development. 38 10 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 49 Indicators 7.3.1 Number of country reports published during the biennium incorporating disaggregated data and analysis of health equity Baseline 2012 40 Targets to be achieved by 2013 7.3 Social and economic data relevant to health collected, collated and analysed on a disaggregated basis (by sex, age, ethnicity, income, and health conditions, such as disease or disability). 60 Indicators 7.4.1 Number of tools produced for Member States or the Secretariat giving guidance on using a human rights-based approach to advance health 7.4.2 Number of tools produced for Member States or the Secretariat giving guidance on use of ethical analysis to improve health policies Baseline 2012 37 16 Targets to be achieved by 2013 7.4 Ethics- and human rights- based approaches to health promoted within WHO and at national and global levels. 45 20 Indicators 7.5.1 Number of WHO tools or documents developed or updated, or joint activities by WHO technical units undertaken, in order to promote gender- responsive actions in the work of WHO 7.5.2 Number of gender mainstreaming activities conducted in Member States and supported by WHO Baseline 2012 85 170 Targets to be achieved by 2013 7.5 Gender analysis and responsive actions incorporated into WHO’s normative work and support provided to Member States for formulation of gender- responsive policies and programmes. 95 203 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 50 Strategic objective 8 To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health Scope This strategic objective is to reduce a broad range of traditional, modern and emerging hazards to health and the environment. The work will encourage strong health-sector leadership for primary prevention of disease through environmental management and impart strategic direction and give guidance to partners in non-health sectors for ensuring that their policies and investments also benefit health. Work will focus on the assessment and management of environmental and occupational health hazards such as unsafe water and inadequate sanitation, indoor air pollution and solid fuel use, and vector transmission of diseases. Its scope also covers: health risks related to change in the global environment (e.g. climate change and biodiversity loss); development of new products and technologies (e.g. nanotechnology); consumption and production of energy from new sources and the increasing number and use of chemicals; and health risks related to changes in lifestyle, urbanization, and working conditions (e.g. deregulation of labour, an expanding informal sector and export of hazardous working practices to poor countries). Key achievements to date The past biennium saw a multipronged effort to address the 25% burden of disease caused by environmental risk factors, by means of major policy initiatives, capacity-building activities in regions and countries, publication of new normative standards, guidance and toolkits, and advocacy. Key highlights include: the First Inter-Ministerial Conference on Health and Environment in Africa, convened jointly by UNEP and WHO, and the resulting Libreville Declaration; a new interagency collaboration on reducing reliance on DDT for vector control; a "mercury-free health care" global initiative; a resolution on health aspects of the sound management of chemicals, which was agreed during the Second Session of the International Conference on Chemicals Management; closer interagency collaboration on the elimination of asbestos-related diseases in the context of implementation of resolution WHA60.26; and approval by the 124 th Executive Board of a workplan developed in the context of resolution WHA61.19 on climate change and health. The theme of World Health Day 2008, "protecting health from climate change" was the subject of advocacy activities across the regions, as well as of WHO contributions to the Fifteenth Conference of the Parties to the United Nations Framework Convention on Climate Change. Key challenges The key challenge is to support Member States in addressing environmental determinants of health and ill-health (primary prevention) through cross-sectoral actions in different settings of daily life (e.g. urban, transport, education, workplace), including the development of integrated health and environment risk/impact systems to strengthen the evidence base for cross-sectoral policy development including support Member States and regional working groups in implementation of commitments made by health and environment ministers (in the Declarations of Libreville, Parma, Jeju and elsewhere) and global environmental agreements where protection and/or promotion of public health is stated as a primary objective. Persuading public-sector policy-makers to consider the co-benefits that would accrue from healthier environments also remains a challenge for WHO. While multisectoral collaboration over climate change mitigation and health impact analysis at national and international level has been successful, the complexities of such collaborative exercises need to be recognized. Similar challenges also face efforts to engender national intersectoral ownership of projects undertaken to implement the Libreville Declaration in Africa. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 51 Priorities and emphasis for 2012–2013 Building on the increased awareness of environmental health issues and the normative standards, guidance and toolkits that have been developed, the priority for this biennium will be to strengthen national health sector capacities to respond to climate change and to improve public health through adaptation and mitigation policies (health “co-benefits”) in sectors such as agriculture, energy, environment, transport and water and providing support to countries to strengthen environmental health governance mechanisms. It will also be important to increase normative capacities, development of national water policies and institutional frameworks to protect drinking water quality, developing- country occupational health services, capacities to support international environmental agreements to which WHO is party and for environmental health risk assessment and communication, and development/consolidation of national/regional health and environment strategic alliances. Work will continue on addressing ongoing public health concerns related to chemicals (especially asbestos, lead and mercury), indoor and outdoor air pollution, water safety and availability, electronic waste, and non-ionizing radiation, through more effective and systematic intersectoral collaboration, in particular between health and environment, at country level. In parallel with efforts to support country implementation, work will continue on developing links between health and sustainable development and "green growth" economy including the further qualification and quantification of the health benefits associated with environmental policies through the systematic collection, collation and analysis of inter-linked health and environment information (inter alia to assist implementation of the Libreville and Parma Declarations) to support the development of evidence-based public health and environment policy options and to monitor the effectiveness of their implementation against measured baselines. More emphasis will also be given to the assessment of risks from hazards in combination, as opposed to the assessment of individual risks. Greater importance will be given to activities such as, decreasing reliance on solid fuel use for heating and cooking, and strengthening the evidence base for the effectiveness of primary health and environment interventions in urban settings, as well as to coordinating support for occupational health. Finally, there is a need to reinvigorate UN and regional partnerships on environment and health using improvement of human health as leverage to gain inter-sectoral commitment and to further position health benefits as a key component of climate change mitigation efforts. Links with other strategic objectives - Strategic objective 5: preparedness and response to environmental health emergencies, crucial to achieving strategic objective 8, are linked with other aspects of emergency response. - Strategic objective 1: strengthening health systems capacities to adapt to the health impacts of climate change, through enhanced early warning and strengthened communicable disease response capacities, will contribute to reducing vulnerability to public health security threats and will help reduce the potential health, social and economic impacts of climate change affected communicable diseases. - Strategic objectives 2 to 4: given that eliminating environmental hazards to health can prevent up to a quarter of the global burden of disease, work will contribute especially to the reduction in disease burden among children (strategic objective 4), from vector-borne diseases (strategic objective 2) and from noncommunicable diseases (strategic objective 3) - Strategic objective 10: occupational and environmental health services are a key part of the preventive function of health services. - Strategic objectives 5, 6, 7, 9 and 12: influencing sectors of the economy to reduce risks and promote health through their investments and policy decisions is essential in terms of work on determinants of health (strategic objectives 5, 6, 7 and 9) and for establishing partnerships to advance the global health agenda (strategic objective 12). PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 52 Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 16.3 10.4 12.5 19.0 14.1 11.0 26.2 110 Special programmes and collaborative arrangements 1 Outbreak and crisis response 0 Grand Total 111 Organization-wide expected results and indicators Indicators 8.1.1 Number of Member States that have conducted assessments of specific environmental threats to health or have quantified the environmental burden of disease with WHO technical support during the biennium 8.1.2 Number of new or updated WHO norms, standards or guidelines on occupational or environmental health issues published during the biennium Baseline 2012 44 20 Targets to be achieved by 2013 8.1 Evidence- based assessments made, and norms and standards formulated and updated on major environmental hazards to health (e.g., poor air quality, chemical substances, electromagnetic fields, radon, poor-quality drinking-water and waste-water reuse). 47 23 Indicators 8.2.1 Number of Member States implementing primary prevention interventions in order to reduce environmental risks to health, with WHO technical support, in at least one of the following settings: workplaces, homes or urban settings Baseline 2012 52 Targets to be achieved by 2013 8.2 Technical support and guidance provided to Member States for the implementation of primary prevention interventions that reduce environmental hazards to health, enhance safety and promote public health, including in specific settings (e.g. workplaces, homes or urban settings) and among vulnerable population groups (e.g. children). 55 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 53 Indicators 8.3.1 Number of Member States that have implemented national action plans or policies for the management of occupational health risks, such as in relation to WHO’s global plan of action on workers’ health 2008–2017, with support from the Secretariat Baseline 2012 72 Targets to be achieved by 2013 8.3 Technical assistance and support provided to Member States for strengthening national occupational and environmental health risk management systems, functions and services. 77 Indicators 8.4.1 Number of Member States that are implementing WHO-supported initiatives to identify and respond to the health impacts of activities in one or more of the following sectors: agriculture, energy, and transportation. Baseline 2012 72 Targets to be achieved by 2013 8.4 Guidance, tools and initiatives created in order to support the health sector in influencing policies in other sectors to allow policies that improve health, the environment and safety to be identified and adopted. 75 Indicators 8.5.1 Number of studies or reports on new and re- emerging occupational and environmental health issues published or co-published by WHO 8.5.2 Number of reports published or jointly published by WHO on progress made in achieving water and sanitation objectives of major international development frameworks, such as the Millennium Development Goals 8.5.3 Number of high- level regional forums on environment and health issues organized or technically supported by WHO biennially Baseline 2012 17 10 10 Targets to be achieved by 2013 8.5 Health-sector leadership enhanced for creating a healthier environment and changing policies in all sectors so as to tackle the root causes of environmental threats to health, through means such as responding to emerging and re- emerging consequences of development on environmental health and altered patterns of consumption and production and to the damaging effect of evolving technologies. 19 12 11 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 54 Indicators 8.6.1 Number of studies or reports on the public health effects of climate change published or co-published by WHO 8.6.2 Number of countries that have implemented plans to enable the health sector to adapt to the adverse effects on health of climate change Baseline 2012 30 30 Targets to be achieved by 2013 8.6 Evidence- based policies, strategies and recommendations developed, and technical support provided to Member States for identifying, preventing and tackling public health problems resulting from climate change. 35 50 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 55 Strategic objective 9 To improve nutrition, food safety and food security, throughout the life-course, and in support of public health and sustainable development Scope Work under this strategic objective focuses on nutritional quality and safety of foods; promotion of healthy dietary practices throughout the life-course, starting with pregnant women, breastfeeding and adequate complementary feeding, and considering diet-related chronic diseases; prevention and control of nutritional disorders, including micronutrient deficiencies, especially among biologically and socially vulnerable groups, with emphasis on emergencies, and in the context of HIV/AIDS epidemics; prevention and control of zoonotic and non-zoonotic foodborne diseases; stimulation of intersectoral actions promoting the production and consumption of, and access to, food of adequate quality and safety; and promotion of higher levels of investment in nutrition, food safety and food security at global, regional and national levels. Key achievements to date The commitment of Member States was demonstrated by the adoption of the resolution on advancing food-safety initiatives at the 63 rd Health Assembly. In light of the increasing attention being paid to this critical area, WHO has promoted increased coherence and effectiveness of the support being provided to member states in collaboration with UN partners, the World Bank and NGOs. Continued collaborative efforts with international partners, including FAO and OIE, have allowed sharing of information on food events through INFOSAN and regional networks. Moreover, WHO has strengthened its system to provide scientific advice on nutrition and updated guidelines on micronutrient fortification and supplementation, on malnutrition, on sugar and fat intake. Within the framework of the FAO/WHO Codex Alimentarius Commission, new standards were developed for, inter alia, the assessment of genetically modified food and the prevention of antimicrobial resistance. All regions have initiated action in more than 70 countries for "Five Keys to Safer Food" Growth standards have been adopted in 109 countries and adoption is considered in 69 additional countries. The WHO Global Database on Child Growth and Malnutrition contains nearly 3 000 surveys from 145 countries, with results presented in a standardized format allowing international comparisons. A Nutrition Landscape Information System has been established, allowing development of country- level nutrition profiles and the analysis of country commitment and readiness to act in nutrition has been completed in 36 countries with the highest burden of chronic malnutrition and a review of food and nutrition policies has been conducted in 115 countries. A key initiative to estimate the global burden of foodborne diseases was launched and in addition, 173 Member States joined the WHO Global Foodborne Infections Network, Key challenges The achievement of MDG 1, 4 and 5 in high burden countries will require appropriate scaling up of nutrition interventions, and this is intricately linked to the need to strengthen national capacities and increase financial resources to implement nutrition interventions in these countries Further work is needed to integrate effective surveillance activities within national health information systems and for WHO, additional resources needs to be mobilized to further strengthen normative functions and for the provision of scientific and technical advice to member states. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 56 Priorities and emphasis for 2012–2013 The primary emphasis for the biennium includes focussing on scaling up nutrition interventions both for children during the first two years of age and maternal nutrition; complementing the ongoing revision of the Essential Nutrition Actions with the inclusion of maternal nutrition interventions in integrated management of pregnancy and childbirth; strengthening the existing international WHO networks such as the GFN , GEMS/Food and INFOSAN to build national capacity for lab testing, integrated surveillance, and global data-sharing; and the application of risk-benefit assessment methodologies to inform development of guidelines that include both food safety and nutrition aspects Stronger emphasis will also be placed on developing and updating of policies addressing the double burden of malnutrition; evidence-based review of essential nutrition interventions; Nutrition surveillance, including nutritional status and dietary patterns; and the provision of guidance on effective nutrition interventions and in monitoring their impact. Furthermore responding to needs outlined in country cooperation strategies to support countries to strengthen national activities in these areas; undertaking country studies for the estimation of foodborne disease burden; strengthening the INFOSAN-IHR linkage for food safety outbreak investigation and response; and concerted efforts in advocacy and resource mobilization are envisaged. Links with other strategic objectives Achievement of this Strategic Objective requires strong links and effective collaboration with other strategic objectives, in particular: - Strategic objective 1: in relation to prevention of zoonoses and foodborne diseases and in relation to the interactions between vaccines and nutritional status - strategic objective 2: in relation to expanding and improving interventions related to HIV/AIDS and TB prevention, treatment, care and support - Strategic objective 3: in relation to the surveillance and prevention of diet-related noncommunicable diseases and the prevention of birth defects and genetic and congenital disorders. - Strategic objective 4: in relation to public-health interventions for maternal, newborn, child and adolescent health - Strategic objective 5: in relation to emergency preparedness, minimizing the impact of emergency situations on the nutritional status of populations and recovery from crises. - Strategic objective 6: in relation to promotion of healthy diet throughout the life-course - strategic objective 7: in relation to addressing social determinants of differences in access to food and care and in nutritional status - Strategic objective 8: in relation to environmental health risks - Strategic objective 10: in relation to the integration of nutrition surveillance into health information systems, assessing costs and cost-effectiveness of nutrition interventions and the provision of nutritional care through health services - Strategic objective 12: in relation to strengthen governance, partnerships and collaboration with UN agencies, the World Bank and other stakeholders PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 57 Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 31.7 12.6 11.0 6.0 8.4 10.0 16.5 96 Special programmes and collaborative arrangements 4 Outbreak and crisis response 0 Grand Total 100 Organization-wide expected results and indicators Indicators 9.1.1 Number of Member States that have functional institutionalized coordination mechanisms to promote intersectoral approaches and actions in the area of food safety, food security or nutrition 9.1.2 Number of Member States that have included nutrition, food-safety and food- security activities and a mechanism for their financing in their sector-wide approaches or Poverty Reduction Strategy Papers Baseline 2012 Food safety/security: 100 Nutrition: 100 Food safety/security: 70 Nutrition: 35 Targets to be achieved by 2013 9.1 Partnerships and alliances formed, leadership built and coordination and networking developed with all stakeholders at country, regional and global levels, in order to promote advocacy and communication, stimulate intersectoral actions, increase investment in nutrition, food-safety and food-security interventions, and develop and support a research agenda. Food safety/security: 110 Nutrition: 130 Food safety/security: 80 Nutrition: 50 Indicators 9.2.1 Number of new nutrition and food-safety standards, guidelines or training manuals produced and disseminated to Member States and the international community 9.2.2 Number of new norms, standards, guidelines, tools and training materials for prevention and management of zoonotic and non-zoonotic foodborne diseases Baseline 2012 Food safety: 20 (+200 Codex standards) Nutrition: 30 5 Targets to be achieved by 2013 9.2 Norms, including references, requirements, research priorities, guidelines, training manuals and standards, produced and disseminated to Member States in order to increase their capacity to assess and respond to all forms of malnutrition, and zoonotic and non- zoonotic foodborne diseases, and to promote healthy dietary practices. Food safety: 20 (+200 Codex standards) Nutrition: 40 5 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 58 Indicators 9.3.1 Number of Member States that have adopted and implemented the WHO Child Growth Standards 9.3.2 Number of Member States that have nationally representative surveillance data on major forms of malnutrition Baseline 2012 70 120 Targets to be achieved by 2013 9.3 Monitoring and surveillance of needs and assessment and evaluation of responses in the area of nutrition and diet-related chronic diseases strengthened, and ability to identify best policy options improved, in stable and emergency situations. 100 140 Indicators 9.4.1 Number of Member States that have implemented at least three high- priority actions recommended in the Global Strategy for Infant and Young Child Feeding 9.4.2 Number of Member States that have implemented strategies to prevent and control micronutrient malnutrition 9.4.3 Number of Member States that have implemented strategies to promote healthy dietary practices for preventing diet-related chronic diseases 9.4.4 Number of Member States that have included nutrition in their responses to HIV/AIDS 9.4.5 Number of Member States supported to address nutrition in emergencies (preparedness plans, emergency response and recovery phases) Baseline 2012 105 75 75 70 50 Targets to be achieved by 2013 9.4 Capacity built and support provided to target Member States for the development, strengthening and implementation of nutrition plans, policies and programmes aimed at improving nutrition throughout the life-course, in stable and emergency situations. 120 80 80 80 70 Indicators 9.5.1 Number of Member States that have established or strengthened intersectoral collaboration for the prevention, control and surveillance of foodborne zoonotic diseases 9.5.2 Number of Member States that have initiated a plan for the reduction in the incidence of at least one major foodborne zoonotic disease Baseline 2012 75 80 Targets to be achieved by 2013 9.5 Systems for surveillance, prevention and control of zoonotic and non-zoonotic foodborne diseases strengthened; food-hazard monitoring and evaluation programmes established and integrated into existing national surveillance systems, and results disseminated to all key players. 85 90 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 59 Indicators 9.6.1 Number of selected Member States receiving support to participate in international standard-setting activities related to food, such as those of the Codex Alimentarius Commission 9.6.2 Number of selected Member States that have built national systems for food safety with international links to emergency systems Baseline 2012 85 70 Targets to be achieved by 2013 9.6 Capacity built and support provided to Member States, including their participation in international standard-setting in order to increase their ability to assess risk in the areas of zoonotic and non-zoonotic foodborne diseases and food safety, and to develop and implement national food- control systems, with links to international emergency systems. 80 85 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 60 Strategic objective 10 To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research Scope The work under this objective seeks to improve health service delivery with the aim of improving health outcomes. It is guided by the principles of primary health care, and is concerned with scaling-up service coverage as well as increasing equity in access and outcomes. Its focus is five of the six supply- side health systems building blocks: governance, finance, human resources, information systems, and the organization and management of service delivery 8 . These building blocks are complemented by efforts that seek to increase the community's participation in health systems development. Each area is under-pinned by research, documentation and comparative analysis. In addition to specific technical work on health systems this objective will include the coordination of efforts - across WHO - which seek to help Member States develop and implement national policies, strategies and plans. A robust national health policy and strategy will ensure complementarity between all the elements needed to improve health outcomes. In countries that receive significant levels of external aid, national strategies provide the best means of ensuring alignment between external inputs and national priorities. While the precise content will be determined by country context, a national health strategy will link an analysis of needs and current performance with future objectives (in terms of health outcomes and health systems) and details of the financial and institutional arrangements needed to achieve them. Key achievements to date WHO has developed - in partnership with others - a normative and conceptual framework - based on the idea of six basic building blocks - which is widely used to guide work on health systems strengthening. On financing, the World Health Report 2010 sets out a decision guide for countries aiming to extend financing for universal coverage. The 2012 WHR will focus on research for better health. In the area of information systems, WHO developed a common monitoring framework for use at country level, which has been agreed by all H8 partners. The 63 rd World Health Assembly adopted a Global Code of Practice on the International Recruitment of Health Personnel. The establishment and strengthening systems to enhance patient safety through raising awareness, building evidence and developing tools for improvement has made rapid progress. In line with the expanded scope of this objective, WHO has also developed a Framework for National Health Policies, Strategies and Plans for review by Member States in 2010-11. Sustained advocacy on the part of WHO and its partners, has resulted in the vital role of health systems in delivering better outcomes being widely acknowledged. Health systems strengthening features strongly in the 2009 UN ECOSOC Ministerial Declaration and at both the 2008 and 2009 G8 summits. A strong health system is now seen as key to improving maternal health and accelerating progress on MDG 5. This combination of growing political prominence and the recognition of the damaging impact of continuing under-investment, has resulted in increased levels of funding for health systems strengthening. Health systems were the prime focus of the High Level Task Force on Innovative Finance convened by the former UK Prime Minister and World Bank President. Both GAVI and the Global Fund have increased their financial support for systems strengthening, as has the World Bank. 8 Medical products and technologies - the sixth building block - falls under Strategic Objective 11. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 61 Several regions have established health systems observatories, modelled in part on the European Observatory on Health Policy and Systems. This network will continue to provide a steady stream of comparative analysis to be used as an input to national policy dialogue. Work has begun on a country health intelligence platform to provide Member States with regularly updated situation analyses of their health systems. Following WHO inputs to the High Level Forum on Aid Effectiveness in Accra, the OECD/DAC-hosted Working Party on Aid Effectiveness has established a specific Task Team on Health as a Tracer Sector to examine and promote strategies for increasing the effectiveness of external technical and financial assistance in the health sector. The International Health Partnership (IHP+), coordinated by WHO and the World Bank, which has 47 partners including 22 developing countries, provides a working model for the scaling-up of efforts to develop national policies, strategies and plans. The JANS (Joint Assessment of National Strategies), developed with a wide range of partners, is also available to be used as a instrument for assessing their conformity to standards of good practice. Financing agreements at country level involving both bilaterals, multilaterals and global partnership demonstrate how a common platform for health systems financing (recommended by the High Level Task Force) can work in practice. Key challenges In summary, WHO has established a strong conceptual base for work on health systems, more resources are beginning to flow to countries, WHA resolutions provide the requisite guidance in key technical areas, many of the necessary tools have been developed, and processes are in place to work in a more strategic way on national policies. The overarching challenge therefore is to be able to respond effectively to the growing demand from countries for high-quality technical support. In the previous biennium, more than 30 countries received support to identify the numbers of people at risk of financial catastrophe linked to out-of-pocket payments and to estimate the financial implications and costs of health insurance. Following the publication of WHR 2010 demand for such support will increase. Similarly, demand will increase from countries proposals to the Global Fund to Fight Aids, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization; from countries wanting to strengthen their information systems and develop plans to train and retain health personnel; from Ministries of Health and hospitals wishing to increase patient safety. Adoption of a Framework for National Health Policies, Strategies and Plans will be followed by demand from countries wanting to use it. While the level of demand for technical support in strengthening health systems increases, the environment in which it is provided becomes more complex - particularly in those countries with many development partners. WHO can draw on a growing body of knowledge and experience in health systems strengthening when providing advice to countries. At the same time, strategic decisions in sensitive areas such as health financing and human resources need to take full account of the political context in which are to be implemented. The challenge for WHO is to help ensure consistency in approach, given the Organization's role as the key supporter of the Ministry of Health, and the potential for conflicting advice coming from different partners. On the other hand, WHO's own capacity is finite and needs to focus on areas where the Organization has a clear comparative advantage. Getting the balance right between being a provider and a coordinator of technical support is particularly acute in the area of health systems strengthening and in the development of national policies, strategies and plans. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 62 Priorities and emphasis for 2012–2013 In the light of the above analysis the key shift in emphasis for the biennium will be toward ensuring that countries can access the technical support they require. This may come from WHO itself, harnessing resources from all levels of the Organization, and increasing efforts to build the requisite capacity in country offices. Equally, WHO will work to establish technical support networks which will both increase access to high quality support as well as help to build institutional capacity in countries. The objective of improving the quality of technical support, responds to one of the key concerns expressed in the Future of Financing discussions. It also underpins each of the 13 OWERS that contribute to Strategic Objective 10. Protecting a critical mass of personnel both to provide support and manage external networks is essential. A second shift in emphasis is to ensure better linkages between work on health systems strengthen and other strategic objectives. This will be most evident in the revitalized work on national policies, strategies and plans, where health systems strengthening and increasing aid effectiveness is but only one part of the picture. Equally, however, if health systems strengthening is a means to achieving health outcomes, rather than an end in itself, there will be more emphasis on working with those programmes whose prime concern is the delivery of technical intervention - on a regular rather than case by case basis. A third area of emphasis concerns WHO as a partner. Effectiveness in delivering on the health systems strengthening objectives in this budget will be enhanced through working as a reliable and consistent member of the UN Country team, and through helping the Organization as a whole to implement the requirements of the Paris Declaration and the Accra Agenda for Action (notably in strengthening country financial management, information and procurements so that other partners can use them with confidence). Within the overall health systems strengthening agenda there are some specific priorities for the biennium. As noted in the introduction to this budget, WHO will give particular priority to the rapid development of information systems and statistical capacity in countries. The objective is to support the strengthening of standard-based country health-information platforms that provide and use high-quality and timely information for country health planning and for monitoring progress towards national and major international goals. In the area of human resources, the main priority is to develop global guidelines for transformative education of doctors and nurses and a global HRH information strategy incorporating best practices in the development of HRH observatories. In relation to service delivery the key concern will remain on reorganization, in line with the four PHC dimensions (Universal Coverage, People Centeredness, New Governance, Public Policies), with a particular emphasis on people-centred care. Work on health systems strengthening will continue to be backed by a strong research, monitoring and normative base. This will include work on classification and terminology work and the revision of International Classification of Diseases(ICD) 11 (in collaboration with the International Health Terminology Standards Development - IHTSDO). Monitoring the global health situation and trends: burden of disease and risk factor analyses, estimates for key health indicators, evaluation of scaling up, and addressing information gaps such as maternal mortality will continue, as will the collection and analysis of National Health Accounts and the refinement of a unified costing tool. While the main shift in emphasis is from the global to the country level - putting evidence into action - there remains a need to improve the quality and analytic rigour applied in the area of health systems PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 63 strengthening. Support to national systems and capacity for better knowledge and evidence for health decision-making will be assured through access, consolidation and publication of existing evidence, facilitation of knowledge generation in priority areas, and global leadership in health research policy and coordination, including with regard to ethical conduct. Building on the early work of the Guidelines Review Committee there will be a focused effort to assess and improve the quality of evidence used in development of health system guidelines. The budget contains no completely new areas of work. Nevertheless, there remains a need to be able to assess the impact of a wide range of new developments on the cost and effectiveness of health systems. Some new technologies, uncontrolled, could rapidly lead to an escalation of costs and an increase in inequity. Others, could have the complete reverse effects, dramatically cutting costs and increasing efficiency. One key area to be explored is e-health. Of 115 countries surveyed in 2009 by the WHO Global Observatory for e-health, 53 had policies in places. The impact of these policies and the potential, for example, for mobile telephony to change service delivery patterns requires urgent exploration. Other trends to be monitored include the changing role of governments in regulating private and voluntary providers; impact of genomics on health services; and the increasing use in both developed and developing countries of different forms of traditional and complementary medicines. Links with other strategic objectives - All strategic objectives concerned with the achievement of specific health outcomes, primarily strategic objectives 1 to 4. - All health- and disease-related strategic objectives: the work provides a platform for close collaboration with the evidence component. - Strategic objective 5: complementing the specific circumstances of service delivery in fragile states. - Strategic objective 7: particularly in relation to health equity, pro-poor health policies and the progressive realization of the right to health - the work translates achievements in those areas into service delivery. - Strategic objective 12: particularly work on providing leadership, strengthening governance, knowledge generation, access to knowledge and encouraging partnerships and collaboration in engagement with countries. Major WHO special programmes and collaborative arrangements contributing to the achievement of Organization-wide expected results, and included within the budgetary envelope - World Alliance for Patient Safety - European Observatory on Health Systems and Policies - Alliance on Health Policy and Systems Research - Global Health Workforce Alliance - Health Metrics Network PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 64 Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 123.00 33.2 44.0 30.8 57.3 39.0 82.1 410 Special programmes and collaborative arrangements 45 Outbreak and crisis response 0 Grand Total 455 Organization-wide expected results and indicators Indicators 10.1.1 Number of Member States that have regularly updated databases on numbers and distribution of health facilities and health interventions offered Baseline 2012 35 Targets to be achieved by 2013 10.1 Management and organization of integrated, population-based health-service delivery through public and nonpublic providers and networks improved, reflecting the primary health care strategy, scaling up coverage, equity, quality and safety of personal and population-based health services, and enhancing health outcomes. 40 Indicators 10.2.1 Number of Member States that have in the last five years developed comprehensive national health planning processes in consultation with stakeholders 10.2.2 Number of Member States that conduct a regular or periodic evaluation of progress, including implementation of their national health plan, based on a commonly agreed performance assessment of their health system Baseline 2012 107 65 Targets to be achieved by 2013 10.2 National capacities for governance and leadership improved through evidence-based policy dialogue, institutional capacity-building for policy analysis and development, strategy-based health system performance assessment, greater transparency and accountability for performance, and more effective intersectoral collaboration. 115 75 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 65 Indicators 10.3.1 Number of Member States where the inputs of major stakeholders are harmonized with national policies, measured in line with the Paris Declaration on Aid Effectiveness Baseline 2012 30 Targets to be achieved by 2013 10.3 Coordination of the various mechanisms (including donor assistance) that provide support to Member States in their efforts to achieve national targets for health- system development and global health goals improved. 35 Indicators 10.4.1 Proportion of low- and middle-income countries with adequate health statistics and monitoring of health-related Millennium Development Goals that meet agreed standards Baseline 2012 45% Targets to be achieved by 2013 10.4 Country health- information systems that provide and use high-quality and timely information for health planning and for monitoring progress towards national and major international goals strengthened. 60% Indicators 10.5.1 Proportion of countries for which high quality profiles with core health statistics are available from its open-access databases 10.5.2 Number of countries in which WHO plays a key role in supporting the generation and use of information and knowledge, including primary data collection through surveys, civil registration or improvement or analysis and synthesis of health facility data for policies and planning 10.5.3 Effective research for health coordination and leadership mechanisms established and maintained at global and regional levels Baseline 2012 90% 35 Mechanisms operating at global and all regional levels Targets to be achieved by 2013 10.5. Better knowledge and evidence for health decision- making assured through consolidation and publication of existing evidence, facilitation of knowledge generation in priority areas, and global leadership in health research policy and coordination, including with regard to ethical conduct. 90% 45 Mechanisms operating at global and all regional levels PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 66 Indicators 10.6.1 Proportion of low- and middle- income countries in which national health- research systems meet internationally agreed minimum standards; 10.6.2 Number of Member States complying with the recommendation to dedicate at least 2% of their health budget to research (Commission on Health Research for Development, 1990) Baseline 2012 15% 23% increase from baseline 2008 Targets to be achieved by 2013 10.6 National health research for development of health systems strengthened in the context of regional and international research and engagement of civil society. 20% 25% increase from baseline 2008 Indicators 10.7.1 Number of Member States adopting knowledge management policies in order to bridge the “know- how” gap particularly aimed to decrease the digital divide 10.7.2 Number of Member States with access to electronic international scientific journals and knowledge archives in health sciences as assessed by the WHO Global Observatory for eHealth biannual survey 10.7.3 Proportion of Member States with eHealth policies, strategies and regulatory frameworks as assessed by the WHO Global Observatory for eHealth biannual survey Baseline 2012 100 170 75 Targets to be achieved by 2013 10.7 Knowledge management and eHealth policies and strategies developed and implemented in order to strengthen health systems. 110 180 90 Indicators 10.8.1 Number of countries reporting two or more national data points on human resources for health within the past five years, reported in the Global Atlas of the Health Workforce 10.8.2 Number of Member States with a national policy and planning unit for human resources for health Baseline 2012 96 50 Targets to be achieved by 2013 10.8 Health- workforce information and knowledge base strengthened, and country capacities for policy analysis, planning, implementation, information- sharing and research built up. 100 55 Indicators 10.9.1 Proportion of 57 countries with critical shortage of health workforce, as identified in The world health report 2006 with a multi-year HRH plan 10.9.2 Proportion of 57 countries with critical shortage of health workforce, as identified in The world health report 2006 which have an investment plan for scaling up training and education of health workers Baseline 2012 50% 25% Targets to be achieved by 2013 10.9 Technical support provided to Member States, with a focus on those facing severe health-workforce difficulties in order to improve the production, distribution, skill mix and retention of the health workforce. 55% 30% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 67 Indicators 10.10.1 Number of Member States provided with technical and policy support to raise additional funds for health; to reduce financial barriers to access, incidence of financial catastrophe, and impoverishment linked to health payments; or to improve social protection and the efficiency and equity of resource use 10.10.2 Number of key policy briefs prepared, disseminated and their use supported, which document best practices on revenue-raising, pooling and purchasing, including contracting, provision of interventions and services, and handling of fragmentation in systems associated with vertical programmes and inflow of international funds Baseline 2012 17 technical briefs Targets to be achieved by 2013 10.10 Evidence- based policy and technical support provided to Member States in order to improve health-system financing in terms of the availability of funds, social and financial-risk protection, equity, access to services and efficiency of resource use. 22 technical briefs Indicators 10.11.1 Key tools, norms and standards to guide policy development and implementation developed, disseminated and their use supported, according to expressed need, that comprise resource tracking and allocation, budgeting, financial management, economic consequences of disease and social exclusion, organization and efficiency of service delivery, including contracting, or the incidence of financial catastrophe and impoverishment 10.11.2 Number of Member States provided with technical support for using WHO tools to track and evaluate the adequacy and use of funds, to estimate future financial needs, to manage and monitor available funds, or to track the impact of financing policy on households Baseline 2012 Tools and frameworks modified, updated and disseminated as necessary Targets to be achieved by 2013 10.11 Norms, standards and measurement tools developed for tracking resources, estimating the economic consequences of illness, and the costs and effects of interventions, financial catastrophe, impoverishment, and social exclusion, and their use supported and monitored. Tools and frameworks modified, updated and disseminated as necessary Indicators 10.12.1 WHO presence and leadership in international, regional and national partnerships and use of its evidence in order to increase financing for health in low-income countries, or provide support to countries in design and monitoring of Poverty Reduction Strategy Papers, sector- wide approaches, medium-term expenditure frameworks, and other long- term financing mechanisms capable of providing social health protect consistent with primary health care 10.12.2 Number of Member States provided with support to build capacity in the formulation of health financing policies and strategies and the interpretation of financial data, or with key information on health expenditures, financing, efficiency and equity to guide the process Baseline 2012 10.12 Steps taken to advocate additional funds for health where necessary; to build capacity in framing of health-financing policy and interpretation and use of financial information; and to stimulate the generation and translation of knowledge to support policy development. WHO participation in 6 partnerships; country support provided on long-term financing options in 28 countries Technical support provided to 75 countries, and annual updates of health expenditures to all Member States, together with new information on the incidence of catastrophic expenditures in 20 countries PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 68 Targets to be achieved by 2013 WHO participation in 8 partnerships; support provided to 40 countries Technical support provided to 90 countries, annual updates of health expenditures to all Member States, and revised and updated information on catastrophic expenditures to an additional 20 countries Indicators 10.13.1 Key tools, norms and standards to guide policy development, measurement and implementation disseminated and their use supported 10.13.2 Number of Member States participating in global patient safety challenges and other global safety initiatives, including research and measurement Baseline 2012 2 global safety standards and 20 major supporting tools 45 Targets to be achieved by 2013 10.13 Evidence based norms, standards and measurement tools developed to support member states to quantify and decrease the level of unsafe health care provided. 4 global safety standards and 40 major supporting tools 90 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 69 Strategic objective 11 To ensure improved access, quality and use of medical products and technologies Scope Medical products include chemical and biological medicines; vaccines; blood and blood products; cells and tissues mostly of human origin; biotechnology products; traditional medicines and medical devices. Technologies include, among others, those for diagnostic testing, imaging, and laboratory testing. The work undertaken under this strategic objective will focus on making access more equitable (as measured by availability, price and affordability) to essential medical products and technologies of assured quality, safety, efficacy and cost-effectiveness, and on their sound and cost-effective use. For the sound use of products and technologies, work will focus on building appropriate regulatory systems; evidence-based selection; information for prescribers and patients; appropriate diagnostic, clinical and surgical procedures; vaccination policies; supply systems, dispensing and injection safety; and blood transfusion. Information includes clinical guidelines, independent product information and ethical promotion. The work outlined above will contribute to the implementation of WHO-led specific actions of the global strategy and plan of action on public health, innovation and intellectual property. In addition, in collaboration with other relevant international intergovernmental organizations – including WIPO, WTO and UNCTAD – specific actions will be undertaken concerning the application and management of intellectual property in support of health-related innovation, and to the promotion of public health. Key achievements to date WHO developed, updated and promoted global nomenclature systems, quality norms and standards in vaccines, medicines and medical technologies, and through the United Nations prequalification programme, prequalified a range of medicines, including paediatric formulations, as well as vaccines. The 17th WHO Model List of Essential Medicines has been published, including the first WHO Model List of Essential Medicines for Children. A draft list of essential medical devices for 100 clinical practice protocols and five types of health facility has been prepared. National programmes to promote access to, and the quality and rational use of, medicines were supported in countries, and training and advocacy meetings were held in policy-related areas and were well attended. A total of 10 countries developed national transplantation policies. The African and Western Pacific Regions updated regional medicine policy guidelines and strategies, and several countries in those regions developed national policies for traditional medicine. Technical support was provided to priority countries for strengthening their blood transfusion services and improving injection safety. A total of 15 countries have developed safe blood policies. Global indicators for monitoring access to essential medicines were refined and used in two United Nations reports on progress towards achieving Millennium Development Goals target 8E. A monitoring and implementation framework for the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property has been developed. By late 2009, 46 national medicine regulatory agencies and 114 vaccine regulatory agencies had been formally assessed and many laboratories in developing countries participated in WHO's external quality assurance system. Several regional economic blocks in Africa are working towards regional regulatory harmonization. Most countries now use national lists of essential medicines as the basis for medicines procurement and use in the public sector. Regional training courses were held and several countries received specific support on clinical guidelines, medicines pricing and reimbursement of essential medicines. Key challenges Many developing countries still lack adequate regulatory systems for medicines, vaccines, blood products, diagnostics and other health technologies. Despite the potential of comprehensive supply strategies and the rational use of medical products to reduce medical and economic waste, progress in promoting them is hampered by a lack of political will at country level and of resources in WHO. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 70 Priorities and emphasis for 2012–2013 There are three priority areas for the biennium. Firstly is to continue and expand the work in relation to policy and access to medical products and technologies. Emphasis will be given to cross-cutting health systems approaches such as medicines benefits as part of health insurance, human resources for medicines supply, comprehensive support to district hospitals as well as programmes to promote transparency, good governance and prevention of corruption. Besides the usual emphasis on essential medicines for priority diseases, access to certain specific categories of medical products, such as essential medicines for children, controlled medicines for pain, terminal palliative care and drug abuse, and antirabies and antisnake sera also needs to be undertaken. Finally, work will continue on developing innovative public health concepts such as promoting patent pools and medicine pricing policies. The second area of focus will be to continue the normative and country support work in relation to quality of medical products and technologies. Emphasis will be given to global regulatory harmonization and regional collaboration to promote efficacy, quality and safety of vaccines, medicines and technologies as well as combatting substandard and falsified medicines. Work will continue in the area of normative functions such as the INN nomenclature programme, quality specifications for medicines and biologicals, good manufacturing standards, the International Pharmacopoeia and the WHO Model List of Essential Medicines including the prequalification of new vaccines and new medicines for neglected diseases and WHO/UN prequalification of vaccines, medicines and diagnostics. Finally, work will continue on developing innovative public health concepts such as those outlined in the Global Strategy and plan of action on public health, innovation and intellectual property as well as medicine pricing policies. Links with other strategic objectives - Strategic objectives 1 to 5 (health outcomes): none of these objectives can be achieved without essential medical products, medicines and health technologies. With regard to access, work under this strategic objective will focus on “horizontal” issues such as comprehensive supply systems, pricing surveys and national pricing policies. On quality assurance and regulatory support, all WHO’s work is covered by this strategic objective. Work on rational use will focus on general aspects such as evidence-based selection of essential medical products and technologies, development of clinical guidelines, pharmacovigilance and patient safety, compliance with long-term treatment regimens and containing antimicrobial resistance. - Strategic objective 10: work also contributes to health service delivery; sustainable financing of products and technologies, on which access also depends. An integrated approach to health systems in support of primary health care will be promoted. - Strategic objective 7: good governance. - Strategic objective 12: global public policy. - Strategic objectives 1 and 2: global strategy and plan of action on public health, innovation and intellectual property. Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Base Programmes Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 23.2 7.7 10.0 5.0 16.1 14.0 59.1 135 Special programmes and collaborative arrangements 17 Outbreak and crisis response 0 Grand Total 152 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 71 Organization-wide expected results and indicators Indicators 11.1.1 Number of Member States receiving support to formulate and implement official national policies on access, quality and use of essential medical products or technologies 11.1.2 Number of Member States receiving support to design or strengthen comprehensive national procurement or supply systems 11.1.3 Number of Member States receiving support to formulate and/or implement national strategies and regulatory mechanisms for blood and blood products or infection control 11.1.4 Publication of a biennial global report on medicine prices, availability and affordability, based on all available regional and national reports Baseline 2012 90 50 30 Report published Targets to be achieved by 2013 11.1 Formulation and monitoring of comprehensive national policies on access, quality and use of essential medical products and technologies advocated and supported. 100 70 40 2 reports published (2011 and 2013) Indicators 11.2.1 Number of new or updated global quality standards, reference preparations, guidelines and tools for improving the provision, management, use, quality, or effective regulation of medical products and technologies 11.2.2 Number of assigned International Nonproprietary Names for medical products 11.2.3 Number of priority medicines, vaccines, diagnostic tools and items of equipment that are prequalified for United Nations procurement 11.2.4 Number of Member States for which the functionality of the national regulatory authorities has been assessed or supported Baseline 2012 15 additional 9 200 300 80 Targets to be achieved by 2013 11.2 International norms, standards and guidelines for the quality, safety, efficacy and cost- effective use of medical products and technologies developed and their national and/or regional implementation advocated and supported. 15 additional 9 300 350 90 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 72 Indicators 11.3.1 Number of national or regional programmes receiving support for promoting sound and cost-effective use of medical products or technologies 11.3.2 Number of Member States using national lists, updated within the past five years, of essential medicines, vaccines or technologies for public procurement or reimbursement Baseline 2012 60 135 Targets to be achieved by 2013 11.3 Evidence- based policy guidance on promoting scientifically sound and cost-effective use of medical products and technologies by health workers and consumers developed and supported within the Secretariat and regional and national programmes. 70 150 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 73 Strategic objective 12 To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work Scope This strategic objective facilitates the work of WHO to achieve all other strategic objectives. Responding to priorities in the Eleventh General Programme of Work, it recognizes that the context for international health has changed significantly. The scope of this objective covers three broad, complementary areas: leadership in global health and governance and coherence of the Organization; WHO’s support for, presence in, and engagement with individual Member States including support for government leadership, coordination and effective management of health actors, partnerships and resources; and the Organization’s role in bringing the collective energy and experience of Member States and other actors to bear on health issues of global and regional importance. The main innovation implicit in this objective is that it seeks to harness the depth and breadth of WHO’s country experience in order to influence global and regional debates, thereby to influence positively the environment in which national policy-makers work, and contribute to the attainment of the health-related Millennium Development goals and other internationally agreed health-related goals. Key achievements to date Coherence and synergy between the work of the different parts of the Organization have improved as a result of the Director-General's leadership facilitated by good working relations with Regional Directors and Assistant Directors-General. Progress has been made towards better aligning WHO country cooperation strategies with countries’ national priorities and harmonization with those of the United Nations and other development partners. The country cooperation strategies underpin the development of WHO biennial workplans, alignment of the core capacity of country offices to countries’ needs, strengthening the health component of the United Nations Development Assistance Framework (UNDAF). At global, regional and country level, WHO has reinforced its collaboration with the United Nations Development Group, the United Nations Development Groups Regional Directors’ teams and the United Nations country teams. WHO’s leadership, in partnership with the United Nations agencies, World Bank, global health partnerships and key bilateral organizations has helped in establishing more effective platforms for action, coordination and coherence at country level. Key challenges Proactive leadership will continue to be required to allow the Organization to respond to current and future global challenges that impact on peoples' health, national health systems, and, in turn, the health of entire populations. It will have to adapt to the challenges posed by changing health needs and expectations, competing priorities and a complex architecture of health actors and financing mechanisms. As the international community considers the progress towards attainment of the Millennium Development Goals, the role of health must continue to be promoted. At the same time, there is a sharper focus on WHO’s core business and priorities, namely, delivering in those areas where it has a clear competitive advantage while leaving other tasks to those best placed to perform them. WHO also needs to show stronger leadership in reducing fragmentation and achieving better alignment of multiple global and national partners supporting national health strategies. Better communication and increased access to information will improve the quality of WHO's work. Priorities and emphasis for 2012–2013 WHO must continue to maintain critical capacities to analyse the impact of - and respond to - the current, new and emerging health challenges. WHO will to work closely with countries to advance the global health agenda and contribute towards supporting member states in formulation of national health strategies and plans based on their needs. With regard to its country support, WHO will ensure a closer PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 74 match between the level and nature of WHO support and the magnitude and nature of country needs, including in those countries in which WHO has no physical presence. WHO will continue its work towards improving he effectiveness and efficiency of its work in and with countries. In those countries with many development partners develop WHO country capacities to broker for technical cooperation, and facilitate governments' efforts for effective partners' support to sound national health strategies/plans. WHO will continue to explore approaches to improving the effectiveness and inclusiveness of global health governance, streamline and rationalize time and resources needed for effective running of all WHO governing bodies, preparatory meetings, partnership boards, working groups, international task forces, etc. WHO’s collaboration with the United Nations and broader engagement in UN reform process will be enhanced, including at country level. Strategies to engage with the commercial private sector will be strengthened, interaction with the nongovernmental sector expanded and operational framework for partnerships developed. There will be increased emphasis on improving organizational performance through continuous monitoring and evaluation of key organizational performance indicators and provision of strategic guidance to enhance institutional mechanisms on integrity and accountability and provision of a sound financing framework. Links with other strategic objectives This SO enables the achievement of others strategic objectives, provides direction and guides the entire work of the organization. It is intrinsically linked to all the other objectives. It is particularly linked to strategic objective 10, since support for national leadership, coordination and management of the health sector is closely related to work on assisting in the development, financing and evaluation of national health policies and strategic plans, in which the areas covered by all the other strategic objectives (except 12 and 13) will be appropriately positioned. It is also closely related and complementary to strategic objective 13, to develop and sustain WHO as a flexible, learning Organization, enabling it to carry out its mandate more effectively and efficiently. While SO 13 is geared towards managerial and administrative issues within the Organization, strategic objective 12 is more outward-looking, focusing on issues of WHO leadership and governance, on work in and with Member States, and collaboration with partners including the United Nations System, at global, regional and country levels. Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 50.2 15.7 16.5 31.7 26.3 17.1 132.2 290 Organization-wide expected results and indicators Indicators 12.1.1 Proportion of documents submitted to governing bodies within constitutional deadlines in the six WHO official languages Baseline 2012 95% Targets to be achieved by 2013 12.1 Effective leadership and direction of the Organization exercised through enhancement of governance, and the coherence, accountability and synergy of WHO’s work. 98% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 75 Indicators 12.2.1 Number of Member States where WHO is aligning its country cooperation strategy with the country’s priorities and development cycle and harmonizing its work with the United Nations and other development partners within relevant frameworks, such as the United Nations Development Assistance Framework, Poverty Reduction Strategy Papers and Sector-Wide Approaches 12.2.2 Proportion of WHO country offices which have reviewed and adjusted their core capacity in accordance with their country cooperation strategy Baseline 2012 23% of the 145 Country Cooperation Strategies updated/revised 70% Targets to be achieved by 2013 12.2 Effective WHO country presence 9 established to implement WHO country cooperation strategies that are aligned with Member States’ health and development agendas, and harmonized with the United Nations country team and other development partners. 29% of the 145 Country Cooperation Strategies updated/revised 80% Indicators 12.3.1 Number of health partnerships in which WHO participates that work according to the best practice principles for Global Health Partnerships 12.3.2 Proportion of health partnerships managed by WHO that comply with WHO partnership policy guidance 12.3.3 Proportion of countries where WHO is leading or actively engaged in health and development partnerships (formal and informal), including in the context of reforms of the United Nations system Baseline 2012 30 100% 80% Targets to be achieved by 2013 12.3 Global health and development mechanisms established to provide more sustained and predictable technical and financial resources for health on the basis of a common health agenda which responds to the health needs and priorities of Member States. 50 100% 90% 9 WHO country presence is the platform for effective collaboration with countries for advancing the global health agenda, contributing to national strategies, and bringing country realities and perspectives into global policies and priorities. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 76 Indicators 12.4.1 Average number of visits per month to the WHO headquarters’ web site 12.4.2 Number of pages in languages other than English available on WHO country and regional offices’ and headquarters’ web sites Baseline 2012 6.7 million 80 000 Targets to be achieved by 2013 12.4 Essential multilingual health knowledge and advocacy material made accessible to Member States, health partners and other stakeholders through the effective exchange and sharing of knowledge. 7 million 90 000 PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 77 Strategic objective 13 To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively Scope The scope of this objective covers the functions that support the work of the Secretariat in country and regional offices and in headquarters. Work is organized within a comprehensive results-based management framework that includes the following processes: strategic and operational planning and budgeting; performance monitoring and evaluation; management of financial resources through monitoring, mobilization and Organization-wide coordination to ensurse an efficient flow of available resources throughout the Organization; and management of human resources, including planning, recruitment, staff development and learning, health and safety, performance management, conditions of service and entitlements that reflect best practice in the United Nations Common System. The work focuses on: delivery of expected results; maintaining excellence in performance and increasing employee engagement; providing an enabling working environment, including management of infrastructure and logistics, security of staff and premises, medical services and information technology; and ensuring appropriate accountability and governance mechanisms across all areas. Key achievements WHO's results-based management framework has been reinforced through the stricter use of performance indicators and closer alignment with the priorities defined in country cooperation strategies. The Global Management System has been introduced in five major offices, and preparations for its implementation in the African Region are in progress. Preparations for full introduction of the International Public Sector Accounting Standards (IPSAS), as part of the United Nations harmonization process, are advancing, and the Global Service Centre is now fully operational. The first Global Human Resources Plan was prepared and a revised selection process for heads of WHO country offices, using a global roster, has been introduced. The decision by the 125 th session of the Executive Board to establish an Independent Expert Oversight Advisory Committee will have a positive impact on risk management and control systems. A WHO working group on cost recovery has been established and has recommended, inter alia, the implementation of a new head-count based cost recovery system to ensure the sustainable financing of strategic objectives 12 and 13. WHO is the first United Nations agency to have a global occupational health and safety policy. In addition to meeting the purchasing requirements of other areas, the sourcing and delivery of essential pharmaceuticals and other health-related products for Member States also falls within the remit of the strategic objective. Key challenges A key challenge continues to be to ensure that the Organization gains the maximum benefits from the new Global Management System (GSM), which should be fully deployed by the start of the biennium. The GSM is the primary platform for consistent, real-time and integrated information management. In parallel, however, it is paramount to ensure good quality and controls, over the delivery of management and administrative support services: maintenance of an adequate control framework in all locations is important to maintain confidence in WHO processes for managing income, assets and expenditure. Given the need to improve controls while simultaneously striving for efficiency improvements, efforts will be made to re-assess the optimum ways of delivering services across the Organization, notably making fuller use of existing specialist administrative networks. This process involves further improving efficiency and effectiveness of operations at the GSC, as well as further enhancement and simplification to the GSM system. In parallel continued assessment, and adjustment, will be carried out across the network to find efficiencies in the delivery of core services, potentially further shifting some functions to low cost locations, in order to meet cost saving objectives. Such developments must however be carried out in such a way as not to compromise internal controls, nor the quality of provision of core services. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 78 Priorities and emphasis for 2012–2013 During 2013 it is expected that there will be a major upgrade to GSM. This project requires detailed analysis prior to deciding the appropriate IT strategy for the upgrade, to ensure optimum benefits are taken of new system features, while ensuring minimum disruption to users. In planning and resource mobilization a systematic integration of countries' priorities within overall planning and budgeting processes will be undertaken, and second, there will be increased engagement with donors to ensure predictable and flexible funding and improved alignment of resource management with programme implementation. Within the area of finance, emphasis will be given to the completion of IPSAS implementation, this being dependant on full GSM implementation to the African region, and completion of fixed assets and inventory data and accounting preparation. Second, there have been incremental changes to back charging and cost recovery mechanisms, and effort is therefore needed to ensure a consistent and coherent approach, which also supports adequate cost control, and optimal resource allocation between offices. Lastly, the Organization's health insurance scheme, the SHI, managed within the department of Finance, and which provides health coverage for current and retired staff and their dependants, will be subject to major review, focusing on governance and on scheme design, in order to ensure that the scheme continues to be fully "fit for purpose." Within the area of human resource management, a key objective is the introduction of a systematic mobility scheme, and an enhancement of staff performance management. Second, improved access to staff health promotion opportunities and occupational safety is needed. Compliance with Minimum Operating Safety Standards has been an objective for the past several biennia, but achievement has to date been made difficult due to resource constraints. Given further resources secured in 2010-11, this area will be given added emphasis in order to completed minimum security requirements in all locations. Lastly, a cross cutting objective to be given more emphasis is to address risk management in a more systematic and effective way - to ensure adequate management of risks that could affect the achievement of any SO13 objectives. Links with other strategic objectives This objective should not be considered in isolation from the other strategic objectives, as its scope reflects and is responsive to the needs of the Organization as a whole. In particular, it should be read in conjunction with strategic objective 12, to provide leadership, strengthen governance and foster partnership and collaboration with countries and to fulfil the mandate of WHO in advancing the global health agenda. Strategic objective 13 is more inward-looking, geared towards managerial and administrative issues, whereas strategic objective 12 is more outward-looking, focusing on issues of WHO leadership and governance and on collaboration with Member States and partners at global, regional and country levels. Strategic objective 13 also covers broad institutional reform that will ensure that the above functions are continuously strengthened and provide better, more efficient and cost-effective support to the Organization, and therefore it is closely linked to broader reforms within the United Nations system at both country and global levels. PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 79 Total budget by location for the strategic objective for 2012–2013 (US$ million) Budget (US$ million) Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Headquarters TOTAL 119.7 29.6 43.5 38.3 44.0 31.6 202.5 509 Organization-wide expected results and indicators Indicators 13.1.1 Proportion of country workplans that have been peer reviewed with respect to their technical quality, that they incorporate lessons learnt and reflect country needs 13.1.2 Office Specific Expected Results (OSERs) for which progress status has been updated within the established timeframes for periodic reporting Baseline 2012 95% 85% Targets to be achieved by 2013 13.1 Work of the Organization guided by strategic and operational plans that build on lessons learnt, reflect country needs, are elaborated across the Organization, and used to monitor performance and evaluate results. 100% 90% Indicators 13.2.1 Degree of compliance of WHO with International Public Sector Accounting Standards 13.2.2 Amount of voluntary contributions that are classified as fully and highly flexible Baseline 2012 Systems and opening accounts fully compliant US$ 300 million Targets to be achieved by 2013 13.2 Sound financial practices and efficient management of financial resources achieved through continuous monitoring and mobilization of resources to ensure the alignment of resources with the programme budgets. First fully compliant IPSAS annual financial statements presented to WHA in May 2013 US$ 400 million PRP TO CHECK Indicators 13.3.1 Proportion of offices with approved human resources plans for a biennium 13.3.2 Number of staff assuming a new position or moving to a new location during a biennium (delayed until biennium 2010–2011) 13.3.3 Proportion of staff in compliance with the cycle of the Performance Management Development System Baseline 2012 100% 300 80% Targets to be achieved by 2013 13.3 Human resource policies and practices in place to attract and retain top talent, promote learning and professional development, manage performance, and foster ethical behaviour. 100% 500 85% PROGRAMME BUDGET 2012-2013 REGIONAL COMMITTEE VERSION 80 Indicators 13.4.1 Number of information technology disciplines implemented Organization- wide according to industry-best-practices benchmarks 13.4.2 Proportion of offices using consistent real-time management information Baseline 2012 5 Headquarters, 5 regional offices and associated country offices Targets to be achieved by 2013 13.4 Management strategies, policies and practices in place for information systems, that ensure reliable, secure and cost- effective solutions while meeting the changing needs of the Organization. 7 All relevant WHO locations, including sub-country and field offices, where appropriate Indicators 13.5.1 Proportion of services delivered by the global service centre according to criteria in service-level agreements Baseline 2012 90% Targets to be achieved by 2013 13.5 Managerial and administrative support services 10 necessary for the efficient functioning of the Organization provided in accordance with service-level agreements that emphasize quality and responsiveness. 100% Indicators 13.6.1 The percentage of offices which are Moss compliant. 13.6.2 Level of funding and execution of the biennial Capital Master Plan Baseline 2012 70% 70% Targets to be achieved by 2013 13.6 Working environment conducive to the well-being and safety of staff in all locations. 95% 950% 10 Includes services in the areas of information technology, human resources, financial resources, logistics, and language services.