•
WORLD
HEALTH
ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Forty-eighth session Sydney 22-26 September 1997
WPRJRC48/9
18 July 1997 ORIGINAL: ENGLISH
Provisional agenda item 13
REGIONAL ARRANGEMENTS WITHIN WHO
In 1996, the Executive Board established a special group to review the WHO Constitution. In January 1997, the Executive Board expanded the terms of reference of the group to cover questions relating to WHO regional arrangements within the framework of the existing Constitution. The special group met on 3-4 April, 10 May and 9-11 July 1997 to discuss the issue of regional arrangements. Member States were invited to participate at each meeting. At the 100th session of the Executive Board, it was decided to request the regional committees to discuss the issue of regional arrangements at their 1997 meetings. This document presents the nine points for discussion as decided by the special group, addresses regional implications and contains as annexes the documentation presented to the meetings of the special group. The Regional Committee is requested to review the nine points and to give comments for consideration at the next meeting of the special group. This group will report to the 10 1st session of the Executive Board in January 1998.
WPR/RC48/9 page 2
1. INTRODUCTION
In 1996, the Executive Board established a special group to review the WHO Constitution. In January 1997, by resolution EB99.R24, the terms of reference of this group were expanded to cover, as a matter of priority, questions relating to WHO regional arrangements within the framework of the existing Constitution. Resolution EB99.R24 also decided there was a need to ensure the participation and input of Mem ber States, with appropriate mechanisms as specified in Rule 3 of the Rules of Procedure of the Executive Board. Member States were consequently invited to sessions of the special group where regional arrangements were discussed. The special group met on 3---4 April, 10 May (during the period of the Fiftieth World Health Assembly), and 9-11 July 1997. The special group agreed upon a number of points to be further examined. These are listed below in section 2, which also discusses regional implications where appropriate. The special group reported on progress to the 100th session of the Executive Board in May 1997, by document EBI00/4 (Annex 1). This is supplemented by the report of the meeting on 9-11 July 1997, EB/Constitution/5/9 (Annex 2).* A further meeting is scheduled to be held on 5-7 November 1997.
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2.
POINTS FOR DISCUSSION BY THE SPECIAL GROUP OF THE EXECUTIVE BOARD
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The issues are set out below according to the nine points for discussion agreed upon by the spccial group. Where documentation for a particular issue was available for the meetings on 10 May or 9-11 July 1997 it is attached as an annex.
Please note that paragraphs 1-14 refer to regional arrangements. Paragraphs 15-31 refer to a review of the constitution.
WPRlRC48/9 page 3
2.1
Status and progress of reform in regional offices and headquarters with reference to the 47 recommendations of the Executive Board Working Group on the WHO Response to Global Change In the Western Pacitlc Region, issues such as the need for ongoing reform of the work of the
Regional Committee, including the trial of technical brietlngs as a form of information exchange; revision of the format of the Regional Director's report; and improvements to the presentation of programme budget information have been addressed in recent years. At the Regional Office, a
review of the value of WHO collaborating centres is ongoing, and proposed new collaborating centres are being assessed with a view to ensuring that they work more closely with WHO. WHO representation at country level is being reviewed in the light of two governing hody requirements. the Executive Board Working Group (EBWG) and Executive Board recommendations to strengthen the WllO offices at country level. and the Executive Board and World Health Assembly requirements to mJl1lmlze increases 111
expenditure.
A
global
synthesis
of progress
is
contained
111
EBiConstitution!5/2 (Annex 3). A regional report of progress on the 47 EBWG recommendations is attached to this annex.
2.2
Current practice at headquarters and in regional offices for budget drafting; prioritysetting and implementation; personnel appointments; programme implementation; and impact of extra budgetary funds on regional budgets and priorities
2.2.1
etogramme budget preparation The development of the global proposed programme hudget is based on the General
Programme of Work in force at the time of the programme budget preparation and on relevant resolutions and discussions at the World Health Assembly and Executive Board.
Dislrihlllion ofregiollal planning allocation. The Director-General issues guidelines to each Regional Director on the basic regional planning allocation for the biennium. This basic planning allocation is distributed to country, intercountry and regional levels. For each country or area, a provisional country planning tlgure is established within the overall basic planning allocation. Criteria related to health-for-all strategies are used to allocate the resources, as well as the level of need of each country, its commitment to building up its health system, its absorption capacity and expected support from other sources.
WPRlRC48/9
page 4 The intercountry programme activities are intended to provide direct support to programmes which are relevant to countries and areas in the Region. They normally make direct contributions to the current needs of the health-for-all strategy, benefit two or more countries or areas, favour least developed countries, include exchange of information and experience and attract external sources of funding, where possible. The planning allocation for the Regional Office is established to cover the costs of managing and running the office as well as of conducting the Regional Committee sessions.
Preparation of the proposed programme blldget.
Resolutions WHA48.2S and EB9S.R4
requested that the programme budget proposals be presented under the 19 major programme headings. However, in the Western Pacific Region, the budget is presented in detail under specific programme headings in order to provide more comprehensive information. The budget proposals are consolidated at the regional level and presented to the Regional Committee for review. After the review, the proposals are consolidated and incorporated by the Director-General into the global WHO proposed programme budget. This is then presented to the Executive Board for consideration and to the World Health Assembly for review and adoption. Document EB/Constitution/S/3 (Annex 4) outlines current practices in headquarters and the six regions. 2.2.2 Priority setting in the Western Pacific Region Resolution WHA30.23 emphasized the need for close collaboration between WHO and Member States in the development of well-defined country health programmes. Within these
programmes, individual health projects and activities can be planned in detail and implemented in relation to overall programme objectives and in close harmony with national health programme processes. During the process of programme development, programme priorities are set as follows: (I) National priorities are established by the governments. They are generally based on national
data and country health needs as identified by epidemiological and survey evidence. They are linked to development objectives, thus each country has its own national priorities. (2) Regional priorities are established by the Regional Committee and are based on the regional The current regional priorities are: development of human resources for health;
situation.
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pageS eradication or control of selected diseases; health promotion; environmental health; exchange of information and experience; strengthening management; and management and control of emerging and re-emerging diseases. There is a further level of priority setting at the regional level. For
example, under control of specific communicable diseases. malaria, poliomyelitis, leprosy and tuberculosis are the focus of WHO activity in the Western Pacific Region. (3) Global priorities are determined and established by the Executive Board. For 1996-1997, the eradication of specific communicable diseases; prevention and
Executive Board priorities are:
control of specific communicable diseases; reproductive health, women's health and family health; promotion of primary health care and other areas that contribute to primary health care such as essential drugs and vaccines and nutrition; and promotion of environmental health, especially community water supply and sanitation. In a letter from the Regional Director to governments of countries and areas informing them of their country planning figures and requesting preparation of the programme budget proposals, governments were requested to focus on the global and regional priorities. These priorities were annexed to the letter and governments were asked to increase allocations to these priority areas. When the proposals are reviewed in the Regional Office, particular attention is paid to the emphasis governments have or have not placed on priority programmes. In this Region, programme budgets have been allocated to priority areas. In the 1996-1997 programme budget, 80.59% was allocated to global priorities and 78.19% to regional priorities. In 1998, 78.75% was allocated to global priorities and 75.02% to regional priorities.
2.3
Regular budget allocation to regions Document EB/Constitution/4/2 (Annex 5), which was presented to the special group at its
meeting on \0 May 1997, contains some possible criteria for establishing regional allocations. A summary of discussions at the 10 May meeting is contained in EB I00/4 (Annex I) paragraphs 6-9. Regular budget allocations to regions were discussed further by the special group at its meeting on 9-11 July 1997. A document prepared for this meeting (EB/Constitution/S/4) is attached as Annex 6.
WPRlRC48I9 page 6
As can be seen from the table below, the percentage of the regular budget received by each of the six regions has remained much the same for 25 years. The slight variations have been largely due to the effects of different inflation and exchange rate changes. Regular budget Region 1975 % 1980-1981
%
1984-1985 %
1990-1991 %
1994-1995
1998-1999
%
%
% of total
regional allocations Africa The Americas South-East Asia· Europe Eastern Mediterranean Western Pacific· Subtotal Global and interregional Total 15.60 9.31 10.41 5.71 10.47 7.87 59.37 40.63 100.00 15.94 8.77 10.53 5.58 9.28 7.72 57.82 42.18 100.00 18.13 9.77 11.79 6.76 10.35 8.87 65.67 34.33 100.00 18.31 9.95 12.34 5.83 10.31 8.89 65.63 34.37 100.00 18.77 9.71 12.03 5.96 10.40 8.70 65.57 34.43 100.00 18.68 9.81 11.78 5.91 10.71 9.53 66.42 33.58 100.00 28.12 14.77 17.74 8.90 16.12 14.35 100.00
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*Mongolia IransferredJrom Ihe Soulh-Easl Asia Regiolllo Ihe Jl'eslern Pacific Region ill 1995.
Regional allocations were last discussed by the Regional Committee at its forty-sixth session in September 1995. The paper prepared for this session (WPRJRC46/6) highlighted the imbalance between the global and regional allocations of the regular budget and population levels. It also drew attention to the number of Member States served by different regions over the period reviewed. The special group is looking at alternative criteria for establishing regional allocations. If the criterion of total population is used, the Western Pacific Region is the most populous region and should be allocated a larger share of the regular budget. If, however, the number of Member States is the criterion, the Western Pacific ranks fourth with 14% of the total, the same percentage as its current allocation of the regular budget. Member States Africa The Americas South-East Asia Europe· Eastern Mediterranean Western Pacific Total 46 35 10 51 22 27 191 0/0·· 24 18 5 27 12 14
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Population in J996 (millions) 602 781 1451 858 466 1629 5787
%·· 10 13 25 15 8 28
"Includes Andorra which joined WHO in 1997 " " TOlals may nol add 10 100 due 10 rounding.
WPRlRC48/9 page 7
The use of selected HF A indicators as a health index could also be used to detennine regional allocations. Another criterion being considered is priority allocation to least developed countries (LDCs). There are currently 30 LDCs in the African Region, seven in the Western Pacific, five in South-East Asia, four in the Eastern Mediterranean and one in the Americas.
The establishment of criteria is complicated, and no single criterion adequately covers the situation.
2.4
Current status of relationsbip between AMRO and P AHO The Pan-American Health Organization (fonnerly International Sanitary Bureau, later
renamed the Pan-American Sanitary Bureau, and then Pan-American Sanitary Organization) has been in existence since 1902. At the time of the development and adoption of the WHO Constitution in 1946, this was recognized specifically in Article 54. This article indicates that the Pan American Sanitary Organization (among others) '· ... shall in due course be integrated with the Organization. This integration shall be effected as soon as practicable through common action based on mutual consent of the competent authorities expressed through the organizations concerned". Current arrangements are outlined in EB/Constitution/4/3 (Annt:x 7) and a summary of the discussion at the 10 May 1997 meeting of the special group is contained in EB I 00/4 (Annex I), paragraphs I 0-12.
2.5
Criteria for determining regions, assignment of Member States to regions and location of regional offices This issue will be discussed at the meeting of the special group in late 1997. There is n(l
document on the global situation. Article 44(a) of the WHO Constitution states: 'The Health Assembly shall, from time to time, define the geographical areas in which it is desirable to establish a regional organization." The Constitution says nothing of the considerations on which the Health Assembly must base its delineation of those geographical areas.
WPRlRC4819 page 8
The First World Health Assembly adopted resolution WHAI.72 delineating the geographical areas for the six regional offices. There are no fixed rules regarding countries changing regions. From past resolutions on assignment and transfer to regions adopted by the World Health Assembly, it can be seen that, in every case, the.determining factor seems to have been the wish expressed by the Member State, as stated in the preambles of those resolutions: Government...". As a result of suggestions raised at the Forty-eighth World Health Assembly and the ninety-sixth session of the Executive Board, the question of reassignment of Member States to regions was submitted to each of the regional committees during their 1995 sessions. The Eastern Mediterranean and South-East Asia Regions have expressed the view that prior consultation should be made with the Regional Committees of the regions concerned before any request for transfer is acted upon by the Health Assembly. The African and Western Pacific Regions favoured maintaining the status quo. The Western Pacific Region was delineated by the First World Health Assembly in 1948. This delineation included Indonesia, which was transferred to the South-East Asia Region by the Third World Health Assembly in ) 950. This Third World Health Assembly also approved the "Having considered the request from the
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establishment of a regional organization for the Western Pacific. The original membership of the Region was eight countries and the "Malay Peninsula". Since then, the membership has increased to 27 members and one associate member, with the admission of a number of newly independent states and the transfer of Mongolia from the South-East Asia Region in 1995 (WHA48.1). _
2.6
Representation of regions in the Executive Board and other bodies - is the current balance fair? For many years, the number of countries of the Western Pacific Region entitled to designat.!
a person to serve on the Executive Board was three, the minimum level. Taking into consideration the fact that the Western Pacific Region has the largest population of any WHO region, in 1981 the thirty-second session of the Regional Committee recommended to the Executive Board and the World Health Assembly that "consideration be given to devising a means of increasing the number of Members from the Western Pacific Region entitled to designate a member of the Board" (WPRlRC32.R7) In 1984, the thirty-fifth session of the Regional Committee made a specific
WPRJRC48/9
page 9
recommendation to the Executive Board and World Health Assembly that the number of members from the Region be increased from three to four (WPRlRC35.RIO). In 1986, the Thirty-ninth World Health Assembly adopted an amendment to the Constitution to this effect (WHA39.6). This had been ratified by two-thirds of Member States by 1994, and a fourth country from the Western Pacific designated a person to serve on the Executive Board in 1995. The current representation of regions in the Executive Board is outlined In
EB Constitution/51S (Annex 8). The current distribution of seats is shown in the following table:
Region Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Total
Number of Member States 46 35
Number of seats 7
6 3 7 5 4 32
10 51
22 27 191
Following a recommendation from the Regional Committee for Europe, the ninety-sixth session of the Executive Board in resolution EB96.RI requested that the Director-General prepare,
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for consideration by the Forty-ninth World Health Assembly, draft amendments to the Constitution increasing the Board's membership from 32 to 33, which would enable an additional Member from the European Region to designate a member of the Board. In September 1995, pursuant to resolution WPRlRC46.R 19, the Government of Cook Islands sent a request to the Director-General proposing amendments to Articles 24 and 25 of the Constitution which would increase the Board's membership from 32 to 34 and allow the Western Pacific Region an additional seat. The two proposals were discussed at the Forty-ninth World Health Assembly, where the majority of the delegates voted to defer the issue uatil there was a constitutional review.
2_7
Terms of office of the Regional Directors, qualifications and method of selection Article 52 of the WHO Constitution provides that the Regional Director shall be "appointed
by the Board in agreement with the regional committee".
The current practice is for regional
WPRlRC48/9 page 10
committees to select one candidate and present the name of that candidate to the Executive Board. The term of office is generally five years (except for the Regional Office for the Americas which is four years to maintain conformity with PAHO), and is renewable without limit of terms. The
qualifications for the position are not specifically laid out, except for the Regional Director for the European Region (see Annex 9). One of the recommendations of the EBWG on the WHO Response to Global Change was to consider options for the nomination and terms of office of the Director-General and Regional Directors, including the use of search committees. The forty-sixth session of the Regional
Committee considered the EBWG recommendations and recommended that no change be made to the current procedures of nomination and terms of office of the Regional Director for the Western Pacific Region. It also did not recommend the use of a search committee. The Executive Board, on the other hand, establ ished an ad hoc committee on the issue of nom ination and terms of office of the Director-General. The report of the group led to the adoption of: (I) criteria for the candidate _
nominated for the part of Director-General (EB97.R I 0); (2) modifications to the rules of procedure of the Executive Board to allow nominations from Member States as well as from Executive Board members, to provide for supporting documentation for each candidate and to establish a screening and interview process by the Executive Board, and (3) modifications to the rules of the World Health Assembly to limit the terms of office of the Director-General to five years and to specify that he or she will be eligible for reappointment once only (WHA49.7). The same World Health Assembly resolution noted that, as a general principle, it is not appropriate to apply such changes to an incumbent Director-General. A summary of discussions at the meetings of the special group on 3-4 April and 10 May 1997 is included in EBI00/4 (Annex I), paragraphs 13-16. The document presented to the 10 May 1997 meeting, EB/Constitution/4/4 (Annex 9) is also attached. One issue of note is the suggestion that Regional Committees should present a list of candidates for consideration by the Executive Board. This is not consistent with the process of selection of the Director-General. In the case of the Director-General, the Executive Board considers all appropriate nominees, and nominates one candidate only to the World Health Assembly.
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WPRlRC48/9 page 11
2.8
Milsion and functions of regional committees, frequency of regional committee meetings The WHO Constitution covers the structure and functions of the Regional Committees which
shall: " ... be composed of representatives of the Member States and Associate Members region concerned". (Article 47) ..... meet as often as necessary and shall determine the place of each meeting". (Article 48) '· ... adopt their own rules of procedure". (Article 49) Article 50 covers the functions of the Regional Committee: "(a) (b) (c) to formulate policies governing matters of an exclusively regional character; to supervise the activities of the regional office; to suggest to the regional office the calling of technical conferences and such additional work or investigation in health matters as in the opinion of the regional committee would promote the objective of the Organization within the Region; (d) In
the
to co-operate with the respective regional committees of the United Nations and with those of other specialized agencies and with other regional organizations having interests in common with the Organization; international
(e)
to tender advice, through the Director-General. to the Organization on international health matters which have wider than regional significance;
(f)
to recommend additional regional appropriations by the Governments of the respective regions if the proportion of the central budget of the Organization allotted to that region is insufficient for the carrying-out of the regional functions;
(g)
such other functions as may be delegated to the regional committee by the Health Assembly, the Board or the Director-Genera!'''
Document EB/Constitutionl516 (Annex 10) was prepared for the 9-11 July 1997 meeting of the special group. and indicates the constitutional functions of the Regional Committee.
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page 12
One of the most important functions of the Regional Committee for the Western Pacific has been the formulation of policy of a regional nature. Recent examples include eradication of
poliomyelitis, elimination of leprosy, the regional action plans on tobacco or health and New horizons ill health.
2.9
Relationship between regional and country offices and impact of this linkage on the work of the Organization The role of WHO country offices was reviewed extensively by a development team within
WHO in 1993 and 1994. The report of the Director-General on the work of the development team was made to the Executive Board at its ninety-sixth session in May 1995. The ninety-seventh session requested the Director-General to take further action on seven specific areas, including development of criteria for establishing WHO country offices. development of guidelines for operation of those offices. and procedures for the selection of WHO country representative. In the Regional Office, the criteria for establishment or disestablishment of WHO country offices and the use of alternative fonns of representation are currently under review. Selection of WHO Representatives is according to the recommendations of the Executive Board, namely consultation with countries and submission by the Regional Director of a shortlist to the Director-General for consideration. The Regional Committee and Executive Board have on several occasions reaffirmed the importance of the WHO country office as the first level of contact between Member States and the Organization. The role of the Regional Office in supplying policy, technical and administrative support to country offices is very important, in that it enables the size of the office to be kept down, while governments are still provided with a full range of services. This issue will be discussed at the meeting of the spec ial group later in 1997. There is no global document.
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WPRlRC48/9
page 13
ANNEX 1
EXECUTIVE BOARD 100th Session
•
World Health Organization Organisation mondiale de la Sante Provisional agenda item 5.3
EB100f4 15 May 1997
Review of the Constitution of the World Health Organization: progress report of the special group In pursuance of resolution EB99.R24, the Executive Board special group for the review ofthe Constitution met on 3 and 4 April and on 10 May 1997 to examine its future work programme and in particular questions relating to WHO regional arrangements within the framework of the existing Constitution. Participants in both meetings included delegates from Member States, who had all been invited by virtue of Rule 3 of the Rules of Procedure of the Executive Board. The special group drew up a list of points to be examined prior to submission of its report on recommendations for action to the 101st session of the Executive Board (January 1998) as requested in resolution EB99.R24. It also adopted a provisional programme of work for the current year. The group reached preliminary conclusions on three pOints and requested further information on these points to be considered before completing its report. The Board is invited to note the progress report.
1. The Executive Board, by resolution EB99.R24, decided to broaden the mandate of its special group for the review of the Constitution to cover, as a matter of priority. questions relating to WHO regional arrangements within the framework of the existing Constitution. 2. The special group met on 3 and 4 April and on 10 May 1997. In compliance with resolution EB99.R24. all Member States were invited to participate in the meeting by virtue of Rule 3 of the Rules of Procedure of the Executive Board. Reports of the two meetings are available on request. I
3. The special group agreed on a number of points that should be further examined. The Secretarial was requested to specify the documentation that could be provided with respect to each point. The points are as follows: ( I ) status and progress of reform in regional offices and headquarters with reference to the 47 recommendations of the Executive Board Working Group on the WHO Response to Global Change; (2) current practice in headquarters and regional offices for: budget drafting; priority-setting and implementation; personnel appointments; programme implementation; and impact of extrabudgetary resources on regional budgets and priorities (statement of problems, suggested solutions);
I
Documents EB'Constitutionl313 and EBIConstitution'4'5.
WPRlRC48/9 page 14 Annex 1
(3)
regular budget allocations to regions; current status of relationship between AMRO and PAHO;
(4)
(5) criteria for determining regions, assignment ot Member States to regions and location of regional offices (consideration of the way in which the WHO regional structure is working with the United Nations system to deal with challgt.~ sinc., 1949); (6) representation of regions in the Executive Board and other bodies - is the current balance fair?
(7) term of office of Regional Directors (should there be a two-term limit as for the Director-General?); qualifications and method of selection; (8) mission and functions of regional committees; frequency of regional committee meetings;
(9) relationship between regional and country offices and impact of this linkage on the work of the Organization.
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4. The group adopted a provisional programme of work for the current ye"T, as follows (documentation referred to in paragraph 3 is indicated): May 1997 Pending the decision of the Health Assembly (General Comminee) a meeting to discuss WHO regional arrangements; documentation 10 be prepared WIth respect to points (3), (4) and (7). A meeting to discuss WHO regional arrangements within the framework of the existing Constitution and the original mandate of the special group; documentation to be prepared with respect to points (I). (2). (6), (8) and (9). A three-day meeting will be held to discuss WHO regional arrangements within the framework of the existing Constitution (one day) and the original mandate of the special group (two days); documentation to be prepared with respect to point (5).
9-11 (tentative) July 1997
Autumn 1997
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5. At its meeting on 10 May the special group concentrated on those points for which documentation was available, namely points (3), (4) and (7).
Point (3) Regular budget allocations to regions 6. A number of participants pointed out that there were imbalances among regions in the current distribution of regular budget resources to countries. They felt that resources should be distributed in an equitable manner, commensurate with the tasks to be undertaken, and directed especially to those countries that were not meeting the health-for-all targets. Some participants considered that allocations should be related to regional contributions, whereas others rejected that suggestion. 7. It was suggested that allocations to regions had to be made according to clearly defined criteria. Current criteria needed to be reassessed, taking into account countries' changing health needs and absorptive capacity. as well as the historical basis for resource distribution. The outcome should be objective, consistent, yet flexible criteria, or rather, guidelines. It was mentioned that factors to be taken into account should include health needs,
WPRlRC48/9 page 15
Annex 1
population, percentage of GDP devoted to health, specific health indicators, and number of countries. The financial implications of the application of different criteria should be provided to the special group. 8. Some participants said that the guidelines should be monitored once they were in operation to ensure that funds were being spent at country level, were being used efficiently, and that the cost of their administration was kept to a minimum. It was agreed by the special group that at its fifth meeting technical staff would present an overview of the subject of a health development index. Key points on this were the choice and weighting of indicators. That meeting would also examine the possibility of creating a task force to draw up a formula for allocation of regular budget funds to the regions. 9. It was also important to know at what level funds were expended, as allocations might be held at one level and spent at another. A breakdown of where funds were allocated and where they were spent would be provided for the ne);t meeting.
Point (4} Current status of relationship between WHO and PAHO 10. Many participants, especially those from the Region of the Americas. stressed the success of WHO/PAHO in meeting health needs. This gave rise to the suggestion that WHO/PAHO might serve as a model that could to some extent be replicated in other regions. However. WHO and PAHO had separate budgets. PAHO was financed by the countries of the Region, the largest contributor covering some 60% of its budget. The same contributor assured around 25% of the WHO budget. It was suggested that the level of funding might be partly responsible forthe success of WHO/PAHO, and might limit the potential applicability of the WHO/PAHO model in other regions. II. A number of speakers said that, from the point of view of transparency of accounting, clearly there could be no valid comparison between the Americas and other WHO regions unless the PAHO budget was taken into account along with the AMRO budget. Information on the PAHO budget, being in the public domain, was readily available on request. WHO documentation should therefore include information from PAHO in order to. present a comprehensive financial picture of AMRO/PAHO. comparable to information from other regions. 12. It was observed that integration between the two organizations had not proceeded to the extent that WHO and PAHO constituted a single entity. Nevertheless, it was underlined that WHO and PAHO were to a large extent functionally integrated. From a legal point of view, although it appeared that the drafters of the Constitution envisaged an eventual legal integration. of the two organizations, another v iew was expressed that integration did not necessarily mean assimilation. In any event, it was observed that the current relationship between WHO and PAHO was not incompatible with the precise terms of Article 54 of the Constitution. It was agreed that these issues should be kept under consideration in preparing the special group's final report to the Board.
Point (7} Term of office of Regional Directors; qualifications and method of selection 13. Most participants favoured a five-year term offic!! for Regional Directors, renewable once. with several indicating that such new conditions should not be applicable to the present incumbents. That would bring the term of office and renewability of contract of the Regional Directors into line with that of the Director-General. 14. Some participants expressed support for the criteria adopted by the Regional Committee for Europe. with some modifications. 15. Some participants mentioned the need for transparency in the selection process. which should be based on merit only. It was suggested that the Board could contrihute to transparency and equity in the regional
WPRlRC4819 page 16 Annex 1
selection process by setting criteria for selection and examining the qualifications of candidates, for which purpose adequate information should be provided. In this respect, it was suggested that candidates should submit written statement~ on their vision of the priorities for the region over the next five years and the objectives they wished to achieve. It was also mentioned that the regional committees could propose two or three candidates, leaving the choice to the Board. Some others said that the views of the Director-General should also be taken into account, and. the selection process should be more democratic and less bureaucratic. 16. On the other hand, there was also support for the current method of selection. Several participants stressed the importance of decentralizing authority to the regions and of enabling Member States, through the regional committees, to select the Regional Director with whom they would have to work. They said it was more suitable for the Regional Directors to be selected by Member States than by members of the Board, who acted in a personal capacity. Others recognized the need for unity in the Organization and therefore the Board's role in the selection and appointment of Regional Directors.
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ACTION BY THE EXECUTIVE BOARD 17. The Board is invited to note the progress report.
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WPRlRC48/9 page 17
ANNEX 2
World Health Organization Organisation mondiale de la Sante EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO
EB/Constitution/5/9 17 July 1997
Review of the Constitution of the World Health Organization Report of the fifth meeting of the Executive Board special group
9-11 July 1997
The Executive Board special group for the review of the Constitution met from 9 to 11 July to continue its examination of items relating to WHO regional arrangements within the framework of the Constitution and its review of the Constitution. Participants included delegates from Member States, which had all been invited by virtue of Rule 3 of the Rules of Procedure of the Executive Board. The group examined in detail five of the agenda items concerning regional arrangements and the two items related to the review of the Constitution. The group would conclude its work on the remaining items at its sixth meeting, scheduled for 5 to 7 November 1997.
I. The Executive Board special group for the review of the Constitution met from 9 to II July 1997 to examine items concerning WHO regional arrangements within the framework of the Constitution and to continue its review of the Constitution. In compliance with resolution EB99.R24, all Member States were invited to participate in the discussions on regional arrangements by virtue of Rule 3 of the Rules of Procedure of the Executive Board.
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Annex 2
Item 2. 2.
Report on progress of work of the special group
The Chairman presented a report on progress of work of the special group.
Item 3. Review of items concerning WHO regional arrangements within the framework of the Constitution 3. The third meeting of the special group (3 and 4 April 1997) had identified nine points relating to regional arrangements to be examined at future meetings.} Agenda subitems 3.4 and 3.7 had been fully discussed by the group at its fourth meeting (10 May 1997)2 Subitems 3.5 and 3.9 would be considered by the group at its sixth meeting in November 1997, when documentation would be available. At its fifth meeting, therefore, the group focused its attention on subitems 3.1,3.2,3.3, 3.6 and 3.8.
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Subitem 3.1. Status and progress of reform in regional offices and at headquarters with reference to the 47 recommendations made by the Executive Board Working Group on the WHO Response to Global Change (Document EB/Constitution/5/2) 4. It was pointed out by some speakers that although implementation of reforms, as an ongoing process, had progressed substantially at global level, progress at the regional level had been uneven and needed to be carefully monitored by regional committees on a region-by-region basis. The inherent decentralization of WHO's structure was considered an asset. but an effort was needed to preserve the unity of the Organization. The first module of the new management information system would soon be operational. and it was thought that this would greatly facilitate both the delegation of authority and feedback from regions and countries.
Subitem 3.2. Current practice at headquarters and in regional offices for: budget drafting; priority-setting and implementation; personnel appointments; programme implementation; and impact of extrabudgetary funds on regional budgets and priorities (Document EB/Constitution/5/3) 5. Participants paid considerable attention to the question of modernizing the budget drafting process. It was suggested by some speakers that regional committees and the Executive Board could be allowed to play a more formal role in that process, perhaps by amending Article 55 of the Constitution, under which the Director-General was responsible for preparation and submission of budget estimates. Such reforms would be consistent with current management thinking on effective decentralized participation in decision-making. Moreover, the possibility was raised by one member of empowering Regional Directors to redistribute up to 10% of the regional resources at their disposal in response to changing local needs, although overall control worldwide would have also to be ensured. In the interests of transparency, detailed accounts of expenditure and outcomes in each region should be produced.
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I 2
See document EB!Constitution!3!3. See document EB/Constitution/415.
WPR/RC48/9 page 19 Annex 2
6. The process whereby priorities fixed by governing bodies and contained in the Ninth General Programme of Work were pursued at global, regional and country levels was clarified, as was the use made of country priorities. Insofar as was possible, the same priorities were applied to extrabudgetary resources, although several participants highlighted the risk of programmes becoming donor driven.'
Subitem 3.3. Regular EB/Constitution/5/4)
budget
allocations
to
regions
(Document
7. There was general agreement that the current regular budget allocations to the regions were based on outdated historical precedents, and that more objective criteria, based on needs at country level, were required if limited resources were to be used effectively and more equitably. There was broad support for the use of a health index for this specific purpose, or of a modified version of existing indices, such as VNDP's Human Development Index, to help in determining budget allocations. However, some participants warned against over-reliance on crude and unreliable mechanisms that were open to abuse and could overlook some of the most important determinants of good health, such as secure employment, decent housing and nutritional security. Despite these reservations, most participants were confident that the use of an index, based on suitably weighted and readily available indicators at country level could assist in determining more equitable budget allocations. However, it would need to be flexible and dynamic enough to respond quickly to changing health needs in countries. 8. It was decided to request the Secretariat to set up a group to draw up a proposal, in consultation with regional offices, for such an index. It would preferably be based on existing indices and modified so as to provide an adequate, transparent and widely acceptable mechanism to serve the exclusive purpose of allocating funds to the WHO regions; a member of the special group could attend meetings of the Secretariat group. The proposed index should be available for consideration by the special group at its sixth meeting in November 1997, together with projections showing its impact on regular budget allocations to the regions.
Subitem 3.6. Representation of the regions in the Executive Board and other bodies (Document EB/Constitution/5/5) 9. Noting that proportionate representation of Member States on the Executive Board had declined, participants made two suggestions that would help to assure a fairer representation of regions on the Board. The first was to add three seats to the Board, one for each of the regions of Africa, Europe and the Western Pacific, which were currently under-represented if the formula based on number of members per region was used. It was noted that this proposal left unresolved some problems of under- and over-representation. Conversely, wi·.h a view to improving efficiency and to effecting savings, the number of seats could be reduced to the original 18. That solution, however, would reduce the democratization of the decision-making process: fewer members would be representing larger bodies of population; smaller countries would risk having less opportunity to designate a person to serve on the Board, and the matter of semipermanent representation would become more acute. It was noted that neither proposal fully addressed the issue of population size. 10. It was agreed that the matter would be considered further so that the special group could make a satisfactory recommendation to the Executive Board in its final report.
WPRlRC48/9 page 20
Annex 2 II. It was noted that the matter of semipermanent representation on the Board should be decided on in the regions, and should be drawn to attention of the regional committees. It was pointed out, however, that regional committees were not formally responsible for deciding on the choice of Member States entitled to designate a member of the Board: that responsibility lay with the Health Assembly.
Subitem 3.B. Mission and functions of regional committees; frequency of regional committee sessions (Document EB/Constitution/5/6) 12. Several participants considered that biennial sessions of the regional committees would be sufficient to deal with the matters they handled. Halving the number of sessions would produce considerable savings that could be channelled to country activities. On the other hand, the coordination of country activities was becoming more important, and the need for contact between ministers of health was increasing. Thus, other participants felt that annual sessions were necessary for ministers of health to share experience and to become familiar with the situation elsewhere in the region, and to ensure visibility at the regional level. 13. Several suggestions were made to reconcile those positions. For example, subregional meetings could be held annually to ensure coordination, whereas the regional committee could meet biennially. Or, in nonbudget years, the regional committee sessions could be longer, in order to prepare the following programme budget proposals, and in budget years, the committees could meet in Geneva before the Health Assembly. However, that suggestion was not considered practical, and the majority of participants favoured maintaining the current frequency of sessions. None the less, sessions could be shorter and better prepared, and could be improved by placing a shorter time-limit on speakers. 14. Ultimately. it ",as for the regions to decide on the frequency of their committee sessions, which should be "as often as necessary", in accordance with Article 48.
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Item 4.
Review of the Constitution Subitem 4.1. Mission and functions: impact of the draft health-for-all policy for the twenty-first century (Document EB99/14, recommendation 1) (Document EB/Constitution/5/7)
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15. It was agreed that any amendments to the Constitution should be consistent with major policy documents such as the draft health-for-all policy for the twenty-first century. Several members of the special group felt that it was important not to lose sight of WHO's fundamental role as a globai leader in the formulation of health policies. Reservations were expressed about the suggestion that WHO should monitor threats to human rights as well as health;3 however, it was pointed out that the same paragraph emphasized that the Organization's main focus was to be on the health consequences of human rights violations. WHO should continue to fulfil those functions for which it was uniquely qualified, while cooperating closely with other international organizations and treaty bodies whose work involved the health sector. There were calls for the Organization to concentrate on positive action that responded to the emerging health needs of the next century and to trends such as globalization and trade that could have an impact on people's health.
J Document EB/Constitution/517, paragraph 100. This document is an extract ofa draft of the health-forall policy for the twenty· first century.
WPR/RC48/9 page 21 Annex 2
16. Members noted that it had already been agreed that if Article 2 of the Constitution was to be amended, the functions of WHO should be grouped generically and should be defined in terms of general principles rather than specific activities. There was considerable discussion on ways to amend Article 2 that would retlect the functions of WHO in a world that was much changed since the article had been drafted. Suggestions were made for additions and deletions, and for replacing some outdated termi.nology.
Additions 17. The following items were suggested for inclusion: primary health care noncommunicable chronic diseases health care for the elderly violence exclusion advocacy and health promotion equity environmental health issues new technological developments affecting the medical sector prevention rehabi \itation health education for children and adolescents (possibly the most cost-effective investment in health) • equitable management of human resources in health greater stress on the leadership function of WHO. I. Some suggestions for specific clauses were: (g) to add "or control", as it was not always possible to eradicate diseases; and to be more specific about "other diseases" (h) to include non-accidental injuries, work-related injuries and occupational diseases (i) to include essential public health functions. • • • • • • • • • • • •
2. It was suggested that pharmaceuticals should be dealt with in a separate paragraph, and that there should be mention of health research into new areas such as genetic engineering and reproductive health, and of the applications of new information technology to the health sector. 3. Several members warned against introducing a proliferation of detail, which might reduce the effectiveness of classifying the functions in generic groupings.
Deletions 4. It was suggested that the reference to "trust territories" could be omitted from 2(e), and one member thought that "in emergencies" could be deleted from 2(d). Another member thought that 2(c}, (e), (g) and (i) were unnecessarily detailed.
WPR/RC4819 page 22 Annex 2
Terminology 5. The following specific suggestions were made: (c) (d) (i) "strengthening health services" could be replaced by "supporting national programmes" "technical assistance" should be replaced by "technical cooperation" "environmental hygiene" should be replaced by "environmental health".
6. It was agreed that the Secretariat, assisted by the Chairman, should produce a draft of the article revised along the lines suggested in time for members of the special group to study it carefully before the sixth meeting in November 1997.
Subitem 4.2. Analysis of constitutional provIsions identified as possibly needing further examination (Document EB99/14, recommendation 4) (Document EB/Constitution/5/8) 7. Preamble: The definition of health should be a dynamic one (as reflected in the health-for-all policy) and should include spiritual well-being. 8. Article 7: It was noted that the Health Assembly determined the conditions operating under Article 7. The more extensive sanctions listed under paragraph 6(a) to (d) of document EB/Constitution/5/8 (see Annex 4) would probably require an amendment to the Constitution, whereas the Health Assembly could certainly decide on application of the sanction listed under paragraph 6( e). 9. Members of the special group unanimously agreed that sanctions should not include suspension of services to countries in arrears. Some members suggested therefore tllat the relevant phrase in Article 7 of the Constitution could be deleted. The discussion did not, however, consider whether the possibility of suspension of services should apply to the other situations covered by Article 7. 10. A number of members maintained that Article 7 should not be amended to include the possibility of applying more extensive sanctions, which in any event would not improve the financial base of the Organization. The Health Assembly should decide upon specific measures on an individual basis. II. It was suggested that a distinction should be made between countries that were unable to pay their contributions, and those that were unwilling to do so. In the latter case stricter sanctions could be applied, such as those in 6(c) and (d). However, it was pointed out that it would be difficult to distinguish a Member's motives for nonpayment. 12. Other suggestions included the setting of a pe'·centage of arrears that had to be paid to avoid losing voting privileges, creation of a mechanism to payoff arrears in instalments, suspension of voting privileges at regional committee sessions, and a more gradual application of sanctions. Some members favoured use of the sanction in paragraph 6( e), unless nonpayment was a result of econom ic conditions. 13. Provisions would be drafted on the basis of the discussion and submitted to the special group for consideration at its sixth meeting. 14. Article 11: It was noted that the minister of health was a political post, and that the incumbent did not need to be a health professional. It should be for Members to ensure that their delegation also
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WPRlRC48/9 page 23
Annex 2 comprised technical experts. Article II should be more flexible in order to reflect the multisectoral dimension of health. 15. It was suggested that the phrase "persons most qualified by their technical competence in the field of health" should be deleted. Some members suggested also deleting the phrase "representing the national·health administration of the Member", as the countries should decide whether they wished to send delegates from other sectors. Others felt that it should be retained, as a ministry of health could in any event delegate representation to another body. It was proposed that the last sentence of Article II should read, "These delegates should preferably represent the national health administration of the Member." 16. A proposal would be submitted to the special group for consideration at its sixth meeting. 17. Article 13: The frequency of Assemblies had already been discussed in relation to regional arrangements. Some members favoured biennial Assemblies, considering the savings that could be made, the fact that regional committees met annually, and the possibility of improved contact using modern telecommunications. 18. However, most members preferred an annual Assembly, considering it necessary for an effective exchange of views among policy-makers, and for ensuring WHO's visibility. Assemblies were now shorter, and therefore cheaper, more efficient and better focused. The length of speeches could be further reduced, and several countries could be represented by one speaker. A biennial Assembly would have to be longer, which would offset savings, as would an extended Board session, which might be necessary in non-Assembly years. 19. Article 18: Changes in the functions of the Health Assembly would depend on recommendations to be made on amendments to Article 2, discussed under subitem 4.1. 20. Article 19: Members agreed that the provision should be retained, as the possibility of adopting an international convention might arise in the future, perhaps as the result of a health summit. 21. Article 21: Some members considered that any new areas included in Article 21 should be clearly specified, so that Member States would be fully aware of the subject matter when the amendment was voted on in the Assembly. Others suggested that it could be couched in more general terms, either replacing subparagraphs (a) to (e), or adding a new subparagraph, in order to cover any future regulations in new areas. It was pointed out that such a general clause might not be accepted by Member States, which might prefer to limit the areas in which binding regulations could be adopted. It was felt none the less that such a clause should be submitted to the Assembly for its consideration. 22. It was agreed that a suitable clause would be drafted for consideration of the special group at its sixth meeting, and information was requested on specific new technologies and new health developments that might be covered by such a clause. 23. Article 24: Some members noted that the change of the term "person technically qualified in the field of health" to "representative" would only reflect reality, as Board members already presented their country's views. 24. However, most members of the group favoured retaining the text with no amendment. A change would mean that the Board would become a political body instead of one where individuals were free to express their personal views. Political representatives would have to report to their governments,
WPRlRC48/9 page 24
Annex 2 which would delay the work of the Board. It was sufficient for Member States to be represented in the Assembly. 25. Article 25: Since there was inevitably a settling-in period for new members of the Executive Board while they became familiar with its working procedures, it was suggested that the greater experience acquired by members during a four-year term of office would enhance the Board's efficiency. However, most members of the group considered that a slower turnover of membership would be a m~or disadvantage, even if it was to some extent compensated for by enlargement of the Board. It was also pointed out that not all matters dealt with by the Board fitted neatly into the same two-year cycle as the budget. Most members favoured keeping the three-year term of office and recommending that Member States should take advantage of existing practices to enable persons they might designate to serve on the Board to attl!lId sessions before taking up office. 26. One member suggested that if the current practice whereby permanent members of the Security Council sat on the Board on a semipermanent basis was abandoned, extension of the term of office to four years would not have a negative impact on the opportunity of Member States to designate persons to serve on the Board. 27. To some members, the semipermanent presence of permanent members of the Security Council on the Board did not appear to hinder its effective functioning, but to others it breached the principle of equitable participation and gave certain contributors undue influence over policy direction. It was noted that informal systems existing within the regional committees for preparing the candidatures of persons likely to be designated to serve on the Board worked well, and would no doubt adjust to new realities if the Security Council were to be expanded. It was agreed to request the Regional Directors to seek the views of the regional committees on the matter for consideration by the group at its sixth meeting. 28. Articles 44-45: It was noted that regional arrangements had already been discussed, and that any adjustments to them would not necessarily require constitutional change. 29. Article 55: It was generally agreed that it was not the role of the Board to revise the budget estimates. In the opinion of some members, no constitutional changes were necessary, as the moral authority of the Board already had an influence on overall policy goals and priority-setting. Others, however, wished to ensure that the Board's strategic view was fully taken imo account in the final drafting of the budget estimates, that is, after the Director-General had considered its suggestions. One way to give greater weight to the Board's recommendations, while respecting the constraints within which the Director-General had to work, would be to emphasize the Board's role in reviewing the budget estimates. This could be done by amending the second sentence of Article 55 to read: -
-
The Board shall consider, review and submit to the Health Assembly the budget estimates, together with allY recommendations the Board may deem advisable. [emphasis added] Some members felt that the French and Spanish versions of the text already reflected these ideas. It was decided that the special group would consider a formulation along these lines at its sixth meeting. 30. Article 73: Members agreed that Article 73 should not be amended. Changes to the Constitution had to be accepted at State level because they might have implications for areas other than WHO's core activities. 3 I. It was suggested that Articles 80-82 should be retained and that at a later stage the Constitution should be examined for any articles that need not appear in the Constitution as such.
WPRlRC48/9
pagelS ANNEX 3
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Organisation mondiale de la Sante Fifth meeting 9-11 July 1997 Provisional agenda item 3.1 EB/Constitution/5/2 26 June 1997
EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO
Status and progress of reform with reference to the recommendations made by the Executive Board Working Group on the WHO Response to Global Change
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In 1993 the Executive Board Working Group on the WHO Response to Global Change produced its report, containing 47 recommendations. In conformity with resolution EB92.R2, the Director-General made proposals for the implementation of the 47 recommendations; since 1993 almost all of these proposals have been implemented, with the exception of a few which are ongoing. All levels of the Organization have been involved in this reform process and many staff members have participated. Furthermore, the scope of the reforms, including budgetary reforms, has extended beyond the original recommendations. This document summarizes the implementation status of the 47 recommendations and their impact on the work of the Organization. It should be considered as a report on progress made by mid-1997. The reform process is ongoing within WHO and the Organization is continuously building on the measures taken in collaboration with its governing bodies.
IMPLEMENTATION OF THE 47 RECOMMENDATIONS OF THE EXECUTIVE BOARD WORKING GROUP ON THE WHO RESPONSE TO GLOBAL CHANGE AND THEIR IMPACT As at June 1997 IMPLEMENTATION STATLIS ANO GOVERNING BODY REFF.RENCF.S' Fully implemented. lhe World Health Report is now i,sued as an annual publication in response to recommendatio-,s 1 and 46. In two regions annual reports focu.s on specifi~ themes and the regional health status. In five regions (the Americas, South-East Asia, Europe, Eastem Mediterranean and Western Pacific) health conditions are evaluated periodically and published; the ulher region. Africa, is considering doing lhe same. Decision E893(6); resolutions EB95,R5, WHA48_ I 5; decision WHA50(8); resolution SEAlRC49IR,1 2. Analyse IIfId define for the yel1f 2000 the specific objectives &Ad operational targets, measured throqh precise indicators, and mobilize appropriate resources to ensure attainment. This should make full use of resoUrces and expertise in regiom and countries. To !be extent that targeU will not be met by the re- 2000, to propose alternative strategies mel pllBS for intensified health programmes, wilh budgetary resources required to attain miaiatum goals, objectives ..d targets for the year 200S, 2010 or as appropriate. The Director-General outlined a new global health policy and presented a draft to the Executive Board at its 100th session. The draft is being revised and will be reviewed by regional committees in 1997. Wide consultation with Member States, organizations of the United Nations system and nongovernmental organil.ations has ensured a sense of ownership of the new policy by those who will use it. WHO's new strategic budgeting process has been specifically based on identifying goals and targets and on describing Ihe measurable products to attain them expected of WHO during the biennium in question. This goes well beyond the year 2000 and involves a fundamental change in WHO's management culture. New goals are now being defined in the context of WHO's policy for health for all for the twenty-first century. Strategic orientations and programme priorities emanaling from the policy will improve the furnlUlalion of specific objectives and operational goals. Clear directions and well-defined targets for health development activities have been developed for adoption in May 1998. lbe strategic orienlations and programme priorities have resulted in new structures and consultations emphasizing the role of health promotiun and leading to a shift of resources to priority programmes. In the regions, meetings and task forces at the highest le_el have focused efforts on the new health-for-all policy. Appropriate strategies and goals are being developed to meet the needs of countries in special circumstances. These will be translated into strategic terms for the biennial programme budgets. -_.-
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IMPACT
I.
Make an annual assessment of world health status and needs, and recommend relevant WHO priorities for international health action to meet those needs. (See also recommendation 46.)
The annual a.ssessmcnt of the world health status is facilitated and has improved planning. prioritization and resource utilization. l1,e World /lealth Repo" is a WHO best-seller and widely used at cuuntry level.
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'According to summary in document WHA4711 9941REC/I , Annex 2. 'lncludinc rqional committee, Executive Board and Health Assembly resolutions and decisions.
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SUMMARY OF RECOMMENDATIONS' 4. Study the feasibility of organizing international workshops or other forums to develop consensus for any adjustments or new directions in the strategy for health for all; stress health promotion and disease prevention and their implications for extending lifespan or disability-free years (e.g. through individual and community responsibility). (See also recommendation 17.)
IMPLEMENTATION STATUS AND GOVERNING BODV REFERENCES' Regions have adopted a range of measllres. In A frica a medium-term policy framework for technical cooperation between Member States ha~ been developed and is being implemented. In the Americas, South-East Asia, Europe and Eastern Mediterranean, updated health-for-all targets have been prepared in full consultation with advisory bodies on health development, health research. health ministers and the regional committees and their standing committees. New regional policy documents, such as "New horizons in health" in the Western Pacific, have been issued. f)ecisian E893(7); resolution WIIA48.16
IMPACT
National policies, the WIIO Tenth General Programme of Work and strategic programme budgets will be prepared on the basis of the new health-for-all policy.
5.
Submit to the 1994 World Health Assembly a proposed resolution authorizing the Executive Board, in coordination with the Director-General, to establish a routine procedure for prior review of all resolutions proposed to the World Health Assembly that have potential impact on the objectives, policy and orientations of WHO, or that have implications in terms of staffing, costs, budgetary resources and/or administrative support. The Executive Board and the Director-General will ensure that resolutions proposed to the World Health Assembly are accompanied by the necessary background information, and that the text of the proposed resolutions includes provision for time limit, evaluation and reporting, as appropriate.
Since January 1994 the Director-General ensures that resolutions proposed to the Ilealth Assembly are accompanied by the necessary background information, and that the text of the proposed resolutions includes provision for time limit, evaluation and reporting, as appropriate. Technical resolutions are considered by the Board before submitting to the Health Assembly. In January 1998, the Programme Development Committee (PDC) will review reporting requirements contained in resolutions with a view to ending or revising reporting.
The number of resolutions from governing bodies has been reduced, and resolutions are more tailored to the work of the Organ ization. Momentum has been taken up by regional committees. In the European Region. the Standing Committee of the Regional Committee has taken on a role similar to that of the Board, facilitating the work of the secretariat and the Regional Committee. In the Eastern Mediterranean, the Regional Consultative Committee reviews selected subjects before submission to the Regional Committee and makes recommendations to facilitate its work. (See also recommendalion 6.) -.
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Resolution WHA47.14 ----_.
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SUMMARY OF RECOMMENDATIONS' 6.
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' Much shorter and more focused documentation has facilitated the discussions and conclusions of the Ilealth Assembly and the Board. Audiuvisual presentations arc given whenever feasible. Work is ongoing to review methods of work of the Health Assembly. As from the Forty-eighth World Health Assembly in May 1995, and on a trial basis, technical discussions were replaced by a limited number of technical briefings and by informal forums for dialogue. The Forty-eighth World Health Assembly approved a budgetary provision for a one-week Health Assembly in nonbudget years. In 1997 (a budget year) the Health Assembly and the Board were both held within a two-week. period.
IMPACT Discussions arc now better focused as all documentation for the Health Assembly and the Board indicates the expected outcome.
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Consider and submit to the Board in January 1994 further proposals for improvements in the method of work of the World Health Assembly, to focus discussions on major policy, strategy and programme issues, make better use of audiovisual methods, and realize further economies in the duration and cost orlbe Health Assembly.
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I From 1998 WHO will meet the cost of travel to the Health Assembly of one representative from the least developed countries only. Rnolutiou5 E894.Rl, WHA48.17, WHA50.1
n,e cost of convening the Ilcalth Assembly was reduced in the 1996-1997 biennium by shortening its duration. The savings thus generated allowed the convening of three meetings of the Executive Board special group for review of the Constitution. one meeting of the Administration, Budget and Finance Committee (ABFC) and two meetings of the Executive Board ad hoc working group on health systems ! development for the future. which were I unforeseen and hence not budgeted for. I Similar changes have been made at regIOnal ' level, th)ls freeing more funds for technical programme implementation. The session of the Regional Committee for Africa has been reduced to five days with consequent savings; a biennial option is being studieu. ·me Regional Committee for Europe considered convening biennially but decided not to do so. Changes in travel regulations will achieve savings of approximately USS 400 000 per biennium.
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SUMMARY OF RECOMMENDATIONS'
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' Fully implemented. A final section to this effect is systematically included in all Health Assembly and Board documents. The Executive Board at its ninety-third session approved a new presentation for documents which included a reduction in length, and clearer identification of the issues requiring advice, guidance and decisions by the Board. In order t~ shift resources from governing bodies to priority areas, an overall limit was set on the number of pages of documentation per session. All regions have proposed measures to focus discussions and to minimize the number of resolutions; four regions (Africa, the Americas, South-East Asia, Eastern Mediterranean) have shortened the duration of their regional committees and related meetings; one region has abolished written minutes of the regional committee and two have streamlined the report. Documents in Africa, the Americas, South-East Asia and Western Pacific are presented in anew, shorter format. In Africa, the implementation of resolutions is monitored annually and the results of monitoring are included as part of the Regional Director's report to the Regional Committee. Decision E893(9); resolutions EB99.R28, SEAlRC48JR 7
IMPACT
,
7.
Identify clearly in Executive Board documents, in an appropriate form, the issues that require the advice, guidance or decision of the Board, confirmed by vote when necessary. Ensure that Executive Board discussions genuinely focus on, and reach clear conclusions and decisions with respect to, all issues concerning health policy, technical, budgetary and financial aspects or other overall supervisory or advisory functions. Prepare summary records that are more succinct, with less reporting of various statements made during discussions, and more focus on conclusions and decisions reached, in addition to the resolutions and decisions formally adopted by the Executive Board.
Shorter more focused discussions have resulted in improved decision-making at lower cost to WHO, with consequent savings in time. The Fiftieth World Health Assembly in May 1997 adopted changes in its rules of procedure which will lead to efficiencies in the conduct of the work of the Assembly. The Region of the Americas ensures that its governing bodies arrive at clear-cut conclusions and decisions on topics relating to health policy, technical, budgetary or financial aspects.
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SUMMARY OF RECOMMENDATIONS' 10. Establish subgroups or committees to meet during, and as part of, the Executive Board sessions each year, to review and evaluate a number of specific programmes, giving attention to interrelated elements of programme policy, priority, targets, plans, budgets, and other available resources including technology. Past performance, outputs and expected outcomes would be evaluated. The temporary subgroups should recommend actions to be taken, including tradeoffs within available resources, and report back to the plenary Executive Board which alone can take the final decision.
IMPLEMENTATION STATUS AND GOVERNING OODY REFERENCES' Fully implemented. Executive Board subgroups were set up in January 1994, and undertook the first review and evaluation of programmes. After completing a full cycle of reviews in 1996, the Board, in January 1997, decided in budget years, to continue to review in depth a small number of selected programmes and, in nonbudget years, in conjunction with the review of the Director-General's financial report, to review an evaluation report covering the whole WHO programme in order to determine to what extent the programme budget had been implemented. Regions adapted this approach for use at their level. (See documents EB97//2 and EB99/3.)
IMPACT Criteria have been established and approved for the selection of programmes to be reviewed by PDC and the Board. Methods for the evaluation have been developed. Guidelines are being drawn up to evaluate implementation of the programme budget and its components, at various levels of the Organization. In all regions, the work of larger forums such as the regional committees has been considerably facilitated by the work of subgroups such as the Programme SubCommittee in Africa, the Consultative Committee for Programme Development and Management in South-East Asia, the Standing Committee of the Regional Committee in Europe, the Regional Consultative Committee in the Eastern Mediterranean, and the Sub-Committee of the Regional Committee on Programmes and Technical Cooperation in the Western Pacific. ----
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SUMMARY OF RECOMMENDATIONS'
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' Fully implemented. ABFC was set up in 1994.
IMPACT
II.
Use the subgroups mentioned above, or establish dedicated subgroups as appropriate, to advise the Executive Board on "cross-programme" issues such as administration and finance.
Prior work by ABFC and POC has guided debates at the Board. An evaluation of the work of the two committees is being carried out in 1997.
Resolution EB9J.RIJ; decisions EB94(5), EB96(5), E8%(JI); resolution WHA47.7 12. Reconsider the need for. and the terms of reference of. the Programme Development Committee of the Executive Board; consider changes in the timing of post-Assembly sessions of the Board, and the plan of work of the Programme Development Committee to better match the work of the Board and its subgroups. 13. Form a special ad hoc subcommittee of the Executive Board to consider options for nomination and terms of office of the DirectorGeneral and Regional Directors. including the use of sean:h committees, and report thereon to the Executive Board in January 1994. Fully implemented. PDC was set up in 1994 to replace the Executive Board Programme Committee. It meets immediately before the Board meeting in January each year.
(See document EBA BFCJ/2.) I
Resolution E893.RI3; decisions E894(3). E894(4); resolution WHA47.6; decisions E896(4). E896(II) The Board established an ad hoc group to consider options for nomination, including possible use of a search process, and the term of office of the Director-General. In the European Region criteria were adopted in 1989 for candidatures for Regional Director. Since 1989 a regional search group has identified and evaluated candidates. A twoterm maximum is likely to be recommended by the Regional Committee for Europe for consideration by the Board. The Executive Board special group for review of the Constitution discussed the method of election of Regional Directors. Regional committees will consider the topic in 1997. It will then be considered by the !.Ioard in January 1998. In the African Region. a special regional workin!; group made recommendations to the forty-seventh session of the Regional Committee on criteria and prucess lor selecting the Regional Directur. The term of office of the Director-General is five years, and he or she will be eligible for reappointment once only. A method for selection has been approved.
(See Jocl/ment EBV71 l/.) Resolutions WHA49.7, EM/H.C40/R4, EM/H.C42/R7; decision I':B95(1); resolutions EB97.H.IO. EB99.R24
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IMrLEMENTATION STATUS AND GOVERNING BODY REFERENCES· A small working group met under the direction of the Chainnan of the Board and reported to the Board in January 1994. The Board decided that in selecting the Chairman, it should give particular attention to qualifications, competence and cumulative experience. With regard to designation of Board members, it requested the Director-General to emphasize to Mem ber States entitled to designate a person to serve on the Board the need to designate persons who :1fe technically qualified in the field of health, recalling, in this respect, the provision of Article 24 of the WHO Constitution. The Board is regularly infonned of the involvement of its individual members in the work of WHO. In the European Region, nominations to committees and the Board are to be supported by a curriculum vitae. In both that Region and in the Western racific there is continuity between office bearers at the regional committee and other meetings of governing bodies. In the Eastern Mediterranean, Board members are invited to important regional activities and provided with a briefing. In the Western Pacific new Board members are given a more thorough briefing. Decision EB93( 12)
IMrACT
c.. 14. Establish a small working group to recommend how to: improve ways in which the Board members are designated; improve the selection procedures for the officers of the Board; and achieve more active involvement of all members throughout the year in the work of the Organization. Specifically, the working group should consider the possibility of deSignating a chainnan-elect from among the officers of the Board, one year in advance of fonnal election under Rule 12, and the continued involvement of the outgoing cbainnan the following year, to permit a team approach at each session of the Board. The working group should also consider ways and means to improve communication and .,.ucipltion among the Chainnan, Board members IJId the Director-Gencral throughout the year, and to keep all Board members informed of the involvement of individual Board members in the work of WHO. The Working Group should report to the Board by January 1994. Board members are visiting other regions and observing their regional committees more frequently. Improved communication has been maintained and will be pursued. Appropriately qualified representatives are selected and there is better continuity between various governing body representatives. Notwithstanding regional mechanisms for deciding infonnally on those Member States submitting their candidatures for election to be entitled to designate a person to serve on the Board, all Member States remain free to submit their candidatures in accordance with Health Assembly procedures. In accordance with Article 24 of the Constitution, the elected Member States designate, at their discretion, a person to serve on the Board.
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SUMMARY OF RECOMMENDATIONS' 15. Conduct from time to time surveys of Member States' opinions and perceptions of the relevance, functioning. efficiency and effectiveness of the work of WHO at all organizational levels.
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' The Executive Board, at its ninety-fifth session, recommended that the opinion of Member States on the work of WHO should be surveyed through the continuous consultation mechanisms set up in all regions and through mechanisms established for coordination and consultation with governing bodies. namely, POC and ABFC; and that other means should be found to survey from time to time the opinion of Member Stlltes on specific aspects of WHO's work. The consultation process to renew the health-for-all strategy included an assessment of Member States' and others' opinions and perceptions of WHO's functions, efficiency and effectiveness with a view to reviewing its mission. In the European, South-East Asia and Eastern Mediterranean regions, dialogue with national officials on concerns and priorities occurs at country-level meetings, joint programme review missions, meetings with health ministers, and the regional committee. Decision EB95(2)
IMPACT The idea of conducting surveys did not fmd wide support among Member States. Alternatives are being explored. Communication with Member States on WHO's management process has increased. especially on the relevance and priorities of WHO at regional and global level.
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16. Request the regional committees to study their own methods of work with a view to harmonizing their actions with the work of the regional office, other regions, the Executive Board and the World Health Assembly and report thereon to the Executive Board in January 1995.
The Board decided to review the method of work of regional committees in 1998 to 1999, recommending that Member States should include Board members in their delegations to regional committees. Each regional committee now includes an item on its agenda to correlate its work with that of the Board and the Health Assembly. In each region, the role of small groups or subcommittees of the regional committees has been expanded. This has facilitated the work of the regional committees and serves to harmonize the working agendas. Coordination will be further expanded from 1998, when the J)irector-General and Regional Directors will address the Board with a common core of talking points. Decision E895(2); resolutions SEAlRC47fR.5, WPRfRC46.Rll, WPRfRC47.RIO
Full involvement of regions ensures greater coordination on policy and programme matters.
(See also recommendation 10.)
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SUMMA RY OF RECOM MENDA TIONS' 17. Consider the establishment of a policy development team, utilizing cUlTent staff to orient the long-ten n vision, policy direction and programme priorities for the health sector and WHO. (See also recommendations 2. J and 4
IMPLEM ENTAT ION STATU S AND GOVER NING BODY REFER ENCES ' The Global Policy Council was established at the highest managem ent level of WHO to oversee policy, direction and programme priorities. A developm ent team on WHO policy and mission, compris ing staff from all levels of the Organi7.ation, was set up with the remit of reorienting longterm vision and policy direction. In response to resolution WHA48 .16 a unit was set up at global level to coordinate elaboration of the new global health policy, and critically to assess health sector priorities and the role of WHO. The African Region has started elaboration of a long-term regional health developm ent vision and policy. Decision EB93(7) ; resolutio n WHA48 .16
IMPAC T The draft new health-for-all policy was reviewed with great interest by the Board and by nongove rnmenta l organizations. The commen ts received will form the basis for a revised draft to be presented to regional committ ees in 1997.
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18. Strengthen UId develop, with the Regional
Directors, an improved policy planning and analysis capability/system to recomm end clear priorities for progI auDile objectives, targets and budgets. These priorities should be coordina ted at all levels of the Organiz ation and reported to the Executive Board (or the Program me Commit tee if it is retained) on an amual basis.
The Global Policy Council and the Manage ment Develop ment Commit tcc oversee policy planning and analysis, set objectives, targets and budgets and coordina te activities at all levels. The Board conducts program me reviews, reviews priorities for the stra1egic program me budgetin g process; and advises on priorities through PDC and ABFC. In the African, South-East Asia, European, Eastern Mediterranean and Western Pacific regions various mechani sms have been adopted to consult on policy directiun and program me priorities. These include internal managem ent bodies and high-level external consultations. Regional steering groups oversee and coordina te renewal of the healthfor-all policy. Decisions EB93(7), EB93(IO); resolutio n EB95.R 4; decision EB96(12 ); resolutio ns WHA47 .8, WHA4I .25
The managem ent system is more cost effective and better integrated. Commun ication on policy and managem ent matters has improved between levels of the Organization. In the European Region, the mechanisms ensure teamwor k among senior management, input into policy, program me and managem ent issues, and a channel for interaction between regional offices and such global structures as the Global Policy Council and the Management Develop ment Committee.
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SUMMARY OF RECOMMENDATIONS' 19.
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' The Global Policy Council and the Management Development Committee were set up in 1993. The management process for WHO has been reviewed and improved since 1993, in order to facilitate effective and efficient policy implementation at all levels, under the aegis of these two bodies Decision E893(1I) The worldwide WHO management information system is in development. The first function, the activity management system, became operational in November 1995, and is used to plan and manage activities to achieve designated objectives and targets throughout the Organization.
IMPACT
Propose IIld implement appropriate management IIld communication systems, particularly with the Regional Directors, to achieve the designated objectives and targets according to the priorities identified. Such management and communications systems shOUld be served by the management information systems for effective and efficient policy implementation.
Exchange of information is faster IIld approaches to programme planning using plans of action have been standardized. I
20. Provide a detailed analysis of the current status, capability, compatibility, plans and programmes of existing management information systems throughout the Organization (headquarters, regional and country levels). The Director-General should develop alternate plans for a WHO worldwide system which could be implemented within variable time frames, e.g. within 3, 5 and/or 10 years. 21. Review the effectiveness of current WHO procedures and criteria utilized at headquarters, regional office and country levels for the development of appropriate staffing patterns and the selection and recruitment of staff. (See also recommendations 22, 39 and 40.) Review the practices of providing technical consultation for the Organization and identify changes needed in the provision and utilization of technical experts.
Decisions E893(II), [895(3), E896(3), [8%(12) Recommendations for a new personnel policy were presented to the Board in January 1997 and generally endorsed for implementation. A range of new procedures is being introduced in the African Region. In the South-East Asia and Easten! Mediterranean regions, the staffing pattern is kept under constant review, and there has been a restructuring of programmes to bring them into line with the classification of the Ninth General Programme of Work.
All regions participated in development of a federated system wh ich is operational at global level and is being gradually improved. It will become operational progressively in all regions. The country/ region module is being jointly developed by the regional offICes for the Americas and for the Western Pacific and is expected to be ready by June 1998. The Organization is coosidering more flexible employment contracts and other new personnel policy initiatives for performance appraisal, staff development and the role of managers. It has already established new and expanded partnerships with centres of excellence.
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(See document UIV717.) Resolutions t:1I97,RII, WJlA49,23, EII99,RIO, WIIASO.2 -~----~
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Review the current delegation of authority between headquarters and regional offices and introduce appropriate changes in the light of experience and .current needs, and report on progress to the Executive Board by January 1994.
A preliminary report was made to the Board in January 1994. Proposals for appropriate changes in delegation of authority are being proposed since the Board considered the development teams' reports on the role of WHO country offices, and WHO's personnel policy, in 1997. (See also recommendations 2. 3 and 4.)
Delegation of authority is pennanently under review and will be amended as appropriate to provide smoother and quicker programme delivery without loss of accountability.
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24. Include as part of the Executive Board's working qenda. on a regular basis, meetings with Regional Directors to review strategies and progress on key operational and management issues.
The Board agreed that Regional Directors' reports to the Board should focus on strategies and progress on key operational and management issues on a regular basis, and should group related issues on developments in the regions. In the European Region regular meetings are scheduled between the Regional Director, the Chairman of the Standing Committee of the Regional Committee and European Board members. Decision EB93(IO)
The approach to management reporting throughout the Organization is more cohesive, with emphasis on issues of concern or priority at the Board. It is being further improved by focusing on common themes in the oral presentations. Board members are well briefed on mat!t;rs of particular concern to their region.
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SUMMARY OF RECOMMENDATIONS' 25. Evaluate current and planned country health programmes and determine the profile of skills and qualifications required to select highly qualified WHO Representatives. 26. Develop appropriate procedures for ensuring career development of the WHO Representatives throush initial and periodic training and by rotation of WHO Representatives (between regions and headquarters) in the light of the Organization's current needs. 27. Direct the Regional Directors and the WHO Represeatatives to provide leadership in intenectoral coordination among the United Nations agencies IIJId between major donors, and report to the January 1994 session of the Executive Board on the results. 28. Review. update and standardize the delegations of authority, the country office administrativcl management and operating procedures, and the basic operating resoun:es for WHO Representatives' offices throughout the Organization and report to the January 1994 session of the Executive Board on the results. 29. Review the role of the WHO Representative and recommend appropriate measures to strengthen the intqration of the work of the WIIO Representative into the policy and strategy development of the Organization. In addition, the Director-General should take advantage of low-cost improvements in communication technologies, such as CD ROMs !lid integration with electronically keyed national libraries (of medicine and others). to improve acc:ess to infonnation for the WHO representative. (See also recommendation 25 ubove.)
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' The revised report of the development team on the role of WHO country offices. covering recommendations 25. 26. 27. 28. 29 and 30. was considered by the Board in January 1996. Subsequently. new personnel procedures were adopted for the selection of WHO Representatives. The new personnel policy provides sufficient tlexibility to meet the specific needs of regions while providing wider opportunities for staf· development and training. Rotation is being considered. Consistent efforts have been made to ensure that WHO Representatives become more efficient. with better communication facilities and access to technical information and support from regional offices. This is expected to enhance their standing with other organizations of the United Nations system and external support agencies. avoiding duplication of activities and maximizing the efficient and effective use of funds. (See documelll £897/5.)
IMPACT WHO has provided leadership in intersectoral coordination among organizations of the United Nations system and donors on numerous occasions. Enhancement of the staff development programme, with continuing education for personnel linked to PAHO, has been planned in the Region of the Americas.
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Decision EB97(13) WHO Representatives can use the WHO documentation module initiated and implemented at global level. It enables them to access the WHOLIS bibliographical database and to use a simple methodology for organizing their collection of WHO-generated publications and documents for rapid and easy retrieval of technical and policy infonnation. Internet technology is being expanded to WHO Representatives' offices. Regular meetings are held in the African. South-East Asia, Eastern Mediterranean and Western Pacific regions to ensure that WHO Representatives are fully involved in the policy and strategy development of the Organization. Dissemination of information on health matters and policy is faster. partly as a result of the installation of electronic networks. "1:1
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SUMMARY OF RECOMMENDATIONS' 30. Inquire 1IR0ng Member States their interest in having alternate forms of WHO representation within their countries. (See also recommenaolion
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' In addition to the report of the development team on the role of WHO country offices, the consultation on the renewal of the health-for-all policy may throw some new light to this issue. Consideration is being given to expanding the use of liaison offices, following the examples in the African, European and Western Pacific regions.
IMPACT Criteria for the establishment and disestablishment of WHO Representatives' offices are being drawn up during 1997. Country representation is more cost effective in certain circumstances. ,
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31. Ensure that the Organization be active in its response 10 the structural and operating reforms IUing place in the United Nations and its programmes. WHO should develop concept papers or action papers to facilitate the adoption of procedures, within the United Nations system, which further interagency cooperation and coUabontion in the re.olution of health and development problems.
The WHO Task Force on Health in Development was established in 1993 to identify issues that can bring health objectives to the forefront of current development strategies and economic policies. Policy and technical relationships have been enhanced with major organizations and bodies of the United Nations system. The Regional Office for Africa serves as the secretariat for the cosponsoring agencies of the health component of the United Nations System-wide Special Initiative on Africa. The Director-General and WHO staff actively participate in ACC, chaired by the Secretary-General of the United Nations, and its subsidiary organs, and in interagency task forces. The health-for-all policy for the twenty-first century will be reviewed at ACe.
Guidelines have been prepared and implemented on collaboration with the United Nations resident coordinator system. Collaboration between WHO and other organizations of the United Nations system is now given greater priority at regional and country levels. At regional level, activities in Africa are coordinated and planned, and achievements reviewed, through an interagency consultation for health development.
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IMPLEMENT ATION STATUS AND GOVERNING BODY REFERENCF.S' "Unified offices" have been superseded by "field offices of the United Nations Development System", under the leadership of the Resident Coordinator. Guidelines for common action at country level have been drawn to the attention of all WHO Representatives.
IMPACT
32. Engage in discussions with appropriate elements of United Nations leadership to ensure optimal use of United Nations "unified offices" with United Nations specialized agency coordinators (not only UNDP coordinators). The newly-designed system, under the overall coordination ofUNDP, could provide clear leadership of the "UN country-team" by the specialized United Nl1ions agencies in their II'eaS of expertise, e.g. WHO on health matters.
Wide dis=ination of the guidelines on collaboration with the United Nations resident coordinator system has facilitated greater coordination and more coherent system-wide collaboration. In all regions, activities of organizations of the United Nations system are increasingly coordinated through the process of drafting a Country Strategy Note.
The experience of UNAIDS will give interesting information on the functioning of country teams and will guide further implementation of this recommendation. The forty-third Regional Committee for Africa recommended that closer collaboration should be fostered among the various organizations to optimize the use of resources of the United Nations system as a whole.
33. Tae appropriate measures to present appropriate information and recommendations to the United Nations/donor agencies responsible for development projects to include disease surveillance, prevention, and control as an integral component of each development project, programme intervention or targeted service for specific geographicalll'eaS.
All activities with United Nations/donor agencies stress the importance of the health aspects of development, including dilCISC surveillance, prevention and control.
In the context of the new health-for-all policy, the regions are ensuring that health is considered in development projects, particularly those involving agriculture and dams. This has increased awareness of health concerns and, in some cases, facilitated fund-raising efforts. I
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SUMMARY OF RECOMMENDATIONS' 34. Engage in dialogue with the United Nations secretariat to study means for reducing differences in regions and operating procedures among United Nations agencies.
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' Operating procedures (e.g. standardization of accounting procedures) are under constant review in interagency bodies; questions relating to differences in regional structure are being looked at in the context of the review of the WHO Constitution. The Executive Board special group for review of the Constitution is studying the matter.
IMPACT The Board will consider the matter in January 1998.
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(See docume"t £897/9.) 35. Assign an Executive Board member to sit on the man....cnt committee of each major CX1nIbudgetary funded programme (generally consisting only of donors), to facilitate coordinatiOll and compatibility of policies, decisions IIId priorities with those of the World Health AssemblylExccutive Board. An analysis of the membership of management committees of the major extrabudgetary funded programmes that held meetings in 1994 showed that one or more Board members, or their alternates, were present. The Board is currently reviewing policies for extrabudgetary funding and WHO's priorities. ~dsion
Measures are implemented de facto by programmes.
EB95(2) The matter is being kept under review.
36. Seck approval from the World Health Assembly to have the authority to assess appropriate overbead rates, up to 35% for extrabudgelary programmes. 37. Establish a pledging system 10 secure additional funds for priority regular budget programmes including those dealing with normative functions.
The Board considered this issue in January 1994. It was agreed that for the time being, the standard programme support cost rate of 13% should be maintained. The Board considered the matter in May 1997. Informal consultations with the donor community continue. The concept of undesignated pledges is slow to find support, although designa:ed pledges for certain priority programmes are continuing.
The matter is being kept under review. Regular contact with donors is maintained, usually on an annual basis.
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SUMMARY OF RECOMMENDATIONS' 38. Noting that the regional and country allocations are based mainly on allocations for previous years, eslablish budgeting systems/mechanisms to derive the greatest benefit from the process of budgeting by objectives/targets and to facilitate the achievement of priorities and to provide for periodic adjustments of these priorities in accordance with changing health needs.
IMPLEMENTATION STATlJS ANI> GOVERNING BODY REFERENCES' The Management Development Committee and the Global Policy Council are keeping the issue under review; a wide range of efficiency measures has been introduced at all levels to contain costs. In 1998 the Health Assembly will consider methods for evaluating the 1996-1997 programme budget in programmatic terms. The African and South-East Asia regions proposed criteria and formulae for the determination of country budget allocations. The Executive Board special group for review of the Constitution is studying the matter further and will report to the Board in January 1998. At regional and country levels, programme planning and evaluation are undertaken jointly with WHO Representatives to ensure an appropriate emphasis on priority programmes and their costlbenefil. (See document E897/8.) Resolutions AFRlRC451R2, WHA48.26
IMPACT The process of programme budgeting has been reoriented to increase transparency, to match country priorities with financial resources, to lay more emphasis on product delivery, and to evaluate the outcome in programme and financial terms. In view of regular budget funding constraints, greater efforts have been made to mobilize extrabudgetary resources.
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39. Improve the personne I procedures to ensure: technical competence as the primary basis for the selection and recruitment of long- and short-term staff; the design and implementation of appropriate career development and continuing education programmes; and the development of a staff rotation system between headquarters and regions. The Director-General should assess the impact of the geographic distribution of posts on the quality of staff. (See rec()mmendaliollS 21 and 25 above.)
The report of the development team on WllO's personnel policy was considered by the Board in January 1996. The new personnel policy was presented in January 19'17. Regular reports are made to the governing bodies on geographical distribution of i'osts and recruitment by gender.
Staff in the professional category at WHO now come from 141 countries; the percentage of women employed in that category is 27%.
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IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' The report of the development team on WHO's personnel policy called on the Board to reaffirm the independence of WHO with regard to the recruitment and careers of staff members.
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Draw to the attention of the World Health Assembly the impact on the quality of staff and on the ability of the Organization to perform its mandated functions due to politically motivated appointments made by the Secretariat as a result of pressures by Member States. (See recommendation 21 above.)
Almost all professional posts are advertised, and recruitment follows official selection procedures.
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Resolutions EB97.RlI, WHA49.2l 41. With a view 10 ensuring the best possible use of all resources available to the health sector, review and update existing guidelines and procedures related to WHO collaborating centres and their participation in research initiatives for the Organization. In particular, the review should focus on ways to facilitate, in a cumulative manner, the coordination of research efforts by the worldwide network of collaborating centres to achieve health for all targets and other priority health initiatives. (See also recommendation 43.) The development team on WHO programme development and management recommended that the period of designation for centres should be flexible; other centres of excellence should be recognized; a beller regional balance between centres should be established; and the complexity of management of collaborating centres should be reduced. After discussion at the Board in May 1995, work accelerated on a research information database within the management infomlation system to facilitate the coordination of research efforts and to simplify instructions relating to identification, selection and redesignation of WHO collaborating centres. The African and South-East Asia regions conducted a review of collaborating centres to ensure that they were optimally used. In the Western Pacific Region, the value of collaborating centres is reviewed at the time of redesignation. Document EM/RC4IflS-E, pp. 22-24; decision EB96(12); resolution WHASO.2 42. Require every programme to include a budgetary item for conducting basic science or operational research activities as part of its institutional development process to achieve technical excellence. -. .-
More effective and efficient use of the technical capacity of partners and wider diversification of partners. The research information database of the management information system is already operational and being upgraded.
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SUMMARY OF RECOMMENDATIONS' 43. Establish a small group to determine, with the Director-General, ways to expand the use of the [collaborating) centres. A special focus should be given to the implementation of priority health research and of primary health carelhealth-for-all initiatives. (See also recommendation 41.)
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' Fully implemented as part of the work of the development team on WHO programme development and management. Selected collaborating centres will also playa key role in framing the renewed health-for-all policy. Their role is also being heightened as part of the budgetary reform process. A situation analysis concerning the existing networks of WHO collaborating centres was requested by the Fiftieth World Health Assembly and will be reported to the Board in January 1998. In Africa and the Western Pacific a regional five-year research strategy is being drawn up and, when implemented, will make optimal use of collaborating centres. Resolution WHASO.2
IMPACT Concerted elIorts have been made to improve the use of WHO collaborating centres and to expand programme activities by using a wider range of partnerships.
44. Develop annual plans with each collaborating centre to facilitate the implementation of appropriate international health work, and the evaluation of the capability of the centre to maintain its special designation. 45. Develop WHO's capability to make greater use of modern communication techniques and methods, partiCUlarly mass media tools, to introduce health promotion and disease prevention concepts.
Prior to designation, WHO collaborating centres prepare a plan of work for a four·year period; from 1996 onwards, their annual plans of action have been closely linked to the annual WHO plans of action. The report of the development team on the WHO communications and public relations policy was endorsed by the Board in January 1995. Progress has been made at global level in developing a WHO home page on the World Wide Web and making available press releases on current and important health topics. At regional level dilIerent types of; management teams play an important role, infer alia in developing use of Intranet and Internet. Decision ED95( I 0)
Activities are more focused and lead to defmed products without duplication of elIort.
In spite of financial constraints, WHO public relations activities are making better use of modern communication methods. Greater visibility of WHO programmes has been achieved and advice provided in relation to specialized and general programmes.
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SUMMARY OF RECOMMENDATIONS' 46. Issue an annual publication which reports on the
IMPLEMENTATION STATUS AND GOVERNING BODY REFERENCES' Fully implemented. Regions are also starting to issue annual reports on the regional health situation.
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WHO's programme activities will be linked to fmdings from annual global assessments. (See recommendation I.)
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Fully implemented. PDC has the remit of following the refonn process, and assisting in programme development in WHO. Resolution EB93.RI3
Advice and oversight of the Organization's programmes is transparent, objective and independent.
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SUMMARY OF REGIONAL VIEWS AND STATUS OF IMPLEMENT ATION OF THE EXECUTIVE BOARD ACTIONS EXECUTIVE BOARD WORKING GROUP REPORT ON THE WHO RESPONSE TO GLOBAL CHANGE
Report section 4.1 Mission of WHO
Executive Board action (I) Request the O-G to make an annual assessment of the world health status and needs, and recommend relevant WHO priorities for international health action to meet those needs.
Regional views and status of implementation A decision was taken to make an annual assessment of the world health status. This is linked to EB action (46) and progress report document EB9311 I Add.1. The proposal was endorsed by EB93. This is likely to require substantial regional staff resources. Regarding priorities for international health action, regional priorities may not always match global priorities; particular attention should be paid to harmonization.
The World Health Report 1995 - Bridging the Gaps was presented to the World Health Assembly in May 1995, and the World Health Report 1996, focusing on Communicable Diseases was presented in 1996. The 1997 World Health Noncommunicable Diseases. (2) Request the O-G to analyse and define year 2000 specific objectives and operational targets, measured by precise indicators, and mobilize resources to ensure their attainment. Report will focus on
The Regional Committee, at its forty-fourth session, endorsed global and regional efforts to redefine the mission of WHO in realistic, outcome-orientated terms, and supported the idea of taking an objective look at the nature and extent of the Region's activities in the light of regional priorities. WHO should not promise more than it can deliver, and resources should be focused on regional priority issues. This will require a comprehensive review of all programmes, consistent with the established priorities. WPR is in the process of doing this already (e.g. environmental health and malaria), and has incorporated this approach in the 1996-1997 budget development process. To facilitate a more fundamental analysis of the situation, the
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Regional views and status of implementation Sub-Committee recommends that the RD prepare a paper reassessing the role of WHO in the Region for submission to the Regional Committee at its forty-fifth session. At the global level, this is shown in progress report document EB93/11 Add.2. The proposal of the D-G to set specific objectives and targets, particularly on the Ninth General Programme of Work concentrating on the;: solution of major health problems was endorsed by decision EB93(7}. Further reporting will be made to the ninety-fifth, ninety-sixth and ninety-seventh sessions of the EB (January and May 1995 and January 1996). The Regional Director presented New horizons in healtil to the Regional Committee in September 1994. The targets and objectives of the programmes under the 9th GPW were included in the budget for 1996-1997. This will be included in the review of the health-for-all strategy. The Sub-Committee recommended to the Regional Committee (at its forty-sixth session in September 1995) that the document New horizons in health should be a central influence in the Region's collaborative work in renewing the health-for-all strategy. This process should accommodate the full range of health needs of the Region through a wide-ranging consultative process. The 1998-1999 Programme Budget focuses further on New horizons in health. ::I ::I to ~
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At the WHO/HQ level, status under (2) above applies. At the regional level, major implications beyond those mentioned in (2) above, include identifying major milestones for 2005, 2010 and beyond if possible. This will be taken up in the review of the health-for-all strategy. The Regional Strategy paper will be reviewed by the forty-eighth session of the Regional Committee in September 1997.
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Report section
Executive Board action
Regional views and status of implementation
(4) Request the D-G to study the feasibility of organizing international workshops or other forums to develop consensus for changes in strategy for health for all; stress health promotion and disease prevention.
At the WHO/HQ level, status under (2) above applies. It is important that such meetings be well-prepared and designed to produce real consensus. All too often the consensus reached in such meetings is so broad as to be ineffective. Consensus also needs to be developed at regional and country levels to ensure coordination of programme efforts. The Sub-Committee recommends that such workshops also be conducted at regional/subregional level to facilitate feedback from Member States. This will be taken up in the review of the health-for all strategy (see 3 above).
4.2 Governing bodies 4.2.1 WHA 4.2.1.1 WHA resolutions
(5) To submit to the 47th WHA in 1994 a proposed Action at the WHO/HQ level was detailed in progress report resolution authorizing the EB to establish a routine document EB93/11 Add.3; the proposal to establish a routine procedure for prior review of all resolutions procedure for prior review of all resolutions to the WHA was proposed to the WHA that have potential impact on endorsed by resolution EB93.RI, submitted to the 47th WHA and the objectives, policy and orientations of WHO, or endorsed by resolution WHA47.14; implementation started in that have implications in terms of staffing, costs, January 1994. The Regional Committee, at its forty-fourth session, endorsed this EB action, noting that regional resolutions budgetary resources and/or administrative support. will include provision for time limit, evaluation, reporting and resource implications, as appropriate. Having a more detailed assessment of resource implications will be helpful to the Region in planning its own work. Inclusion of provision for time limit, evaluation and reporting, as appropriate, as an integral part of WHA resolutions will improve programme performance. However, meeting this requirement to respond to resolutions that come from the floor during WHA deliberations (e.g. budgetary reform, WHA46.35) may be a problem.
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(6) Request the D-G to submit to the Board in January 1994 further proposals for improvements in the method of work of the WHA, to focus discussions and realize further economies in the duration and cost of the Health Assembly.
Action at the WHO/HQ level was detailed in progress report document EB93111 Add.4, with follow-up due in two to four years. The Regional Committee, at its forty-fourth session, suggested shortening the duration of the WHA to one week in non-budget years and nine days in budget years. The work of WHA was further streamlined in 1997. The Sub-Committee noted the attempts being made at the WHA level, including the replacement of Technical Discussions by technical briefings. At the regional level, a significant contribution could be made by the Regional Committee representatives by improving the quality of their participation. This should also be done at the WHA level.
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EB decisions
(7) Request the Secretariat to identify clearly in EB documents the issues that require the advice, guidance or decision of the EB.
Action at the WHO/HQ level was detailed in progress report document EB93/1l Add.5; a new document format was introduced in January 1994 and approved by decision EB93(9). This also approved shortening the summary records, which is already being done at the regional level in Regional Committee documentation.
(8) Ensure that EB discussions genuinely focus on At the WHO/HQ level, the status under (7) above applies. The and reach clear conclusions and decisions with Regional Committee has been working consistently on this at its respect to all issues concerning health policy, sessions over the last few years, particularly with respect to technical, budgetary and financial aspects or other improving transparency of the budgetary process. With reference to securing maximum transparency, accountability and efficient overall supervisory or advisory functions. use of WHO's resources, the Regional Committee, at its fortyfourth session, addressed the question of the appropriateness of regional and country allocations in relation to current needs and capabilities, and suggested that a zero-based budgeting approach should be adopted in determining the programme budget and such a budget should not exceed available funding.
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(9) Request the Secretariat to prepare summary At the WHO/HQ level, status under (7) above applies. Regional records that are more succinct and focus more on Committee documentation has been moving in this direction for conclusions and decisions reached. some time. (10) The EB should establish subgroups to meet In January 1994, the EB began a trial programme review by during, and as part of, the EB sessions each year, to subgroups of the Board itself. At its meeting in May 1994, the review and evaluate specific programmes. EB formalized the process and established three subgroups of the Board to review a number of WHO programmes each year. As decided by the EB in resolution EB93.R13 and endorsed by the 47th WHA, resolutions WHA47.6 and WHA47.7, two Committees of the Board were established. One Committee is on Programme Development, and the other on Administration, Budget and Finance. These Committees consist of seven members each and will meet outside the regular sessions of the EB and report to the Board itself (the process is under review in 1997). The EB subgroups and Committees will require considerable input of information from the regions. The Sub-Committee of the Regional Committee on Programmes and Technical Cooperation addressed the issue of programme review and evaluation at the regional level. The Sub-Committee recommends that EB members representing countries from the Western Pacific Region should also attend the Regional Committee to ensure continuity and linkages between governingbody levels, and report on activities and discussions that took place at the EB and the two Committees (Programme Development, and Administration, Budget and Finance).
4.2.2.2 Metbod of work of the ED
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(12) The EB should reconsider the need for, and the Action at the WHO/HQ level was detailed in progress report terms of reference of the Programme Committee of document EB93/11 Add.6; resolution EB93.R13 changed the the EB. Programme Committee to the Programme Development Committee (see (10) above); A separate committee, the Administration, Budget and Finance committee, was also established. (13) To form a special ad hoc sub-committee of the EB to consider options for nomination and terms of office of the D-G and RDs,. including the use of search committees. At EB93, it was decided that views of Member States and regional committees would be solicited and reported to the EB in January 1995 (see document EB93/11 Add.7). The use of a search comm ittee is theoretically attractive, but important issues of make-up (i.e. selection of committee members) and method of operation need thorough evaluation. The Regional Committee, at its forty-fourth session, discussed the issues at length but no consensus was reached. The Sub-Committee of the Regional Committee on Programmes and Technical Cooperation was asked to review and assess all aspects of the various mechanisms (e.g. search committee), and to report the results of its discussions to the Regional Committee at its forty-fifth session in September 1995. The Executive Board, at its ninety-fifth session, established an ad hoc group of six members to consider the options for nomination and terms of office of the D-G. The group reported to the Executive Board, at its ninety-seventh session, in January 1996, and its report was sent to the World Health The recommendations of the Assembly in May 1996. Executive Board are: that the nominated candidates should meet a series of criteria, having sufficient skills in at least one
4.2.2.4
Nomination and terms of office of the D-G and RDs
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Regional views and status of implementation of the official working languages of the Organization (full details in EB97.RIO). The Board also recommended that the term of office of the D-G should be five years, renewable once. This was not to apply in the case of the incumbent. The Sub-Committee recommends to the Regional Committee (at its forty-sixth session in September 1995) that no change should be made to the procedure for nomination and terms of office of the regional directors. It does not recommend the use ofa search committee at this stage. At the ninety-ninth session of the EB, the whole issue of regional arrangements was included in the terms of reference of the subgroup of the EB reviewing the WHO Constitution.
4.2.2.5
Participation of E8 members in the work of WHO
(14) To establish a small working group to recommend how to: improve ways in which the board members are designated; improve the selection procedures for the officers of the Board; and achieve more active involvement of all members throughout the year in the work of the Organization.
This is discussed in the Report of the EB Programme Committee document EB93/1 I. The EB consensus is reflected in decision EB93(12), which requests the D-G to emphasize to Member States entitled to designate a person to serve on the Board the need to designate persons who are technically qualified in the field of health, recalling the provision of article 24 of the Constitution. The current procedure in WPR, including the "gentlemen's agreement" regarding representation of United Nations Security Council permanent members, seems to work An informal meeting of the Regional Committee well. representatives is convened to come to a consensus on the selection of EB members from the Region and officers for the WHA. Including EB members (regional) in Regional Committee delegations has been useful in strengthening linkages between the EB and the Regional Committee and should be further encouraged. Discussions of the Sub-Committee emphasized the need to ensure that: technically qualified EB members are selected; EB members become more actively involved in the work of WHO; and new EB members are more thoroughly briefed.
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The Sub-Committee recommended to the Regional Committee (at its forty-sixth session in September 1995) that the recommendation of the 1994 Sub-Committee regarding inclusion of Executive Board members in the de.legations to the sessions of the Regional Committee should be reaffirmed and endorsed. All four Executive Board members from the Region attended the forty-sixth session of the Regional Committee in 1995, and three of the EB members attended the Regional Committee in 1996. (15) The EB should conduct, from time to time, surveys of Member States' opinions and perceptions of the work of WHO. At the EB level, implementation would start in 1995, together with recommendations (2) and (3). From a regional perspective, properly conducted surveys could provide useful information for decision·making. These surveys should be well thought out and should advocate a broad consensus on regional and global outcomes. The Sub-Committee noted the need for regional involvement in carrying out such surveys and guiding their direction. In this context, the Sub-Committee itself could look at broader issues as part of its country visits. The Executive Board therefore decided in decision EB95(2) that the opinion of Member States on the work of WHO should be surveyed through the continuous consultation mechanisms set up in all regions and through the mechanisms established for coordination and consultation with the governing bodies: namely, the Programme Development Committee and Administration, Budget and Finance Committee of the Executive Board; that other means be found to survey from time to time the opinion of Member States on specific aspects of WHO's work; and that the Board be kept informed of the opinion of Member States.
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4.2.3 Regional Committees
4.2.3.1
Method of work of Regional Committees
(16) Request the regional committees to study their own method of work and report to the EB in January 1995.
The Regional Committee, at its forty-fourth session, affirmed the current method of work as generally effective, especially as it relates to health policy, budgetary and financial matters. Nevertheless, the Sub-Committee on Programmes and Technical Cooperation was asked to review the method of work of the Regional Committee, further assess the regional implications of the Report of the Executive Board Working Group, prioritize these regional implications in relation to regional priorities, and prepare a background document to guide discussion of this agenda item by the Regional Committee at its forty-fifth session. The Sub-Committee generally endorsed the current method of work of the Regional Committee. but emphasized the need for ongoing review and evaluation in the light of changing circumstances and health needs in the Region. The view was supported that the Regional Committee and its Secretariat should always be searching for more effective ways of doing things, including the idea of sharing information and experience among other regions.
The Executive Board decided to review the method of work of the Regional Committee in three to four years (EB9S(2), January 1995). The Regional Committee in resolution WPRlRC46.Rll reaffirmed its commitment to review its method of work and made two specific requests: - urges Member States to provide recommendations to future sessions of the Regional Committee on changes in work methods; and
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Polity determination
(17) Request the D-G to consider the establishment At the WHO/HQ level, the Global Policy Council, Management of a policy development team, utilizing current staff, Development Committee and development teams ha'/e been to orient the long-term vision, policy direction and established, and Regional Office participants have been programme priorities for the health sector and WHO. designated. The WPRO Programme Committee and RD's weekly meeting with Programme Directors cover this issue at the regional level. The Sub-Committee noted the developments at the WHO/HQ level and encouraged active and informed WPR participation. (18) Request the D-G to strengthen and develop, with the RDs, an improved policy planning and analysis capability/system to recommend clear priorities for programme objectives, targets and budgets. (19) Request the D-G to propose and implement appropriate management and communication systems, particularly with the RDs, to achieve the designated objectives and targets according to the priorities identified. At the WHO/HQ level, a Management Development Committee and Global Policy Council have been established, and Regional Office participants have been designated. The Regional Committee, at its forty-fourth session, noted that WPR has made a special effort to maintain consistency with organizational policy. At the WHO/HQ level, Management Development Committee, Global Policy Council and development teams have been created, as detailed in progress report document EB93111 Add.8. The proposal was endorsed by decision EB93( 11), with regular reporting to the Programme Development Committee. Th.is is linked to EB action point (20) below.
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4.3.2 Management information systems
(20) Request the D-G to provide a detailed analysis of the current status, capability, compatibility, plans of existing management and programmes information systems throughout the Organization.
Action at the WHO/HQ level is shown in progress report document EB93/11 Add.S. The proposal was endorsed by decision EB93( II). The development team on information systems was created and a report was presented to the ninetyfourth session of the EB (May 1994). Plans for implementation are to be completed in mid-1995. At the regional level, Regional Office experience/expertise in management information systems is being shared with other regions.
The progress on development of a WHO Management Information System is regularly reported to the Executive Board. In early 1996 Version 0 was launched. This is Dot yet suitable for country level operations and WPRO is not adopting this version of the MIS until further development is assessed. The country/regional office version is to be developed in 1997 by the regional offices led by AMRO and WPRO. 4.4 Regional Offices 4.4.1 Staffing needs and patterns
(21) Request the D-G to review the effectiveness of current WHO procedures and criteria for the development of appropriate staffing patterns and the selection and recruitment of staff.
This is an extremely important matter that requires careful examination of a number of issues, including: the appropriate mix of scientists, generalists and programme managers; the issue of post ownership as it relates to recruitment; cross-programme sharing of staff; staff rotation (particularly fuml HQ to the field); and the resources required to implement any changes. Personnel procedures will have to be reviewed thoroughly in the light of recommended changes. The Regional Committee, at its fortyfourth session, endorsed this view, emphasizing need for an assessment of resources required to implement recommended changes. The Regional Committee strongly emphasized the importance of the role of regional offices, and recommended further delegation of authority, particularly in areas where certain
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regions have a particular interest (e.g. in malaria). At the WHO/HQ level, development teams were created to implement activities, and Regional Office participants were designated. In addition, the Sub-Committee pointed out the need for including personnel in administration and management positions in the scope of this EB action. Also, the importance of being able to work effectively in cross-cultural situations was emphasized (it was not enough simply to have the appropriate technical background).
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Technical consultants
(22) Request the O-G, in collaboration with the ROs, to review the practices of providing technical consultation for the Organization and identify changes needed.
Consideration of cost implications is extremely important (particularly, increases in consultant fees). More effective of the expert panel system (including utilization selection/designation process) and collaborating centre staff should be explored. The Regional Committee, at its forty-fourth session, endorsed this view, noting the need to include an examination of the potentials of expert panels and collaborating centres, and the need to consider cost implications of all recommendations. Also, the need to expand the pool of available consultants was recognized.
This was covered by the Development Team on WHO Programme Development and Management, which endorsed the increased use of expert panels.
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4.4.3 Communications and collaboration
(23) Request the D-G to review the current delegation of authority between headquarters and regional offices and introduce appropriate changes.
The Regional Committee, at its forty-fourth session, noted that the current mechanism has worked reasonably well in the Western Pacific Region. However, the Regional Committee strongly expressed the need for further delegation of authority and devolution of responsibility to the Regional Office and on to country level. The Regional Committee also stressed the need for clarification of roles and responsibilities of the different levels of WHO. At the WHO/HQ level, progress report document EB93/11 Add.9 reported that the Global Policy Council is following up and will report at a later stage with the conclusions of the development team on Programme Development and Management. The Sub-Committee emphasized the need for regional involvement in this process. This has no particular regional implications, although it is related to the issue of improving the linkages between the EB and the Regional Committee (referred to in Section 4.2.2.5) Action at the WHO/HQ level was detailed in progress report document EB93/11 Add.6. The proposal to improve the Board's discussions with RDs was endorsed by decision EB93( I 0).
(24) The EB should include as part of its working agenda, on a regular basis, meetings with the RDs.
4.5 Country Offices WHO Representatives
4.5.1 WRs' responsibilities
(25) Request the D-G to evaluate current and planned country health programmes and determine the profile of skills and qualifications required to select highly qualified WRs.
If carried out thoroughly, this should lead to the selection of WRs who are better equipped to deal effectively with a wide range of issues related to health. At present, most WPR WRs have medical degrees. While medical qualification is desirable, more use could be made of health professionals with other
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If done in a thorough, professional manner, this would help ensure the recruitment and retention of well-qualified people. At present, WR's briefing, training and career development are not standardized and there is no clear strategy. Also, there is no clear policy of rotation within or between regions. Consideration should also be given to allocating a percentage of the regional budget (e.g. 1%) specifically for staff development and training; appropriate staff performance appraisal; early identification of potential WR candidates from among professional staff and putting them on an appropriate career track; and establishing a maximum period for posting to a particular country of 4-5 years, in conjunction with a comprehensive policy on rotation. The Regional Committee strongly re-affirmed the importance ofWRs' and CLOs' offices for country operations. The Sub-Committee stressed that, at the WHO/HQ level, studies were to be undertaken by a development team; Regional Office participants have been designated and a background paper prepared by the Regional Office.
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This is part of the report of the Development Team on the Role of WHO Country Offices. The report was presented to the Executive Board in May 1995 and further details were presented in May 1996. A draft of technical and educational profile for WRs is to be prepared. (27) Request the D-G to direct the RDs and the WRs to provide the leadership in intersectoral coordination among the UN agencies and between major donors. This is a mandate that the RDs and WRs already have. The real question is how to enhance their abi Iity to carry out this role, assuming that people with the appropriate skills and qualifications have been selected in accordance with Section 4.5.1 above. To be more effective, WRs would need to have: a level of representation consistent with other agencies, especially UNDP; adequate staff; and be supported with clear, concise and unambiguous programme and policy information. The Regional Committee, at its forty-fourth session. endorsed this view, and the Sub-Committee stressed that, at the WHO/HQ level, studies were to be undertaken by a development team; Regional Office participants have been designated and a background paper prepared by the Regional Office.
4.5.2
WRand intersectoral coordination
This is part of the report of the Development Team on the Role of WHO Country Offices. The Suh-Committee recommended to the Regional Committee (at its forty-sixth session in September 1995) that WHO should cooperate actively with other United Nations organizations and other external support agencies to avoid duplication of activities and thereby maximize the efficient and effective use of funds. This was supported.
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Executive Board action (28) Request the D-G to review, update and standardize the delegations of authority, the country office administrative/management and operating procedures, and the basic operating resources for WR offices.
Regional views and status of implementation The current general delegation of authority in WPR is clear and adequate in most cases. The extent to which this delegation is exercised, however, varies considerably from country to country (i.e. WR to WR). If WRs with appropriate skills and qualifications are selected in accordance with Section 4.5.1 above, the implementation of delegation of authority should become more consistent throughout the Region. The Regional Committee, at its forty-fourth session, endorsed this view (see also comment under Section 4.4.1 (21). The Sub-Committee noted that, at the WHO/HQ level, studies were to be undertaken by the development team; Regional Office participants have been designated and a background paper prepared by the Regional Office.
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This is part of the report of the Development Team on the Role of WHO Country Offices. Delegation of authority in the Western Pacific Region is clearly defined. (29) Request the D-G to review the role of the WR and recommend appropriate measures to strengthen the integration of the work of the WR into the policy and strategy development of the Organization. Twice-a-year meetings with WRs at the Regional Office are intended to help ensure this kind of involvement. These forums clearly provide the opportunity for substantive input from WRs. WRs may benefit from attending Regional Committee sessions. The development of clearer, more concise programme and policy information for WRs would improve the likelihood of achieving substantive involvement. The Regional Committee, at its fortyfourth session, endorsed this view; and the Sub-Committee noted that, at the WHO/HQ level, studies were to be undertaken by a development team; Regional Office participants have been designated and a background paper prepared by the Regional Office.
4.5.4
WRs' involvement in policy and technical dialogue
This is part of the report of the Development Team on the Role of WHO Country Offices.
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4.5.5 WHO
representation in Member States
(30) Request the D-G to inquire among Member The emphasis of this EB action is on developed countries. The States their interest in having alternative forms of designation of WRs and CLOs in all countries in WPR is not feasible. A WHO focal point (national staff) at country level is WHO representation. important to enhance cooperation and coordination. See (25)-(29) above for status.
This is part of the report of the Development Team on the Role of WHO Country Offices. Alternative forms of representation was under consideration in the Western Pacific Region. 4.6
Coordination with UN and other agencies 4.6.1
UN structural reforms
(31) Request the D-G to ensure that the Organization be active in its response to the structural and operational reforms taking place in the UN and its programmes.
The underlying message for national health authorities is that improved coordination is needed among national agencies in their relationship with UN and other external support agencies. The Regional Committee, at its forty-fourth session, endorsed this view. indicating the need for commensurate concern at the national level. The Sub-Committee discussions pointed to the need to reinforce the WHO Representative's appropriate role in UN forums.
Ongoing discussions at the Administration Committee on Coordination (ACC) on coordinating reforms across the UN system (see also 32-34 below). This was part of the report of the Development Team on the Role of WHO Country Offices. ~
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(32) Request the D-G to engage in discussions with appropriate elements of UN leadership to ensure optimal use of UN "unified offices" with UN specialized agency coordinators.
While "unified offices" offer potential administrative economies, the location of specialized agencies in their counterpart national organizations (e.g. the Ministry/Department of Health in the case of WHO) offers the possibility of improved service. The WHO/WPR practice of locating offices in the ministry/department of health insofar as possible is preferred. The Sub-Committee again stressed the importance of WHO defining and promoting a relevant role for itself in the UN system, and strongly supported the idea of a unified approach among UN agencies to programme development and implementation.
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(33) Request the D-G to 'present appropriate The Regional Committee, at its forty-fourth session, noted that infOimation and recommendations to the UN/donor the major responsibility for advocating, among UN/donor agencies to include disease surveillance, prevention, agencies, the integration of health concerns in the development and control as an integral component of each decision-making process must be shouldered by the WR. The Regional Secretariat has initiated specific projects on integrating development project. health and environment considerations in sustainable development planning in the Philippines and Viet Nam; Urban Health Development initiatives have been launched in China, Malaysia and Viet Nam. The Sub-Committee supported these types of approaches, and suggested that they be widely promoted elsewhere. Lack of standardization does cause some pr:,olems in WPR (e.g. when dealing with ASEAN issues; and issues affecting the IndoChina peninsula). Much stronger operational and functional linkages could and should be developed among regions and organizations. Geographical standardization may be helpful, but it is not at the heart of cooperation and coordination problems. At the WHO/HQ level, this EB action will be considered for later
4.6.4 UN regional standardization
(34) Request the D-G to engage in dialogue with the UN Secretariat to study means for reducing differences in regions and operation procedures among UN agencies.
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4.7 Budgetary and financial considerations 4.7.1 Extrabudgetary programmes and funding
(35) The EB should consider assigning an EB member to sit on the management committee of each major extrabudgetary-funded programme to facilitate coordination and compatibility of policies, decisions and priorities with those of the WHAIEB.
This has no particular regional implications. In many cases, this is already done at the WHO/HQ level.
An analysis of the membership of the management committees of the major extrabudgetary-funded programmes that held meetings in 1994 shows that one or more Board members, or their alternates, have generally been present at such meetings. Staff of missions in Geneva, who may be advisers to the Board members, also sometimes participate in management committees, but they do not have any mandate to speak for, or report back to, the Board. Such representation is not the consequence of any formal requirement, but is the result of the normal processes for identifying interested countries and competent individuals as members of management committees. Albeit informal, it is nevertheless an avenue for coordination. The Board has also decided in decision EB95(2) to examine the feasibility of assigning the follow-up of one or more programmes (whether funded from regular budget or extrabudgetary resources) to each Executive Board member, at no additional cost to WHO.
(36) Request the O-G to seek approval from the WHA to have authority to assess appropriate
Whether the overhead rate of up to 35% is justified or not depends on a number of significant related organizational changes
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overhead rates, up to 35%, for extrabudgetary (e.g. a move to seek extrabudgetary funding on a competitive basis; resolution of issues related to quality, cost-effective programmes. service; the resolution of problems related to staffing needs and patterns, etc.). In the absence of the resolution of these related issues, WHO cannot support a standard 35% overhead charge. If this is insisted on, WHO may face difficulties at the regional level in attracting extrabudgetary funds. A more rational approach that recognizes the actual overhead cost of implementing activities in the various regions and incorporates these costs in project proposals would be preferable. At the WHOIHQ level, this matter is being studied; outcomes will be reported to the ninetyfifth session of the EB (January 1995). The Sub-Committee stressed that 35% should be considered a maximum level, and that good programme management would ensure levels considerably lower. The Sub-Committee recommended to the Regional Committee (at its forty-sixth session in September 1995) that there should be no change in the programme support costs of 13%; WHO should seek to mobilize additional extra budgetary funds; and direct those resources to priority health programmes. The Regional Committee at its forty-sixth session endorsed this view. The GPC in January 1997 confirmed current rates of programme support costs. (37) The EB should establish a pledging system to secure additional funds for priority regular budget programmes. This is a good idea in principle. However, a great deal of bureaucratic streamlining would be required to make such a system effective. Historically, WHO has been very cautious in its approach to this area. From the WHOIHQ perspective, this EB action is to be implemented in 1995/1996 in conjunction with action (33). The Sub-Committee took note of the potential risks associated with initiating action on the basis of pledges. However, it felt that the potential benefits were substantial, and
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Regional views and status of implementation suggested taking a liberal posItIon towards programme development on the basis of pledges, but a conservative position on implementation/fund disbursement (i.e. do not spend what you do not have on hand). Additional emphasis was placed on countries doing a much better job of preparing to receive and spend extrabudgetary funds. This includes the preparation of sound proposals consistent with established priorities, and the development of efficient implementation mechanisms.
The Executive Board reviewed the D-G's report (EB9S/IS) and made 80 decision. The Board requested the D-G to keep the issue under review. 4.7.2 Budgetary inputs and outputs
(38) The EB requests the D-G to establish budgeting In 1994-1995, WPR was the only region to fully support HQ systems/mechanisms to derive the greatest benefit priorities with related budgetary increases. The D-G and the RDs from the process of budgeting by objectives/targets have to set aside a budget for priority programmes in and to facilitate the achievement of priorities and to 1996-1997. This EB action emphasis was incorporated in WPR's provide for periodic adjustments of these priorities in 1996-1997 budget development process; and the associated accordance with changing health needs. development of a long-term planning perspective and programme vision. The Sub-Committee emphasized the need for countries to allocate their own budgets in line with established, agreed priorities.
On the issue of regional allocations, the Executive Board requested the D-G to continue dialogue with Regional Directors. This issue was discussed at the Regional Committee at its forty-sixth session (provisional agenda item 9.3), and this issue will be taken up again at tbe GPC level. The matter was discussed at the Executive Board in January 1996 but no consensus was reached. The issue of programme priorities was discussed in ED9S and ED99 in the context of the proposed programme budget for 1998-1999.
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~ (39) Request the D-G to improve the personnel procedures to ensure: technical competence as the primary basis for the selection and recruitment of staff; the design and implementation of appropriate career development and continuing education programmes; and the development of a staff rotation system between headquarters and regions. A~; with tile section on Staffing needs and patterns (4.4.1) no asscssmen' ,.)f increased financial resource requirements has been made. [,i,ting rules and regulations allow for selecting and maintainip:.: technically competent people. Unfortunately, in practice. tl;( ir application is sometimes too heavily influenced by political cl',,<;iderations. Suitability for international service is a criterion "",]lIch is inextricably linked to technical competence. During discussions at the forty-fourth session of the Regional Committee, emphasis was placed on the need for examination of the issues of staffing needs and patterns, technical/managerial competence, and technical consultants from a regional perspective. The Regional Committee reaffirmed its commitment to technical competence and suitability for international service as the primary criteria for staff selection at all levels. The Regional Committee also discussed expanding the pool of available consultants. At the WHO/HQ level, this EB action is to be implemented in relation to point (21). The Sub-Committee took note of the fact that this matter will be taken up by the development team on personnel policy.
The Executive Board reaffirmed that technical competence is the primary basis for recruitment when endorsing the Development Team report. (40) The EB should draw to the attention of the WHA the impact on the quality of staff and on the ability of the Organization to perform its mandated functions due to politically motivated appointments.
Politically motivated appointments may be a particular problem at other offices of WHO. Political considerations should not be overriding; people can be selected who accommodate political concerns and are technically competent and are suitable for
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international service. view.
The Sub-Committee fully endorsed this
The Executive Board reaffirmed that technical competence is the primary basis for recrnitment when endorsing the Development Team report. 4.8.2
Research in itialives
(41) With a view to ensuring the best possible use of all resources available to the health sector, the D-G should review and update existing guidelines and procedures related to WHO collaborating centres and their participation in research initiatives for the Organization.
The forum for accommodating this at the regional level is the WPACHR and the RPD programme. The Regional Committee, at its forty-fourth session, endorsed th is idea, noting that the current approach to applied research in the Western Pacific Region is working well and is a more cost-effective use of resources. At the WHO/HQ level, implementation is under way after a review of WHO's role in research by the EB and in close relation to points (19) and (20). It is assumed that the reference to "every programme" refers only to technical programmes. As indicated above, the WPACHRRPD forums provide for this in WPR. WHO should be involved principally in operational and applied research with relatively little basic research. A 1982 Scientific Group on Research Needs for HF Al2000 established regional research priorities which were subsequently endorsed by the WPACHR. Reaffinned in 1988, these priorities continue to guide applied research efforts in WPR. The WHOIHQ approach to this EB action is progressive implementation as of 1995, after a review of WHO's role in research by the EB.
(42) Request the D-G to require every programme to include a budgetary item for conducting basic science or operational research activities.
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The WPACHR adopted a regional research strategy for 1997-2001 at its meeting in August 1996.
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(43) The EB should establish a small group to More attention needs to be paid to strengthening the monitoring detennine with the D-G ways to expand the use of and evaluation function in relation to assessing the effectiveness the centres. of the centres. This process is under way in WPR. The Regional Committee, at its forty-fourth session, endorsed this approach, emphasizing the importance of the monitoring and evaluation function. At the WHO/HQ level, the development team on programme development and management will review the operations of collaborating centres, after a review of WHO's role in research by the EB. The Sub-Committee stressed that the small group should not only consider ways to expand the use of the centres but should also consider ways of streamlining their operations and improving effectiveness.
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In WPRO there is concerted effort to improve the use of WHO Collaborating Centres and strict application of criteria for designation and redesignation. (44) Request the D-G to develop annual plans with each collaborating centre to facilitate the implementation of appropriate international health work, and the evaluation of the capability of the centre to maintain its special designation. In WPR, annual work plans are already required as part of the monitoring and evaluation process. This was endorsed by the Regional Committee at its forty-fourth session, indicating that this is already being carried out in the Western Pacific Region. A development team has been created at the WHO/HQ level, to review collaborating centre operations, after a review of WHO's role in research by the EB.
In WPRO there is concerted effort to improve the use of WHO Collaborating Centres and strict application of criteria for designation and redesignation. 4.9
Communications
(45) Request the D-G to develop WHO's capability to make greater use of modem communication techniques and methods
The greater use of modem communication methods, partiCUlarly mass media tools, has significant resource implications which should be thoroughly assessed. A development team was created
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Regional views and status of implementation at the WHO/HQ level, and a report is to be presented to the ninety-fifth session of the EB (January 1995). The SubCommittee emphasized that this issue involves much more than methodology and hardware. It also concerns the elements of content, style and forums. WHO needs to be more creative and strategic in its approaches, and more involved in and aware of what is going on in Member States across the full spectrum of health-related programmes and organizations. In WPRO tbis issue is under continued review by an in-house Office Automation Committee, wbicb is developing proposals for intranet and internet. The use of e-mail was expanded considerably in 1996.
(46) Request the D-G to issue an annual publication Such a document should be seen as a replacement for or a which reports on the Organi"zation's efforts and consolidation of some existing publications rather than as an addprogrammes for improving the world health on effort. Consideration should be given to modifying the RD's report to accommodate the region-specific needs of such a global situation. publication. Action at the WHO/HQ level is shown in progress report document EB931 II Add. I. The proposal to produce an annual publication was endorsed by decision EB93(6), with resource mobilization beginning in 1994, and publication to start in 1995. The Sub-Committee reiterated its emphasis on communications noted in (45) above. Tbe World Health Report 1995 - Bridging the Gaps was presented to the World Health Assembly in May 1995 and annual World Health Reports are planned. In 1996 tbe Regional Committee reviewed tbe format and periodicity of the Regional Director's Report. From 1997 tbe report will be annual and focus on the regional situation and priority areas of interest to WPRO. Eacb year tbe report will also contain an in-deptb review of a selected issue of relevance to the health development of Member States.
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(47) The work recommended by the EBWG is the responsibility of the D-G, the EB itself, or a series of working partners who must resolutely pursue the opportunities outlined in this report. However, to ensure continuity, there is an urgent need to devise means for the EB to monitor the work and continue activities, including the potential contribution from the current EBWG members.
This has no real regional implications apart from the extra documentation required for the EB monitoring function. However, at least one WPR Member State should be represented in this activity (e.g. an EB member from the Region). The Regional Committee, at its forty-fourth session, endorsed this view. The Sub-Committee noted that this was a collective responsibility of the Member States, and that the Regional Committee should take more responsibility for making WHO's work more effective.
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ANNEX 4
World Health Organization Organisation mondiale de la Sante EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO Fifth meeting 9-11 July 1997 Provisional agenda item 3.2 EB/Constitution/5/3 25 June 1997
Current practice at headquarters and in regional offices for: budget drafting; priority-setting and implementation; personnel appointments; programme implementation; and impact of extrabudgetary funds on regional budgets and priorities
.-
This brief information note outlines current practice in headquarters and the regional offices in areas requested by the special group. It concentrates on the respective roles of regional and global levels.
BUDGET DRAFTING AND PRIORITY-SETTING 1. The foJlowing are the key steps presented in highly summarized form:
WPRlRC48/9 page 72 Annex 4
Global level - Prepares overall guidance on format and global priorities (based on input from the Health Assembly, Executive Board and DirectorGeneral).
Regional level - Issues provisional country planning figures to WHO Representatives and national governments from within total regional allocation received, together with indications of regional priorities (based on input from regional committees and Regional Directors) and global priorities. - Governments and WHO Representatives jointly draw up proposals. - Reviews proposed country programme budget, including national, regional and global priorities. - Prepares intercountry and regional office programme budget. - Reviews programme budget with subcommittee or standing committee of regional committee, where established. - Submits regional programme budget document to regional committee. - Transmits draft regional programme budget proposals to Director-General after review by regional committee.
- Sets total level and allocations to six regions and headquarters. - Prepares global and interregional budget proposals. - Reviews regional proposals.
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- Consolidates overall budget document for submission to governing bodies.
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Prepares levels of cost increases and exchange rates worldwide for submission to governing bodies.
PERSONNEL APPOINTMENTS 2. Staff are appointed by the Director-General who has delegated the authority for appointment at all levels up to P.5 in the regions to the Regional Director, and the authority for appointment of general service staff at headquarters to the Director of Personnel. Apart from the most senior posts, staff selection committees consider candidacies and make recommendations to the appointing officers.
PROGRAMME IMPLEMENTATION 3. At all levels, the biennial programme budget provides the basis for yearly plans of action for implementation. The plans of action describe how and at what cost the products indicated in the strategic programme budget will be achieved. Implementation of plans of action is monitored regularly and adjustments made whenever necessary.
WPRlRC48/9 page 73
Annex 4
IMPACT OF EXTRABUDGETARY RESOURCES ON REGIONAL BUDGETS AND PRIORITIES 4. In tenns of total amount of extrabudgetary resources, the situation varies by region, as indicated in the programme budget document. All regions have confinned that such funding does not distort the regional budget or the established priorities. In the Region of the Americas, extrabudgetary resources amount to approximately 50% of the total funds assigned to technical cooperation. Within this, disease prevention and control and health promotion and protection receive the greater part of their resources from extrabudgetary funds, whereas development of health systems and services and environmental protection and development receive the greater part from regular budget financing. In the South-East Asia Region, the extrabudgetary resources supplement both the intercountry and country programmes, and about 75% of the resources in 1994-1995 were concentrated in the five priority areas identified by the Executive Board. In the Western Pacific Region, for example, it is estimated that 70% to 75% of extrabudgetary funding goes to supporting the seven regional priorities. 5. There is still scope, however, for a more integrated approach to the planning of extrabudgetary funding, in particular given the relatively short notice of availability of such resources in comparison to regular budget financing. This and other issues will be reviewed by the working group on extrabudgetary resources set up by the Board at its IOOth session in May 1997.
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WPR/RC48/9 page 74
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WPRlRC48/9 page 75
ANNEX 5
World Health Organization Organisation mondiale de la Sante EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO Fourth meeting 10 or 12 May 1997 Provisional agenda item 2.3 EB/Constitution/4l2 30 April 1997
Regular budget allocations to regions One of the areas identified by the special group for the review of the Constitution at its third meeting as possibly meriting further consideration is the subject of regular budget allocations to regions. This document provides some facts to assist the special group in its work.
WHAT ARE REGIONAL ALLOCATIONS? I. are: In WHO, regional allocations may be considered as parts of the proposed regular programme budget that
(i) reviewed by Member States at regional committee meetings on the basis of proposals from the Regional Directors (the total amount of the allocation by region and general programme orientations having been determined initially by the Director-General); (ii) consolidated by the Director-General (including any amendments the Director-General may wish to make) in the overall proposed programme budget to the l\.Ssembly (with prior review by the Board);
(iii) once adopted by the Assembly as part of the approved programme budget, and within certain limits. implemented by Regional Directors under delegated authority from the Director-General.
WHAT ARE THEY USED FOR? 2. At present, the regional allocations comprise regular budget monies for: (i) running the six regional offices and certain other management or support activities based there (regional office programmes); (ii) implementing programmes that are managed from the regional offices and which benefit the region as a whole or groups of countries within a region [mtercountry programmes); (iii) implementing programmes that are managed from the regional offices and which beneftt individual countries (country programmes).
WPR/RC48/9 page 76 Annex 5 3. The regional allocations thus do not comprise regular budget monies managed from headquarters (global or interregional programmes) or extrabud~etarv funding (managed from any location) irrespective of whether those funds may either partly or in whole be spent for a regional office. intercountry or cC\untry programme.
HOW MUCH ARE THEY? 4. The trend with respect to regional allocations since 1975 has been as follows:
Regional alloeations: share of the regular budget 1975 19B0-19B1 1984-19B5 1990-1991 1994-1995 1998-1999'
% Africa
% 16.0 8.8 10.5 5.6 9.3 7.7
% 1B.1 9.8 11.8 6.8 10.4 8.9
% 1B.3 10.0 12.3 5.8 10.3 8.9
% 1B.8 9.7 12.0 6.0 10.4 B.7
% 18.7 9.8 11.8 5.9 10.8 9.6 0.6
USS million 158 83 100 50 91 81 6 568 278 846
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15.7 9.3 10.4 5.7 10.5 7.9
The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Unspecified countryl Subtotal Global and interregional Total
59.4 40.6 100.0
57.9 42.1 100.0
65.7 34.3 100.0 65.6 34.4 100.0 65.6 34.4 100.0
67.2 32.8 100.0
, As proposed by the Director-General to the World Health Assembly in document A50/4. Following a request by the 1995 World Health Assembly to transfer 2% of global and interregional allocations to priority programmes at country level. Amount has not yet been allocated to individual countries and is shown under globallinterregional in document ASO/4. 2
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5. It is important to note that the small changes identified are primarily the resuh of different inflation and exchange rate impacts as well as changes in count!)' affiliations - in real terms the relative ratios have remained essentially static apart from the shift from 1980 to 1984-1985 which was a policy decision. as' was the small change in 1998-1999 noted in footnote 2 to the table above. 6. The major shift in regional allocations from 1980 was primarily as a consequence of resolution WHA29.48 which requested that "allocations of the regular programme budget reach the level of at least 60% in real terms towards technical cooperation and provision of services by 1980". The extent of technical ~peration activities Wlder the regular budget has not been precisely recorded. This work is Wldertaken in many programmes at all three levels of WHO - global, regional and country - and may well currently account for over three-quarters of the regular budget.. .
WPRlRC48/9 page 77
Annex 5 7. As regards the current breakdown of regional allocations between country, intercountry and regional office, the current proposed budget for 1998-1999 has the following figures:
Country USS million Africa The Americas' South-East Asia Europe Eastem Mediterranean Western Pacifi::: Unspecified country Total
Intercountry USS million
Regional office USS million
Total USS million
95 ~2
31 33 16 25 15 21
31 8
158 63 100 50 91
74 5 60 45 6 328
10 20 16 15
81 6 569
141
100
, The breakdown of the budget of the Region of the Americas has to be considered in conjunction with the PAHO budget
POSSIBLE CRITERIA FOR ESTABLISHING REGIONAL ALLOCATIONS 8. There has been debate since the creation of WHO on establishing criteria for allocating the budget and. in particular, the counuy budgets and/or overall regional allocations. Some regions have developed such criteria for allocations to countries within their region. In general, however, as between regions, all criteria have been subordinate to, rather than determinants of, the final decisions, which have been based on the process of debate and consensus-building among the membership, and on consideration of priorities at particular times. Among criteria mentioned in the past for determining the regional allocations have been the number of 9. Member States, population, and overall state of development. A wide range of health and health-related indicators have also been mentioned, such as for maternal mortality, child malnutrition, immunization, prenatal care, water supply and sanitation and health expenditures. A single health development index would need to address the issue of ethical values and related weighting. 10. The tables below give, purely for purposes of debate, a few of the possible criteria broken down on a regional basis. It is velY clear, however, that these limited ranges of statistics cannot be used without fur.her refinement. The special group may wish to consider whether it would wish further work undertaken on this aspect.
WPRlRC4819 page 78
Annex 5
Number of WHO Member States 1955 No. of Members ""mca The Americas South-East Asia Europe Eastem Mediterranean Westem Pacific Total 2 21 7 3D 12 9 81 1955 No. of Members 28 24 9 33 17 11 102 1975 No. of Members 33 27 10 1985 No. of Mem!:lers No. of Members 46 35 10 50' 1995 Population (million) 602 781 1 451 858 456 1629 5778
44 34 11 32
34 23 13 140
22 20 163
22 27 190'
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, Andorra has since joined, making the current (1997) totals 51 and 191 respectively.
Selected heallh-for-all (HFA) indicators -1996 Ufe expectancy at birth (years) (HFA target >60) Infant mortality rate (per 1000 live births) (HFA larget <SO) Under-S mortality rate (per 1000 live births) (HFA larget <70)
Member Slates which Member Slates which Member States which have not met the HFA have not met the HFA have not met the HFA Regional Regional Regional target target target average average average No. of Populabon No. of Populabon No. of Population countries (million) countries (million) countries (million) Africa The Americas South-East Asia Europe Eastern Mediterranean Western PaCific 53 72 62 73 37 1 4 0 5 3 524 7 195 0 75 20 91 33 73 21 89 37 39 4 7 2 10 5 528 204 1349 67 338 142 41 97 26 97 <13 40 3 5 0 9 4 570 39 1148 0 317 20
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63 70
23
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WPRlRC4819 page 79 ANNEX 6
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:.' ~ World Health Organization Organisation mondiale de la Sante Fifth meeting 9-11 July 1997 Provisional agenda item 3.3 EB/Constitution/5/4 25 June 1997
EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO
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Regular budget allocations to regions The document follows up en a number of issues raised at the fourth meeting of the special group for the review of the Constitution. The group will need to decide what further steps it wishes to take on the matter of regular budget allocations to the regions, in preparation for any recommendations it might wish to make to the Executive Board in January 1998.
I. At its fourth meeting, the special group reviewed an analysis of the regular budget allocations to regions. ' The group, in paragraphs 4 to 7 of its report, identified a number of issues of concern, in particular, whether the criteria used for establishing allocations needed to be reassessed.: It requested information on the financial implications of different criteria, and on the location at which funds were actulilly expended.
FINANCIAL IMPLICATIONS OF DIFFERENT CRITERIA 2. Factors mentioned during the special group meeting which might be used to establish regular budget allocations to regions included health needs, poplilation, percentage of GOP devoted to health, specific health indicators and number of Member States. As regards the health-related factors, the special group requested a presentation during its fifth meeting by technical staff on the subject of a health development index. It was noted that key points in such an index were the choice and weighting of indicators. 3. Until the group has considered the presentation on the health development index, it is not thought feasiole to show the financial implications of using any of the many possible variants of such an index. The table, "Selected health-for-all indicators - 1996", which shows regional averages for selected health-for-all indicators, together with the number of Member States which have not met certain health-for-all targets, is also relevant background to this consideration.' It would also be important for the group to consider whether it is the more appropriate to aggregate indicators to a regional basis or to have a disaggregated breakdown showing individual country needs. 4. As regards criteria other than health, the following table shows for each region the actually approved budget for 1998-1999 (both the total regional budget and, within that, the total country budgets). It also shows,
I
Document EBIConstitutionl412.
, Document EB/Conslitulionl4lS. , Documenl EB!ConSlitulionl412. p. 4.
WPRlRC4819 page 80 Annex 6 purely for illustrative purposes as requested, the share of the total regular budget that would be allocated to individual regions if the allocations were made on the basis of, (i) population (ii) number of Member States (iii) number of Member States not in the category of "Western European and other Group". Information on GNP per head is also included, but is not-used as the basis for any calculation.
APPROVED BUDGET 1998-1999 AND NON-HEALTH INDICATORS, BY REGION Total budget for region Country budgets for region Non-WEOG* Member States No. % GNP per head
Population
1998-1999 US$ million Africa The Americas South-East Asia Europe Eastern Mediterranean Western Pacific Total
Member States
1998-1999 US$ million % Million
1994 US$
%
%
No.
%
--
158 83 99 50 90 80 560
28 15 18 9 16 14 100
96 43 74 5
30 13 23 2 19 14 100
602 781 1451 858 466 1629 5787
10 13 25 15 8
46 35 10 51 22 27 191
24 18 5 27 12 14
46 33 10 28 22 24 163
28 20 6 17 13 15 100
598 11 739 487 10766 1249 3762
60 44 322
28 100
100
* Western European and other Group_
EXPENDITURES AT VARIOUS LEVELS OF THE ORGANIZATION 5. During its fourth meeting, the special group requested further information on the expenditures of the Organization, in particular noting that budget funding held at one level of the Organization may be spent for the benefit of another level. At its simplest expression; this might mean, for example, that a staff member based at headquarters or in a regional office might travel to a particular country to provide advice, or to implement a particular project for that country which is also funded at the global or regionallintercountry levels. The budget and expenditure for that activity will be shown as pertaining to global or regional levels, and not as country expenditure. 6. It has however proved extremely difficult to obtain a breakdown of expenditure figures which would provide a sufficiently accurate estimate of global, regional and intercountry activities in direct support of individual countries. The Organization-wide systems have focused in the past on the technical programmatic areas of these expenditures. The new systems now being put in place should be able to identify non-staff costs more clearly, but staff time will remain difficult to calculate. Further information will be provided to the special group during its meeting.
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CONCLUSION 7. The special group may wish to consider whether and how it wishes to take forward the issue of regular budget allocations to the regions, in preparation for any recommendations it may wish to make to the Executive Board.
WPRlRC4819 page 81
ANNEX 7
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World Health Organization Organisation mondiale de la Sante Fourth meeting 10 or 12 May 1997 Provisional agenda item 2.4 EB/Constitution/4/3 28 April 1997
EXECUTIVE 'BOARD Special Group for the Review of the Constitution of WHO
Current status of the relationship between WHO and PAHO One of the areas identified by the special group for the review of the Constitution at its third meeting as possibly meriting further consideration is the current status of the relationship between WHO and PAHO. This document describes briefly the current status of legal and practical integration achieved. I. Article 54 of the Constitution provides that the Pan American Health Organization, I which existed prior to the establishment of WHO, " ... shall in due course be integrated with the Organization. This integration shall be effected as soon as practicable through common action based on mutual consent of the competentauthorities expressed through the organizations concerned."
,-
2. On 24 May 1949. the Director-General of WHO and the Director ofPAHO signed an Agreement between the two organizations. The Agreement is stated in the Preamble to be a mea~ure towards the implementation of integration as provided for in Article 54. It provides that the governing bodies of PAHO (Pan American Sanitary Conference and the Directing Council) and the Pan American Sanitary Bureau (which acts as the Secretariat of PAHO) serve respectively as the Regional Comminee and the WHO Regional Office for the Americas, though each organization shall retain its respective names, It establishes the basis for a range of coordinated actions through the adoption by PAHO of conventions and programmes that are compatible with the policy and programmes of WHO, the exchange of information. the provision of a budget for regional work and the management offunds allocated by WHO to the Bureau as the Regional Office. in accordance with the financial policies and procedures of WHO. The Agreement also provides that it may be supplemented with the consent of both parties. although this has never been formally done. 3. Apart from the Agreement there have been a number of areas in which PAHO and WHO have been integrated in practice. albeit not as a single legal entity.2 Although separate budgets are approved (first WHO, then PAHO), they are developed in parallel. The membership ofPAHO and the Region of the Americas are the same. Furthermore. although PAHO staff have a separate legal status from WHO staff. they are functionally integrated. In addition. the salaries. pension and staff health insurance benefits of PAHO staff are all the same as for WHO staff. The Staff Regulations and Rules of WHO. as well as the WHO Manual sening forth the administrative rules applicable to the functioning of the Organization, are also applicable to PAHO, although provision exists for modifications to be made when necessary.
I
Called at the time "the Pan American Sanitary Organization".
, For a review ofthe impact this continued separate legal status has on the lenn of office and selection process of the Director. AMRO. see document EBIConstilUtion/4/4.
WPR/RC48/9 page 82
WPRlRC4819 page 83
ANNEX 8
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8)
. ) World Health Organization ., ~ Organisation mondiale de la Sante Fifth meeting 9-11 July 1997 Provisional agenda item 3.6 EB/Constitution/S/5 26 June 1997
EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO
Representation of regions in the Executive Board and other bodies
EVOLUTION OF PATTERN OF REPRESENTATION I. The first Member States entitled to designate persons to serve on the Board were approved by a majority vote after a long debate on the list of countries submitted by the General Committee to the First World Health Assembly in July 1948, in accordance with Article 24 of the Constitution. At that time Article 24 stated that the Board shall consist of 18 persons designated by as many Members. 2. The General Committee of the World Health Assembly, in reviewing the basis for representation in the Executive Board, had taken into account a wide range of considerations, including geographical areas, population, fair representation of all continents, countries in greatest need, health problems, resources and potentialities, budgetary contributions, efficiency of technical staff in various regions, and particular knowledge and experience in international health. The Committee finally decided to base its recommendation on equitable geographic distribution among the countries which had ratified the Constitution at that time. No member should represent his or her country or region, but all members. individually and as a body, should represent the total number of Members of WHO. 3. In the absence of any provisions in the Constitution or the then Rules of Procedure concerning the aClion to be taken in order to meet the requirement as to equitable geographical distribution, the Health Assembly allocated to each region a proportional number of seats on the basis of the number of States in each region. 4. By amendments to Articles 24 and 25 of the Constitution adopted in 1959, 1967, 1976 and 1986 respectively (see Table I and the Figure below), the membership of the Board was subsequently increased. The increase came into force after ratification by two-thirds of the Members in conformity with Article 73.
WPRlRC48/9 page 84 Annex 8
TABLE 1. NUMBER OF MEMBER STATES AND DISTRIBUTION OF SEATS ON THE EXECUTIVE BOARD: HISTORICAL PERSPECTIVE
1948 Region MembersJ seats
1959 Members! seats
1967 Members! seats
1976 Members! seats
1986 Members! seats
1997 Members! seats
Africa Americas South-East Asia Europe Eastern Mediterranean Western Pacific Total
2 8
1 3 2 8 2 2 18
5 22
3 5 2 8 4 2 24
30 26 7 31 17
7 6 2 7 5 3 30
41 29 10
7 6
44
7 6
46 35 10 51 22 27 191
7 6 3 7 5 4 32
34 11 35 22 20 166
5 25 10 4 54
6 30 14 10 87
3 7 5 3 31
3 7 5 4 32
34
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20 15 149
13 124
TABLE 2. NUMBER OF MEMBER STATES AND DISTRIBUTION OF SEATS ON THE EXECUTIVE BOARD: CURRENT SITUATION
Region Africa Americas South-East Asia Europe Eastern Mediterranean Western Pacific Total
Number of Member States
Theoretical number of seats (ratio of 321191 = 0.1675)
Current number of seats
46
7.71 5.86 1.68 8.54 3.69 4.52
7 6 3" 7 5 4 32
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35 10 51 22 27 191
" Article 24 of the Constitution specifies that a minimum of three members of the Executive Board must be from each region.
WPRlRC48/9 page 85
Annex 8 PROPORTIONAL INCREASE IN THE NUMBER OF SEATS COMPARED TO INCREASE IN MEMBERSHIP
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SEMIPERMANENT REPRESENTATION 5. The process by which Member States are elected by the Health Assembly under Article 24 of the Constitution to designate a member to serv~ on the Executive Board has evolved over the years. In recent years. the Member States in each region have agreed informally. prior to the election, which countries would be suggested and the number of suggestions has matched the number of vacant positions. There is no rule of procedure which allows any country to have permanent or semipermanent entitlement to designate a person to serve on the Board. However. the Member States in the Region of the Americas. and the European and Western Pacific regions have informally in each case decided that the list of countries suggested from those regions should include, in three out of four years, the permanent members of the United Nations Security Council, and in each case the Assembly has indeed elected those States. This has no effect on the other regions, but. of course, it affects the possibility for other countries in the three regions concerned to have the opportunity to be entitled to designate a person to serve on the B,Jard.
NONPAYMENT OF CONTRIBUTIONS AND THE RIGHT TO DESIGNATE AN EXECUTIVE BOARD MEMBER 6. This item is dealt with in document EB/ConstitutionJ5/S.
WPRlRC48/9 page 86
Annex 8 REPRESENTATION OF REGIONS IN OTHER BODIES 7. There are a number of established committees of the Executive Board, and ad hoc working groups are set up from time to time. As a general rule, such groups nonnally consist of one member from a country of designation in each of the six WHO regions, and, possibly, the Chainnan or a Vice-Chainnan of the Board. The fonnula therefore is not proportionate representation vis-a-vis the actual membership of the Board, but so far, this does not appear to have caused any difficulty. It would be for the special group on the review of the Constitution (itself established on such a basis) to consider whether this fonnula should be maintained, or whether a different fonnula (for example, based on technical backgrounds of Board members, or on nonregional characteristics) might also be considered by the Board in the case of specific tasks.
OTHER ORGANIZATIONS OF THE UNITED NATIONS SYSTEM 8. In other organizations in the United Nations system, membership on the governing body similar to the Executive Board is based essentially on regional distribution, except for the International Labour Organization, which has a tripartite structure (government, employers, workers) and the World Food Programme, divided between developing and developed countries. A list of representation in some selected organizations is attached as an Annex
CONCLUSION 9. The special group may wish, in the light of the above information. to consider whether it wishes to make any recommendations regarding the representation of regions in the Executive Board and other bodies.
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WPRlRC4819 pageS7
Annex 8
ANNEX REPRESENTATION ON GOVERNING BODIES IN SEI:-ECTED ORGANIZATIONS OF THE UNITED NATIONS SYSTEM
Organization FAO Africa Asia Europe latin America Near East North America Southwest Pacific Total UNDP/UNFPA African States Asian States Eastern European States Latin American and Caribbean States Westem European and Other States Total UNICEF African States Asian States Eastem European States latin American and Caribbean States Western European and Other States Total UNESCO Group I (Europe) Group II (Eastern Europe) Group III (Latin America .and Caribbean) Group IV (Asia and Pacific) Group V (African and Arab States) Total ilO Governments" Employers Workers Total WFP Developing Member Countries Economically developed Member countries Total
Members/seats 48 20 40 33 21 2 9 173 53 48 21 33 27 182 53 48 21 33 27 182 12 9 10 9
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6 2 1 49 8 7 4 5 12 36 8 7 4
5 12 36 9 7 10 12 20 58 28 14 14
56 129 45 174 22 14 36
" Of the 28 government representatives, 10 hold nonelective seats representing Member States of "chief industrial importance" and 18 represent Members elected by It1e International Labour Conference.
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WPRlRC48J9 pageSS
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WPRlRC48/9 page 89 ANNEX 9
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~ World Health Organization Organisation mondiale de la Sante Fourth meeting 10 or 12 May 1997 Provisional agenda item 2.7 EB/Constitution/4l4 30 April 1997
EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO
Term of office of Regional Directors, qualifications and method of selection One of the areas identified by the special group for the review of the Constitution at its third meeting as possibly meriting further consideration is the term of office of Regional Directors, their qualifications and method of selection. This document reviews the historical context to these issues and provides various options for consideration by the group.
I. The term of office, method of selection and qualifications of Regional Directors have been considered many times during the existence of the Organization. The subjects were discussed in the Executive Board in 1956: in 1964, I in 1988 and in 1994-1995. without any agreement being reached to change the status quo. 2. Article 52 of the Constitution provides only that Regional Directors shall be "appointed by the Board in agreement with the regional comminee". During the preparatory conferences prior to adoption of the Constitution. Regional Directors were to be appointed by regional comminees with the approval of the Executive Board. The change to the current text has been interpreted as a wish by the drafters of the Constitution to strengthen the role of the Executive Board. However. it is generally recognized that the selection is for all practical purposes done by the regional comminees. each region presenting only one name to the Executive Board. The current practice is nevenheless not inconsistent with the actual wording of Anicle 52, which can be interpreted to mean either that the Board shall have the primary role in the decision or only that it shall have the final decision. 3. The most recent review of the selection and term of office of Regional Directors derives from decision E889(19). which established the Working Group on the WHO Response to Global Change. The report of the Working Group recommended, in what subsequently became knovm as recommendation 13. to "consider options for nomination and terms of office of the Director-General and Regional Directors. including the use of search committees".' This recommendation was considered at the ninety-third session of the Executive Board.' following which the views of the regional comminees were sought on the question and reported to the ninety-
I When it was suggested that the regional comminees present several candidates for consideration by the Board - a measure which was provisionally implemented by one region.
: Document EB92/1 993/RECI I , Annex I, paragraph 4.2.2.4. ) Document EB93/19941REC/I. Annex I, pan VU"Nomination of the Director-General and Regional Directors (Implementation of recommendation 13)" as well as EB9311994/RECI2, pp. 50-54.65-66 and 69-73.
WPRlRC48J9
page 90 Annex 9 fifth session.' The ninety-fifth session of the Executive Board, after no consensus was reached with respect to the issue of the nomination of Regional Directors, adopted decision EB95(1) establishing an ad hoc group to consider options for nomination, including possible use of a search process, and terms of office of the DirectorGeneral. 4. The repon of the ad hoc group2 was submitted to the ninety-seventh session of the Board and led to the adoption of resolution EB97.RI0, (i) establishing criteria for the candidate nominated for the post of DirectorGeneral. (ii) amending Rule 52 of the Rules of Procedure,' and (iii) recommending to the Health Assembly the establishment of a limitation of the term of office to five years. renewable once. The Forty-ninth World Health Assembly subsequently adopted resolution WHA49.7. which amended Rule 108 of the Rules of Procedure of the Health Assembly by adding "The term of office of the Director-General shall be five years. and he or she shall be eligible for reappointment once only.'" The resolution noted. however. that as a general principle. it is not appropriate to apply such a change to an incumbent.
TERM OF OFFICE 5. In the light of the Health Assembly's action limiting the term of office of the Director-General to a maximum of two five-year terms, the special group may wish to consider whether or not to recommend to the Executive Board the establishment of a similar rule for Regional Directors. In fact, the Standing Committee of the Regional Committee for Europe already considered this issue at its session in December 1996 and proposed that the Regional Committee should recommend to the Executive Board that the term of office of the Regional Director should be five years. renewable once. In considering this issue it should be recalled that there are two competent bodies involved in the selection 6. process: the regional committee, which makes a nomination and recommends the duration of the contract. and the Executive Board,which makes the appointment and decides on the duration of the contract. If the issue is to be handled at the regional committee level, it may only be decided by the committees to limit the nomination of candidates to two terms and to decide what length of contract to recommend. On the other hand. the Executive Board - the body competent actually to make the appointment - would be in a position to limit the number of appointments and decide on the maximum duration of the contract. In this respect. action by the Executive Board on this issue would be more consistent with the approach adopted by the Health Assembly with respect to the Director-General. 7. That being so, different considerations would apply for the term of office of the Regional Director for the Americas, which coincides with the constitutionally prescribed four-year term of office of the Director of the Pan American Sanitary Bureau (which acts as the secretariat of PAHO) as provided in the Constitution of PAHO. By agreement between WHO and PAHO. the governing bodies ofPAHO (Pan American Sanitary Conference and the Directing Council) and the Bureau serve respectively as the Regional Committee and the WHO Regional Office for the Americas. Consequently, the Director of the Bureau and the Director of the Regional Office must be the same person. As a result, although it might be possible to implement a two-term limit through a change in the Rules of Procedure of the Pan American Sanitary Conference. a change from a four-year term would require a constitutional amendment.
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I Document EB95/1 995lRECIl , Annex 4, Appendix I, "Summary of discussions in regional comminees in 1993 and 1994 on recommendation 13: Nomination and terms of office of the Director-General and Regional Directors".
: Document EB97!1 996lREC/I , Annex I. J So as to expand the range of sources for proposing candidates. provide for establishing a shon-list and for Interviewing of shon-listed candidates (see BasIC Documents, 41st ed., pp. 156 and 157).
'See Basic Documents, 41st ed., p. 139.
WPRlRC48/9 page 91 Annex 9 QUALIFICA TIONS 8. Set forth in Annex I are the criteria for candidates for the post of Regional Director adopted by the Regional Committee for Europe at its fortieth session. as well as the criteria for the post of Director-General. adopted by the Executive Board in resolution EB97.RIO.' The special group may wish to consider whether any of these lists of ~riteria could be adapted for use in the selection process for Regional Directors in general. If a recommendation is made to the Board for the establishment of such criteria. the Board might adopt a resolution recommending to the regional committees a set of appropriate criteria for their consideration. This approach . would have the effect of promoting unifonnity between the regions.
METHOD OF SELECTION 9. Various issues may be included within this section. In addition to maintaining the current arrangements for selecting Regional Directors. as has been the result of previous Executive Board reviews. the following paragraphs provide other possible options for dealing with the issues. 10. The possible use of search committees has been considered in previous reviews by the Board. most recently in 1994-1995. The Regional Committee for Europe has adopted a search committee procedure. amending Rule 47 of its Rules of Procedure accordingly (the current text of Rule 47 is set forth in Annex 2).' and the Governing Council of the International Agency for Research on Cancer has used a search committee process for the selection of its Director, though without amending its rules of procedure.
II. During previous discussions of this issue in the Executive Board. various suggestions were made for providing for a larger input from headquarters and/or the Executive Board in the overall selection process. It has been suggested that the views of the Director-General should be sought by the regional committees or the Executive Board. As a practical matter. the Director-General endeavours always to be present at each regional committee session when there is a nomination for Regional Director, as well as during the Executive Board session at which an appointment is decided upon. in order to be able to be consulted by the members of the committee and Board. It should also be noted that the timetable for the search gf':;UP established by the Regional (~ommittee for Europe at its forty-third session. when making its review of candidates. provided for consultations with the Director-General as required. 12. It has also been suggested that regional committees should provide the Executive Board with the names of more than one nominee from which to choose. thereby enhancing the role of the Executive Board in the selection process. This would require amendments to the rules of procedure of the regional committees. but it would not require a constitutional change. This approach could be further elaborated upon. without necessarily even requiring a change in rules of procedure. by having the Director-General submit to the Executive Board his assessment and/or recommendation with respect to the various nominees. In addition. by a change in rules of procedure it could be provided that the Board would make its selection in the order in which nominees are recommended by the Director-General: namely. the first recommended choice would be the subject of a vote confinning or rejecting the candidate. In the event of a rejection. the Board would proceed to the next on the list. 13. None of the approaches mentioned in the preceding paragraph would. however. be readily applicable to the Region of the Americas. In view of the separate legal status ofPAHO and its constitutional requirement that
Board
al lIS
, Reference can also be made 10 document EB811J988/REC'1 (pp. 195·197) for detailed criteria considered by the eighty-third session.
: The Standing Committee is considering recommending to the Regional Comminee the adoption of various refinements to the text of Rule 47 in preparation for the nomination of a Regional Director in 1999.
WPRlRC4819
page 92 Annex 9
the Director of PAHO (who also serves as WHO Regional Director for the Americas) shall be elected by a majority of the governments ofPAHO,' all of the suggested approaches would require amendment of the PAHO Constitution. 14. As another approach to the selection process for Regional Directors, the Director-General could propose a list of names to each regional committee, which could choose from those candidates as well as other candidates proposed by Members of the Region or, alternatively, from only those candidates. Either variant of this approach would require an amendment of the rules of procedure of all of the regional comminees. It would appear to be implementable even within PAHO.
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Anicle 21 of the ConstilUtion of PAHO.
WPR/RC48J9 page 93 Annex 9
ANNEX 1
CRITERIA FOR CANDIDATES FOR THE POST OF REGIONAL DIRECTOR IN THE EUROPEAN REGION 1
The following criteria were approved as guidelines b~ the Regional Committee at its fortieth session (resolution EUR/RC 40 l R31. The candidate must have a true commitment to WHO's mission. The candidate should be trul\ committed to the values. roles and policies of WHO and notably the goal of health for all. There should be c1e;r evidence of his/her personal involvement in furthering that commitment. The candidate must han proven leadership qualities and integrit),. The candidate must have demonstrated long-term and consistent leadership qualities, A commitment to outcomes and effective results as opposed to merely a concern about processes - is essential. and the person must be dynamic, Ability to communicate in a clear and inspiring way is an important requirement, Such communication skills need to be effective with widely different target groups. including the mass media. and involve direct personal contact with political and other leaders in the public health field. health personnel. a wide range of academic and other professional groups outside the health sector. and WHO staff. etc. In view of the high goals of WHO and its Impartial international character. the personal integrity of the candidate and the ability to withstand pressures from official or pm'ate sources contrary to the interests of the Organization are essential. The candidate must h3\'e pro\'en managerial ahilit),. The person should have demonstrated clear abili~ to manage a complex organization in the health field. Hislher performance in that role should have demonstrated a determination to make a thorough analysis of the problems and possibilities for solving them: the setting of c lear goals and objectives: the design of appropriate programmes for optimal use of the total resources: the efficient use of those resources: and a careful process for monitoring and e,·aluation. Importance should be attached to the candidate' s skills in fostering teamwork - with appropriate delegation of responsibilit~ - and in creating a harmonious working en\'ironment. In view of the need for the work of the Region to interact \\ ith and acti\'el~ support the efforts of other regions and headquarters. the candidate's ability to work effectively with leaders. at both national and international le\els. in health and other sectors. is an important element. The candidate should be a person professionall~' qualified in the field of health and ha\'ing a sound I-:nowledge of public health and of its epidemiological basis. This ~'pe of qualification and background would greatly assist the candidate in the performance of his/her duties. and in contacts with national health administrations. The candidate must ha\'e a broad understanding of the health problems and political. cultural. ethnic and other sensitivities in the Region. In view of the above. it follows that the candidate would normally be a national of one of the Member States of the Region. The candidate should be fluent in more than one of the working languages of the Regional Comminee. and knowledge of others would be an asset.
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, The Standing Comminee of the Regional Comminee has proposed that these criteria be amended the criteria contained in resolution EB97 ,R I 0,
to
take
Into
account
WPRlRC4819 page 94 Annex 9
RELEVANT PROVISIONS OF RESOLUTION EB97.R10 CONCERNING QUALIFICATIONS FOR THE POST OF DIRECTOR·GENERAL
The Executive Board.
I. RESOL YES that the candidate nominated by the Executive Board for the post of Director-General should fulfil the following criteria: he or she should have: (I) (::Ol (3) (41 (5) (6) (7)
a strong technical and public health background and extensive experience in international health: competency in organizational management; proven historical evidence for public health leadership: sensitiveness to cultural. social and political differences: a strong commitment to the work of WHO; the good physical condition required of all staff members of the Organization: and
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sufficient skill in at least one of the official and working languages of the Executive Board and Health Assembh _ --
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·. WPRlRC48/9<
page 95 Annex 9 ANNEX 2
RELEVANT PROVISIONS OF RULE 47 OF THE RULES OF PROCEDURE OF THE REGIONAL COMMITIEE FOR EUROPE 47.1 At its session preceding the one at which a person is due to be nominated as Regional Director. the Committee shall appoint a Regional Search Group to make a preliminary evaluation of candidates for nomination in the light of the criteria specified by the Committee and to perform related functions as set out in this Rule. 47.2 Not less than eleven months before the date fixed for the opening of a session of the Comminee at which a person is due to be nominated as Regional Director. the Director-General shall inform each Member of the Region that he will receive proposals of names of candidates for nomination bv the Committee as Re12:ional Director. ~ 47.3 Any Member of the Region may propose the name or names of one or more persons. each of whom has indicated willingness to act as Regional Director. submitting with each proposal particulars of the person' s qualifications and experience. Such proposals shall be sent to the Director-General so as to reach him not less than seven months before the date fixed for the opening ofthe session. This time-limit may be extended by the Chairman of the Committee on the proposal of the Regional Search Group. Any such extension shall be communicated by the Chairperson of the Regional Search Group to the Director-General. who shall promptly inform the Member States of the Region. 47.4 A person holding office as Regional Director for the Region shall. ifhe is eligible and has so requested within the time-limit referred to in Rule 47.3. be a candidate for nomination without being proposed under the preceding paragraph. 47.S Not later than two weeks after the expiration of the time-limit referred to in Rule 47.3. the DirectorGeneral shall transmit a list of names and all particulars of candidates received to the Chairperson of the Regional Search Group. 47.6 The Director-General shall. not less than ten weeks before the date fixed for the opening of the session. cause copies of all proposals for nomination as Regional Director (with particulars of qualifications and experience) received by him within the period specified to be sent to each Member of the Region and shall indicate to each Member whether or not the person holding the office is a candidate for nomination. Copies shall be sent to each representative appointed to attend the session of the Committee as well as to the Chairperson of the Regional Search Group. 47.7 At the same time. the Chairperson of the Regional Search Group shall send. under confidential cover. the evaluation report of the Search Group to the Chairman of the Committee. to each Member State of the Region for the attention of its chief representative designated to attend the Committee' s next session. and to the Director-General. 47.8 If within the prescribed time-limit no proposals have been received in accordance with Rule 47.3. and no request has been made by a person holding office as Regional Director for the Region as described in Rule 47.4. or if in the opinion of the Regional Search Group the candidatures submitted did not offer an adequate choice for the Committee. the Regional Search Group shall propose the extension of the time-limit in accordance with Rule 47.3. It shall take such action as it considers appropriate to identify potential candidates and report to the Member States of the Region on the results of such action. The Regional Search Group may also propose the name or names of one or more persons for nomination as Regional Director in accordance with the procedure set out in Rule 47.3.
·. WPRJRC4819 page 96
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WPRlRC48/9 page 97
ANNEX 10
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l· ~ World Health Organization
Organisation mondiale de la Sante Fifth meeting 9-11 July 1997 Provisional agenda item 3.8 EB/Constitution/5/6 25 June 1997
EXECUTIVE BOARD Special Group for the Review of the Constitution of WHO
-. Mission and functions of regional committees; frequency of regional committee sessions
The report of the third meeting of the special group stated that The frequency of regional committee sessions was in the hands of the regional committees and could be altered without any change to the Constitution. The group felt that the frequency of meetings should be decided upon in the light of the mission and functions of regional committees. This document reviews the provisions in the Constitution and resolutions related to the functioning of regional committees, reflects upon present arrangements in the regions, and sets out various options for consideration by the special group. The document has been prepared on the basis of material from all six regional offices. Only limited input however has been provided by the Regional Office for Africa, because of communication difficulties in connection with the civil strife prevailing in Brazzaville at the time of drafting.
FUNCTIONS OF REGIONAL COMMITTEES I. The functions of regional comminees are broadly set out in Article 50 of the Constitution:
(a) (b)
to formulate policies governing mailers of an exclusively regional character; to supervise the activities of the regional office;
(c) to suggest to the regional office the calling of technical conferences and such additional work or investigation in health malters as in the opinion of the regional commiUee would promote the objective of the Organization within the region;
WPRlRC48J9 page 98
Annex 10 (d) to cooperate with the respective regional commillees of the United Nations and with those of other specialized agencies and with other regional international organizations hm'ing interests in common wah the Organization; (e) to tender advice. through the Director-General. to the Organization on international health mailers which have wider t/tan regional significance: (f) to recommend additional regional appropriations by the Governments of the respective regions if the proportion of the central budget of the Organization allOl/ed to that region is insuffiCient for the carl)'ing-out {l{the regional functions:
(g) such other functions as may be de/egated to the regional commillee by the Health Assembly, the Board or the Director-General. 2. A review of past Executive Board and Health Assembly resolutions gives linle guidance on how these functions should be discharged. However, after a study in 1979 of WHO's structures in the light of its functions,' the Health Assembly adopted resolution WHA33.17 in May 1980, which related to integrating activities at all operational levels to deliver health for all by the year 2000. In that context, the Health Assembly covered the responsibilities of the various levels of WHO, and urged the regional comminees: (1) to take a more active part in the work of the Organization and to submit to the Executive Board their recommendations and concrete proposals on mailers of regional and global interest;
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(2) to intensiJj' their efforts to develop regional health poliCies and programmes in support of national, regional and global strategies for health for all. and to consider establishing or strengthening appropriate subcommillees to this end: (3) to promote greater interaction in the regions between the activities of WHO and those of all other bodies concerned, including bodies of the United Nations system and nongovernmental organizations, in order to stimulate common efforts for allaining healthfor al/ by the year 2000; (4) to support technical cooperation among all Member States. porticularlyfor allaining health for all;
(5) to provide support for the establishment or strengthening of multisectoral national health councils to Member States which so desire; (6) to foster the channelling of external funds for health into priority activities in the strategies for healthfor all of the countries most in need; (7) to extend and deepen their analysis of the interregional, regional and national implications of Health Assembly and Executive Board resolutions. and to provide such analyses to Member States; (8) to increase their monitoring. control and el'Oluationfunctions so as to ensure the proper reflection of national. regional and global health policies in regional programmes and the proper implementation of these programmes, and to include in their programmes of work the review of WHO's action in individual Member States within the regions. 3. In recent years. an important additional item on the agendas has been the manner in which regional committees have addressed the recommendations of the Executive Board Working Group on the WHO Response to Global Change. Significant rationalizations have been achieved in the method of work of regional
I
Document WHA33fl980fRECIJ Annex 3.
WPRlRC48/9 page 99 Annex 10 committees, such as reduction of duration (see paragraph 17), limitation of volume of documentation, introduction of technical briefings instead ofthe previous more formal Technical Discussions, and so on. These measures are reported on under agenda item 3.1, Status and progress of reform in regional offices and at headquarters with reference to the 47 recommendations made by the Executive Board Working Group on the WHO Response to Global Change (document EB/Constitution/5/2).
SUBGROUPS OF REGIONAL COMMITTEES 4. A number of linkages between regional committees and the regional offices are ensured through the establishment of various subgroups of the regional committees set up to facilitate the work of the regional committees and to advise the regional offices, particularly in areas (I), (2), (6), (7) and (8) of paragraph 2 above. 5. In the Region of the Americas, the PAHO Constitution establishes and defines the functions of the Executive Committee with nine elected Member governments, which has also been designated as the Working Party of the Regional Committee.' The Executive Committee has itself established various subcommittees, including the Subcommittee on Planning and Programming and the Subcommittee on Women, Health and Development, which facilitate the work of the Committee. 6. In the South-East Asia Region, the Consultative Committee for Programme Development and Management consists of a member from each Member State in the Region and meets twice a year to advise the Regional Director on matters related to programme formulation and implementation, prioritization, and other policy areas as requested by the Regional Director. 7. In the European Region the Standing Committee of the Regional Committee comprises nine elected senior health officials from the Region and the Deputy Executive President of the Regional Committee (ex officio who acts as Chairman). The Committee was established in 1993 with the basic mandate to act for and represent the Regional Committee and to counsel the Regional Director as and when appropriate between sessions of the Regional Committee. It meets in formal sessions four to five times a year. In the Eastern Mediterranean Region, the Regional Consultative Committee was established by the 8. Regional Committee in October 1983, and is composed of eight rotating members. It acts as the advisory body to the Regional Director in matters relating to implementation and evaluation of the strategies and plans of action for health for all, policies for the development of technical cooperation between and among countries of the Region, and main thrusts and directions for preparing the programme budget. It also reviews methods of work of the Regional Committee, monitors WHO's structure in the light of its functions, and assists the Regional Director in efforts to mobilize resources. 9. In the Western Pacific Region the Subcommittee on Programmes and Technical Cooperation, consisting of eight members selected by rotation among the Member States, supports the Regional Committee. It reviews issues relating to the General Programme of Work, to the health-for-all strategy, and to other policy matters before they are discussed by the Regional Committee. The Subcommittee also undertakes each year visits to at least two countries to review WHO collaboration in a specific field. For example, the topic for review in 1997 was emerging and re-emerging communicable diseases.
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I The fonnal agreement between the Pan American Health Organization (PAHO) and the World Health Organization (WHO) of24 May 1949, established the Pan American Sanitary Conference, through the Directing Council ofPAHO, as the Regional Committee of WHO for the Western Hemisphere.
: WPR/RC48/9 page 100
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Annex 10 APPOINTMENT OF REGIONAL DIRECTORS 10. The role of regional committees related to the appointment of Regional Directors (Article 52 of the Constitution) was discussed at the fourth meeting of the special group meeting on 10 May 1997.
MISSION OF REGIONAL COMMITTEES II. A comprehensive review of past governing bodies resolutions reveals that the question of a mission statement for regional committees (or for that matter of the Executive Board or Health Assembly) has so far not been a matter of concern for Member States. The regional committee functions, as stated in the Constitution, have up to now been regarded as the basis to pursue the work of these bodies. 12. The special group would have to decide whether it wished to consider the issue of mission statements for the governing bodies of the Organization and, in particular, the regional committees. .-
FREQUENCY OF REGIONAL COMMITTEE MEETINGS 13. The Constitution states (Article 48) that regional committees shall meet as often as necessary. In practice the regional committees meet once a year, in September or October. 14. Should it be decided that the Health Assembly meets only biennially, i.e. in the year when the programme budget would be discussed, then the regional committees could follow suit. In fact, the Forty-sixth Regional Committee for Africa requested the Regional Director to look into the feasibility of holding biennial meetings. Furthermore, in an effort to effect savings at the time of budget reductions in July 1995, the Regional Director for Europe proposed that regional committees should meet biennially. (The proposal was not agreed to for the reasons given in the next paragraph.) 15. On the other hand, it could be argued that annual meetings of regional governing bodies are essential, as they allow ministers of health and other senior staff to maintain their familiarity with, and guide, the work of the regional office. As such, annual meetings facilitate close contact between the regional office and national policy-makers, and provide an invaluable forum for decision-makers in the region, which they would otherwise not have. In addition, it should be noted that annual meetings of the Regional Committee for the Americas (the Conference and the Council) are specified by the PARO Constitution. 16. In considering the question of annual compared to biennial meetings, the issues of time and cost savings, rationalization of work, developments in health, participation in the work of WHO, and harmonization within the United Nations system, all need to be carefully reviewed.'
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LENGTH OF REGIONAL COMMITTEE MEETINGS 17. As part of cost containment in general, regional committees have for a long time looked at ways and means of condensing their work. For example, none of the regional committees will henceforth meet for more than five days. In fact, the regional committees of the European, Eastern Mediterranean and Western Pacific regions currently only meet for four and a half days, which include approval of the report and closure of the meeting.
J
See document WHA331l980lREC/l Annex 3.
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WPRlRC48/9 page 101 Annex 10
GENERAL 18, In order to facilitate the best possible understanding of policies and ideas at global and regional levels. letters of invitation to Member States for regional committee sessions normally include a standard paragraph drawing their attention to resolution WHA33.17, which requests Member States to coordinate their presentation at regional committees and the Health Assembly, Member States often respond by designating ministers of health and other high-level representatives. who nonnally also attend the Health Assembly. Likewise, Executive Board members will nonnally attend sessions of regional committees and the Assembly.
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