Report of the fifteenth meeting of the Consultative Committee for Programme Development and Management

. c WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH EAST ASIA Fifteenth Meeting of the Consultative Committee for Programme Development and Management, New Delhi, 19 - 20 April 1989 SEA/PDM/Meet.l5/7 2 May 1989 REPORT OF THE FIFTEENTH MEETING OF THE CONSULTATIVE COMMITTEE FOR PROGRAMMEDEVELOPMlBll' ANDMANAGEMENT CONTENTS 1. 2. Introduction Review of the implementation of WHO's collaborative programmes in the Member States during the first twelve months of the biennium 1988-1989, i.e. 1 January to 31 December 1988 3. Review of the implementation of **Management of WHO's Resources** in the recent past, with a view to further accelerating programme implementation 4. Review of the manner and schedule of reporting to the Regional Committee and the Consultative Committee for Programme Development and Management Annex List of Participants 1. INTR0DUcT10N In pursuance of the directive from the Regional Committee that the Consultative Committee for Programme Development and Management (CCPDM) meet every six months to carry out a review of the implementation of the Organization's collaborative programmes in the Member States, the Regional Director convened the fifteenth meeting of CCPDM in the WHO Regional Office for South-East Asia in New Delhi on 19 and 20 April 1989, with the following terms of reference: 1. To review the implementation of WHO's collaborative programmes in the Member States during the first twelve months of the biennium 1988-1989, i.e. 1 January to 31 December 1988, 2. To review the implementation of "Management of WHO's Resources** in the recent past, with a view to further accelerating programme implementation, and 3. To review the manner and schedule of reporting to the Regional Committee and the Consultative Committee for Programme Development and Management. Welcoming the participants to the meeting, the Regional Director, Dr U Ro Ro, stated that the Organization was on the threshold of entering the period covered by the Eighth General Programme of Work (GPW), the second of the three GPWs leading to the target date of achieving the goal of Health for All by the Year 2000. Recalling the achievements recorded by the Organization in the past forty years, he pointed out that the perspective for WHO programme development and management was acquiring a new thrust of country-oriented focus with pragmatic programme planning and implementation under the leadership of the Director-General, Dr Hiroshi Nakajima. Although the financial position of the Organization had somewhat improved with the major contributor paying its share of the assessed contribution, the situation was still uncertain due to non-payment by several Member States. This was further compounded by the fluctuations and instability of major world currencies and cost escalations due to inflation. As a result, the budgetary implementation at country and regional/intercountry levels had to be reduced in the 1988-1989 biennium. The programme budget for 1990-1991 had been kept at the level of the 1988-1989 biennium so as not to increase the burden of assessment on Member States, particularly the developing countries. In order to enable the Member Countries to optimally use the available resources for implementing their national HFA strategies, effective management of internal and external resources was of paramount importance. In view of the keen interest of the Executive Board in programme planning and implementation at the country level, with stress on the strict application of the procedures for use of the Organization's financial resources, it was imperative to carry out proper planning and accelerate programme implementation to achieve full implementation. He hoped that the Committee would identify the actions necessary for speeding up programme delivery during the remaining period of 1989 so as to avoid the likelihood of financial cuts as were encountered in 1987. 2In conclusion, the Regional Director hoped that the deliberations at the current meeting would not only provide useful ideas towards better development and management of WHO's collaborative programmes in the Member Countries, but also help further strengthen the cordial relationship between WHO and the Member States to achieve the common goal of Health for All by the Year 2000. xx xx xx Dr U Tin U of Burma was elected Chairman and Dr S.P. Bhattarai of Nepal as Rapporteur. A list of participants is attached (see Annex). 32. REVIEW OF THE IMPLEMENTATION OF WHO'S COLLtlBORATIVE PROCRAMMES IN THE MEMBER STATES DURING THE FIRST TWELVE MONTHS OF THE BIENNIUM 1988-1989, i.e. 1 JANDARY TO 31 DECEMBER 1988 (Agenda item 3) The CCPDM noted that the working paper (SEA/PDM/Meet.l5/4) reflected the status of implementation of WHO's collaborative programmes in the Member Countries for the year 1988. It further noted that the implementation of the Organization's programme for the Region for the first year of the biennium 1988-1989 under the Regular Budget was 54 per cent, which was an improvement over the previous biennium. The Committee was, however, concerned over the low implementation rate for certain components, viz. short-term consultants, fellowships, local cost subsidy and contractual services agreements, by some Member Countries. cl The Committee felt that it was essential for the Member Countries and WHO to institute necessary measures to ensure that the Organization's resources were fully and optimally utilized, especially in the context of the increasing need of the countries for more funds to implement their national HFA strategies. The Committee recalled the recommendations made by it at its tenth meeting in September 1986 outlining the actions to be taken by the Member Countries and WHO for implementing various components. It was important for all concerned to continue to endeavour to implement the same in order to achieve full and smooth implementation of all WHO collaborative programmes. The Committee noted that the 1990-1991 budgetary allocation showed a "real decrease" of $3 million, vis-a-vis the approved budget for 1988-1989 a fact that should be borne in mind. It, however, felt that in order to secure additional funds for implementing national HFA strategies, it was essential to utilize the existing resources well before the end of the biennium to enable the Regional Office to make a justification to the Director-General of WHO for a higher allocation to this region. The issue of increasing the allocation for the South-East Asia Region in the WHO global programme budget came up for discussion. Points were made that the Region had a high population, low economic development, relatively underdeveloped health systems and high disease burden. Thus it required a higher allocation of funds from the global programme budget. In this context, it was suggested that the Members of the Executive Board from this region could raise this issue with the Director-General. It was also suggested that the delegation of the Member Countries at the World Health Assembly might also like to take up this matter. For these purposes, the Regional Office could provide information. In this context, the Regional Director informed the Members how the allocations were made to the regions after the World Health Assembly approved the WHO global programme budget. The country allocations were decided upon by the Director-General for all countries in a region, which was further divided among countries of the region on the basis of agreed criteria such as that adopted by the Regional Committee for South-East Asia so far as South-East Asia was concerned. He emphasized that under no circumstances did any country receive a lower allocation than that it had received during previous biennia. The following observations and issues emerged from the discussions on this subject: - There is a need to strengthen the WRs' offices in the countries concurrently with decentralization of authority, along with commensurate accountability in order to improve programme delivery. 4- The implementation of the fellowship component has lagged behind due to a variety of reasons, (FAFs), such as late receipt of fellowship application forms difficulties in securing suitable placement, lack of language proficiency, etc. English to some Member States, As the training of nationals remains important they may not reprogramme the fellowship funds till it is confirmed that placements will definitely not be possible. It was suggested that if funds under this component could be kept alive for at least one year beyond the period covered by the respective biennium i.e. funds could be obligated on receipt of fellowship nominations from the Member States pending actual placements by the Regional Office. This arrangement would allow one more year beyond the biennium for arranging actual placements i.e. the period allowed as per the WHO Manual for the liquidation of obligated funds. It was, however, clarified that according to the existing financial rules obligations could be made only when the placement was ensured and the Final Fellowship Estimate (FFE) raised since the quantum of funds required would be known only at that stage and not at the time of nomination. In this context, steps also be taken to implement the recommendations made by the Third SEA Regional Conference on WHO Fellowships, held in New Delhi from 29 November to 3 December 1988. - The Regional Office should make available clear guidelines for the use of WHO's resources through contractual services/special services agreement and local cost subsidy. These should be made available to the departments/ministries of all Member States to enable them to initiate requests that meet all the required information to facilitate their timely processing. - WHO's policy regarding the procurement of supplies and equipment be made more flexible, allowing maximum procurement at the country level. - The functional linkage between the joint Government/WHO coordinating mechanisms and the country support teams (CST) be strengthened so that necessary support from CST can be sought in programme formulation and developing detailed programme activities for the implementation of WHO's collaborative programmes. - Lists of available candidates/experts in various fields (with their bio-data) be made available to the Member States from time to time for the respective fields that the country needs to enable them to take necessary ,and timely steps for indicating the suitable short-term consultants required by them. - The recommendations made by CCPDM at its tenth meeting which, inter alia, required the preparation of detailed plans of action for the first year of the biennium, should be adhered to by the countries and the Organization for timely implementation of various components of the programme budget. 53. %VIaJ OF THE IMPLEMENTATION OF "MANAGEMENT OF WHO'S Rl?iSOfJRCEi$J" IN TIQ$ R.ECENT PAST, WITH A VIEW TO FURTHER ACCELBRATING PROGRAMbE IMPLEMENTATION (Agenda item 4) The CCPDM noted that the working paper (SEA/PDM/Meet.l5/5) provided an update on the recent developments on "Management of WHO's Resources" emanating from the deliberations on the subject in the Programme Committee of EB, the EB itself and the WHA. It also outlined the managerial mechanisms available at the country level and actions initiated by the WHO Regional Office to make optimum use of WHO's resources including the adoption of the Regional Programme Budget Policy. In this regard, the Committee noted that the joint Government/WHO coordinating mechanism had been functioning in one form or the other in all the countries, participating in programme formulation and implementation. I t should evolve more as an effective workable mechanism, flexible enough to suit the needs of individual countries. The Committee did not favour the use of this mechanism as another bureaucratic level in programme implementation. Ideally, the country collaborative programmes should be need-driven rather than demand-driven and that it should reflect a proper balance between the two. The Committee felt that management of resources should not be judged from the financial angle alone, but also, more importantly, from the standpoint o f quality and effectiveness. In the Committee's view, delegation of additional authority to the WRs would contribute to efficient implementation of WHO's collaborative programmes at the country level. The Committee also felt the need for strengthening the department/division in the Ministry of Health concerned with coordination of resources from UN and bilateral agencies at the country level, The following recommendations were made by the Committee: - The structure and functions of the joint Government/WHO coordinating mechanism may not be bureaucratized. This mechanism may be used mainly for policy direction and overall coordination of programme formulation and implementation. This mechanism may also ensure orderly and timely programme implementation and compliance with WHO financial rules. - The quality of programme implementation becomes relevant only when full implementation in financial terms has been achieved. However, it would also be useful for the countries to undertake evaluation of priority programmes periodically. - Support should be given to the department concerned in the Ministry of Health dealing with coordination of resources from UN and bilateral agencies. - Member Countries of the Region may take initiatives in the Executive Board and the Programme Committee of the Rxecutive Board to ensure that matters of regional concern are articulated clearly. 64. REVIEW OF THE MANNER AND SCHEDULE OF REPORTING TO THE REGIONAL COMMITTEE AND THE CONSULTATIVE COMMITTEE FOR PROGRAMME DEVELOPMENT AND MANAGEMENT (Agenda item 5) The CCPDM noted that the document SRA/PDM/Meet.l5/6 outlined briefly the evolution of changes in the presentation of information on various aspects of programme implementation. The Committee noted that the question of reducing the volume of documentation had been discussed at its last meeting in September 1988 but that no definite conclusion had been reached. The document presenting financial and technical aspects of programme implementation had undergone qualitative and quantitative changes with the inclusion of additional information from time to time at the request of the Committee. It was, therefore, essential to make a critical analysis of what types of information the Committee would really need and use in reviewing programme delivery at periodic intervals. The information needs in relation to programme implementation were currently being met through other channels, viz. the project delivery monitoring (PDM) cards, which the Committee acknowledged to have helped programme monitoring at the country level. As regards inclusion of an analysis of problems and constraints encountered in country programme implementation and actions to overcome these problems, the Committee reckoned that these were best dealt with at the country level in a concurrent manner with programme implementation. A suggestion was made that the Committee could drop its review of programme implementation for the first six months in view of the paucity of material information. Similarly, its review of the 24-month implementation could be confined to an overall summary of experiences in programme delivery during that biennium. The Committee concluded that there was a need to take a fresh look at the continued relevance of all the elements that had gone into the report with a view to weeding out those that were redundant or repetitive in the light of other forms of information currently available, and retaining those which were considered essential for the Committee to undertake its programme implementation review. The Committee, therefore, decided that the members should examine the question of reducing the volume of the report in the light of actual current needs of CCPDM and the types of information on programme implementation that had been introduced through other channels, viz. the PDM cards. The Committee also felt that the members should undertake necessary consultations with the officials concerned in their respective countries and convey their views and specific suggestions in this regard to the Regional Office by 15 June 1989. Eased on the information received from the countries, the Regional Office would prepare a working paper for consideration by the sixteenth meeting of CCPDM in September 1989. In the meantime, the status guo would be maintained. LIST OF PARTICIPANTS BANGLADESH 1. BHUTAN 2. BUEtMA 3. 4. DPRKOREA 5. 6. Mr Kazi Colam Rahman Joint Secretary Ministry of Health and Family Planning People's Republic of Bangladesh Dhaka Dr J. Norbhu Director of Health Services Royal Government of Bhutan Thimphu Dr U Tin U Director-General Department of Health Ministry of Health The Union of Burma Rangoon DrU Kan Tun Training Officer Department of Health Ministry of Health The Union of Burma Rangoon Dr Li Chang Born Senior Officer Department of Science and Technology Ministry of Public Health Democratic People's Republic of Korea Pyongyang Mr Kwon Sung Yon Officer Department of E&emal Relations Ministry of Public Health Democratic People's Republic of Korea Pyongyang -2- INDIA 7. Mr R.K. Ahooja Joint Secretary Ministry of Health and Family Welfare Government of India New Delhi 8. Mrs Veena Maitra Director (International Health) Ministry of Health and Family Welfare Government of India New Delhi INDONESIA 9. 10. MALDIVES 11. Mr Mohamed Rasheed Assistant Director of Planning and Coordination Ministry of Health and Welfare The Republic of Maldives Male MQNGQIJA 12. NEPAL 13. Dr Nyoman Kumara Rai Chief Bureau of Planning Ministry of Health Republic of Indonesia Jakarta Dr Darjono Jasmiredja Chief Division of Foreign Aid Planning Bureau of Planning Ministry of Health Republic of Indonesia Jakarta H.E. Dr P. Nymadawa Deputy Minister of Health Government of the Mongolian People"8 Republic Dlaanbaatar Dr S.P. Bhattarai Chief Manpower Development and Training Division Ministry of Health His Majesty's Government of Nepal Kathmandu contd .****p* 3 -3- SRI LANKA 14. 15. Dr Joe Fernando Director-General of Health Services Ministry of Health Democratic Socialist Republic of Sri Lanka Colombo Dr Damrong Boonyoen Acting Chief Medical Officer Office of the Permanent Secretary Ministry of Public Health Government of Thailand Bangkok WHO SECRETARIAT Dr D.B. Bisht, Director, Programme Management Mr N.P.H. Milner, Director, Support Programme Dr M.Z. Husain, Director, Planning, Coordination and Information Dr Aung Myint, Programme Development Officer Dr Samlee Plianbangchang, Planning Officer Mr C.R. Krishnamurthi, Health for All Officer Mr J. Mittar, Budget and Finance Officer Mr R.V. Narasimhan, Special Assistant to Director, Programme Management Mr S. Vedanarayanan, Senior Administrative Assistant Mr P.K. Mr P.P. Dr Uton Dr N.K. Dr Aung Mr M.L. Bansal, Administrative Assistant Singh, Clerical Assistant RESOURCE PRRSONS Muchtar Rafei, Director, Health System Infrastructure Shah, Director, Prevention and Control of Diseases Than Batu, Director, Research and Health Manpower Gupta, Chief, Promotion of Environmental Health WHO REPRESWTATIVES Dr A.N.A. Abeyesundere, WHO Representative, Bangladesh Dr M. Saifullah, WHO Public Health Administrator, Bhutan Dr Ranjit Roy Chaudhury, WHO Representative, Burma Dr P. Micovic, WHO Representative, India Dr S. Khanna, WHO Representative, Indonesia Dr Anan C. Pakdi, WHO Representative, Maldives Dr P. Hybsier, WHO Representative, Mongolia Dr Aung Myat, WHO Representative, Nepal Dr K. Fdstrom, WHO Representative, Sri Lanka Dr W.C. Newbrander, Ag. WHO Representative, Thailand INDIA - 2 - 7. Mr R.K. Ahooja Joint Secretary Ministry of Health and Family Welfare Government of India New Delhi 8. Mrs Veena Maitra Director (International Health) Ministry of Health and Family Welfare Government of India New Delhi INDONESIA 9. 10. MALDIVES Dr Nyoman Kumara Rai Chief Bureau of Planning Ministry of Health Republic of Indonesia Jakarta Dr Darjono Jasmiredja Chief Division of Foreign Aid Planning Bureau of Planning Ministry of Health Republic of Indonesia Jakarta 11. MONGOLIA 12. NEPAL 13. Mr Mohamed Rasheed Assistant Director of Planning and Coordination Ministry of Health and Welfare The Republic of Maldives Male H.E. Dr P. Nymadawa Deputy Minister of Health Government of the Mongolian People"8 Republic Ulaanbaatar Dr S.P. Bhattarai Chief Manpower Development and Training Division Ministry of Health His Majesty's Government of Nepal Eathmandu contd . . . ..p. 3 64. REVIEW OF THE MANNER AND SCRRDDLJ3 OF REPORTING TO THE REGIONAL COMMITTEE AND THE CONSULTATIVR COMMITTRR FOR PROGRAMMR DEVRLOPMENT AND MANAGEMENT (Agenda item 5) The CCPDM noted that the document SRA/PDM/Meet.l5/6 outlined briefly the evolution of changes in the presentation of information on various aspects of programme implementation. The Committee noted that the question of reducing the volume of documentation had been discussed at its last meeting in September 1988 but that no definite conclusion had been reached. The document presenting financial and technical aspects of programme implementation had undergone qualitative and quantitative changes with the inclusion of additional information from time to time at the request of the Committee. It was, therefore, essential to make a critical analysis of what types of information the Committee would really need and use in reviewing programme delivery at periodic intervals. The information needs in relation to programme implementation were currently being met through other channels, viz. the project delivery monitoring (PDM) cards, which the Committee acknowledged to have helped programme monitoring at the country level. As regards inclusion of an analysis of problems and constraints encountered in country programme implementation and actions to overcome these problems, the Committee reckoned that these were best dealt with at the country level in a concurrent manner with programme implementation. A suggestion was made that the Committee could drop its review of programme implementation for the first six months in view of the paucity of material information. Similarly, its review of the 24-month implementation could be confined to an overall summary of experiences in programme delivery during that biennium. The Committee concluded that there was a need to take a fresh look at the continued relevance of all the elements that had gone into the report with a view to weeding out those that were redundant or repetitive in the light of other forms of information currently available, and retaining those which were considered essential for the Committee to undertake its programme implementation review. The Committee, therefore, decided that the members should examine the question of reducing the volume of the report in the light of actual current needs of CCPCM and the types of information on programme implementation that had been introduced through other channels, viz. the PDM cards. The Committee also felt that the members should undertake necessary consultations with the officials concerned in their respective countries and convey their views and specific suggestions in this regard to the Regional Office by 15 June 1989. based on the information received from the countries, the Regional Office would prepare a working paper for consideration by the sixteenth meeting of CCPDM in September 1989. In the meantime, the status quo would be maintained. 2In conclusion, the Regional Director hoped that the deliberations at the current meeting would not only provide useful ideas towards better development and management of WHO's collaborative programmes in the Member Countries, but also help further strengthen the cordial relationship between WHO and the Member States to achieve the common goal of Health for All by the Year 2000. xx xx xx Dr U Tin U of Burma was elected Chairman and Dr S.P. Bhattarai of Nepal as Rapporteur. A list of participants is attached (see,Annex). 4- The implementation of the fellowship component has lagged behind due to a variety of reasons, (FAFs)~ such as late receipt of fellowship application forms difficulties in securing suitable placement, lack of language proficiency, etc. English to some Member States, As the training of nationals ,-remains important they may not reprogramme the fellowship funds till it is confirmed that placements will definitely not be possible. It was suggested that if funds under this component could be kept alive for at least one year beyond the period covered by the respective biennium i.e. funds could be obligated on receipt of fellowship nominations from the Member States pending actual placements by the Regional Office. This arrangement would allow one more year beyond the biennium for arranging actual placements i.e. the period allowed as per the WHO Manual for the liquidation of obligated funds. It was, however, clarified that according to the existing financial rules obligations could be made only when the placement was ensured and the Final Fellowship Estimate (FFE) raised since the quantum of funds required would be known only at that stage and not at the time of nomination. In this context, steps also be taken to implement the recommendations made by the Third SEA Regional Conference on WHO Fellowships, held in New Delhi from 29 November to 3 December 1988. - The Regional Office should make available clear guidelines for the use of WHO's resources through contractual services/special services agreement and local cost subsidy. These should be made available to the departments/ministries of all Member States to enable them to initiate requests that meet all the required information to facilitate their timely processing. - WHO's policy regarding the procurement of supplies and equipment be made more flexible, allowing maximum procurement at the country level. - The functional linkage between the joint Government/WHO coordinating mechanisms and the country support teams (CST) be strengthened so that necessary support from CST can be sought in programme formulation and developing detailed programme activities for the implementation of WHO's collaborative programmes. - Lists of available candidates/experts in various fields (with their bio-data) be made available to the Member States from time to time for the respective fields that the country needs to enable them to take necessary :and timely steps for indicating the suitable short-term consultants required by them. - The recommendations made by CCPDM at its tenth meeting which, inter alia, required the preparation of detailed plans of action for the first year of the biennium, should be adhered to by the countries and the Organization for timely implementation of various components of the programme budget.