W O R L D
H E A L T H
REGIONAL SOUTH
ORGANIZATION
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OFFICE EAST
FOR
ASIA
REGIONAL COMMITTEE Thirty-seventh Session
.5EA/~C37/19
20 S e p t e m b e r 1 9 8 4
REPORT OF THE SUB-COMMITTEE ON PROGRAMME BUDGET
1.
Introduction
The SubCommittee on Programme Budget held a preliminary meeting on 18 September 1984. Dr Uthai Sudsukh was elected Chairman. The Sub-committee reviewed its terms of reference (SEA/RC37/4) and the working paper S E A / R C ~ ~ / P B / W Pand . ~ all attachments relating to the implementation of the programme for the biennium 1982-1983, the first six months of the 19841985 biennium, and the Proposed Programme Budget for 1986-1987. The Sub-Committee met again on 20 September to conclude its work and to finalize its report. The meeting was attended by: Dr Dr Dr Dr Mr Dr Ms Dr Dr Dr Dr Dr 2.
Akhtar Iqbal Begum P.W. Samdup U Lun Wai Kwon Sung Yon R.K. Jindal* A. Brotowasisto Husna Razee 7 . . Jadamba Krishna Bahadur Singh S.D.M. Fernando Damrong Boonyoen Uthai Sudsukh
Bangladesh Bhutan Burma Democratic People's Republic of Korea India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Thailand
Review of the implementation of the programmes during the hiennium 1982-1983
The SubCommittee reviewed the working papers, paying particular attention to the conclusions of the Fifth Meeting of the CCPDM as recorded in document sEA/PDM/Meet 5/6. The SubCommittee endorsed these conclusions (see Annex l), with the following observations:
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Concern was expressed regarding the need for the careful monitoring of the activities of STCs in order to ensure that their technical performance was of acceptable quality. The benefits of short-term consultancies could be more fully derived through the provision of appropriate counterpart(s). National expertise may be utilized to fulfill requirements for short-term technical consultancy through the mechanism of the Special Services Agreement. The SubCommittee noted that broad proposals for the intercountry programme for 1986-1987 were now regularly being discussed by the CCPDM in order to bring about a better complementarity with country activities. However, it was felt that information regarding distribution of intercountry funds by activity and by country should be available. It was agreed that this subject be considered, further in detail, at a future meeting of the CCPDM.
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*Mr P.P. Chauhan, India, attended the first meeting on 18 September 1984
SEA/RC37/19 Page 2
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The Committee reviewed a proposal for re-examining the basis for allocation of a real increase in the Regional Budget and decided to recommend that the existing criteria be maintained for the time being. While more detail had been given regarding data in the "Others" column in the review of the first six months of the 1984-1985 biennium, it was requested that further information be provided in future concerning the composition of this column.
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3.
Review of the implementation of programme during the first six months of the biennium 1984-1985
The Committee reviewed the working papers, paying particular attention to the conclusions of the Sixth Meeting of the CCPDM as found in . The Sub-committee endorsed these document sEA/pDM/~eet 618 Section 2 conclusions (see Annex 2 ) with the following observations:
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The Sub-Committee noted the importance of extra budgetary resources to the total WHO Programme and the relatively low proportion of UNDP resources that are currently being allocated to the health sector. It urged that efforts be made to increase the proportion of these resources made available for health programming. The Sub-committee also noted that efforts had been made in one country to organize meetings between country-based representatives of potential funding sources and the Ministry of Health and that such meetings were found t o be productive. The Sub-committee requested that steps be taken by the Regional Office to further expedite the placement of Fellows.
4.
Review of Proposed Programme Budget for 1986-1987
After reviewing the Programme Budget Proposals for 1986-1987 contained in document SEAIRC3713 and Working Paper SEAIPDMlMeet 513, the Sub-Commit tee agreed: (1) that the programme proposals conform to the Seventh General Programme of Work for the period 1984-1989, are linked to the Medium-term Programme for the same period. and conform to the Organization's policy guidelines; and that the proposals for 1986-1987 reflect national and regional priorities;
(2)
The Sub-committee was informed that the Proposed Programme Budget for 1986-1987 represented an increase of 17.5% for country activities over the 1984-1985 approved budget, representing 13.52 for cost increases and 4% for real increase. It noted with concern the possibility that the 4% reflected as a real increase may be reduced or even eliminated, depending upon the as yet undetermined global funding situation.
SEA/RC37/19 Page 3 The SubCommittee noted that the broad country programme proposals could be modified according to changing national priorities. There was a need to avoid overlap between p r o g r a m s and to accord appropriate priority to the improvement of the competence of personnel engaged in primary health care. Response to these concerns could be reflected in the Detailed Programme Budget to be submitted to the thirty-eighth session of the Regional Committee. The SubCommittee recommends that the Regional Committee request the Regional Director to transmit the proposed programme budget (SEA/RC37/3) to the Director General for inclusion in his Proposed Programme Budget for 1986-1987.
5.
Other Issues
The SubCommittee discussed at length the established practice of the CCPDM conducting a Review of of programme implementation at 6, 12, 18 and 24 months of the biennium, and felt that this practice was worthwhile and should continue.
SEA/RC37/19 Page 5 Annex 1 EXTRACTS FROM THE REPORT OF THE FIFTH MEETING OF THE CONSULTATIVE COMMITTEE FOR PROGRAMME DEVELOPMENT AND MANAGEMENT, SEARO, NEW DELHI, 16-18 APRIL 1984 (Document SEA/PDM/Meet.S/6) Conclusions While being appreciative of the report on programme implementation as contained in the document sEA/PDM/Meet.5/2, the Committee felt that there was scope for further improvement in preparing and presenting the report and reached the following conclusions; 1. As regards information on activities of WHO undertaken with extra-budgetary resources, the Committee felt that it would be useful to include information on the financial and technical aspects of programme implementation relating to projects/programmes supported by extra-budgetary sources and executed by the Organization. Even though it would be difficult to obtain complete information in the existing situation, it would be worthwhile for the Secretariat to make an effort to do so. 2 . A breakdown of the different components included under the heading "others" such as CSAs, CTSAs, Common Services and participants, was likely to make the statement on implementation unwieldy and might not be essential for identifying the strengths and weaknesses of the implementation process. However, information relating to these elements should be more consistently and clearly presented in respect of the item "others" in future reports. It was suggested that the Secretariat should explore whether, in future, information under this heading could adhere to the description of components as given in the Detailed Programme Budget. 3 . As regards information on how far and how much intercountry programme activities supported the activities country by country, it was realized that it would be extremely difficult at this stage to furnish this information in a quantitative manner. The Secretariat should, however, strive to give a qualitative description of how the intercountry activities have been or would be supporting the country activities as a whole and, wherever feasible, country by country.
4. It would be interesting to review the detailed account/description of all reprogramming and the reasons therefor. However, the changes made in the planned programmes through reprogramming were all at the request of the governments and according to the changing needs of the countries. The required information regarding reasons for reprogramming can, therefore, be provided by the countries themselves. If the information was made available by the countries, it could be included in the report by the Secretariat. 5. Implementation of the STC component continued to be uneven. The problems had been identified at earlier CCPDM sessions; essentially the initial hurdles for the timely recruitment of STCs consisted of the difficulty experienced at the country level in drawing up the terms of reference and determining the timing for placement of STCs. At the Regional Office level, the delay was often due to difficulties in identifying suitable candidates at the right time. Often, the delay is due to
SEA/RC37/19 Page 6 excessively long clearance procedures in both the giving and receiving countries. The Secretariat, in collaboration with the Member States, should take the initiative to overcome the impediments so that this component could be implemented as planned in the current and in the ensuing biennium. 6 . The Committee felt that in view of the fact that six-monthly reporting over 6, 12. 18 and 24 months of a biennium was needed for submission to the CCPDM, the WPCRs' six-monthly report and other reports on programme development and implementation produced by the countries should be effectively coordinated in order to avoid duplication of efforts by WHO and by the countries.
As regards the provision of quarterly monitoring reports giving the budget/financial status of projects/programmes, it was agreed that the Regional Office should continue to provide such information to the WPCRs and the countries. Such an effort had already been initiated by the Secretariat commencing January 1984 and project delivery monitoring (PDM) cards were being supplied to the WPCRs. This system would be further refined based on the experience acquired during implementation. An evaluation of PDM cards should be undertaken after at least a year.
7 . The Committee realized that it would be difficult to provide a programme trend analysis based on country situations. It noted that the country desks were still in the process of being set up. Once this had been done, consideration would be given to providing a programme trend analysis. 8 . Further delegation of authority of reprogramming at the country level had already been recommended by previous sessions of the CCPDM. This was an area which needed to be studied, and tailored to thc needs of the individual countries, after mutual consultations between the national authorities, the WPCRs and the Regional Office. Action bas already been initiated in this regard in a few countries. Further action should be . i i l , e n on a country by country basis by the Regional Office in t t i e remaining Member States. 9. An effort should be made by the Regional Office to review obligations that in the past had resulted in variations in the estimat~d savings, and which in turn had led to ad hoc reprogramminc, and unplanned and not-so-relevant expenditure. 10. While realizing that there were various difficulties in generating timely information on total resources deployed and utilized in i~ealiii development activities in the Member States, the Committee felt that the entire health activity, whether supported by national budget, b y WHO resources or by funds from other agencies, should be reflected as a total effort for the realization of the objectives of health programme 0 0 0 in the countries. CCPDM development towards Health for All by the Year 2 should strive to review the total activity in an integrated manner and, in order to facilitate this type of review, the national authorities and tl-e Organization should make serious efforts to generate the necessary information as soon as possible.
SEA/RC37/19 Page 7 Annex 2 EXTRACTS FROM THE REPORT OF THE FIFTH MEETING OF THE CONSULTATIVE COKHITTEE FOR PROGRAHME DEVELOPMENT AND MANAGEMENT, SEARO, NEW DELHI, 16-18 APRIL 1984 (Document SEA/PDM/Meet 5/6) Review of Implementation of the WHO Collaborative Programme for the First Six Months of the Biennium 1984-1985, i . e . , 1 January to 30 June 1984 The Cornittee noted that the working paper (SEA/PDM/Meet 6/5) showed the status of implementation of WHO'S collaborative programmes in the Member Countries of the Region during the first six months of the 1984-1985 . e . . 1 January 30 June 1984 and that, in accordance with the biennium 1 Committee's recommendations made at its fifth meeting in April 1984, information on the technical and financial aspects of programme Implementation of projects and programmes supported by extra-budgetary funds (UNDP, UNFPA and voluntary funds) had been included in the working paper, as was information on CSA/SSA, which had been separated from the "Others" component. The Committee noted that the real trend of programme implementation would not be discernible from this working paper as implementation was in its initial stages and that most of the funds obligated were to cover the cost of long-term staff already in position, in accordance with provisions of the WHO Manual. As regards the delivery of country programmes, the Committee noted that programme implementation in the countries at the beginning of the biennium tended to be sluggish and gathered momentum only during the latter part of the biennium. The following points emerged from the Committee's deliberations on this agenda item: (1) Some countries utilized the joint WHO/government coordination mechanism quite effectively to monitor and evaluate the implementation of the Organization's activities at the country level, which facilitated timely action for corrective measures or for readjustment of the programme activities according to the government priorities. The recruitment of short-term consultants was a time-consuming process, involving the completion of diverse formalities. It would be helpful, in order to ensure the timely recruitment of STCs, if Member Countries could provide the terms of reference for short-term consultants and indications regarding the suitable dates for the assignment of the consultant. Some countries wanted the Organization to provide the bio-data of experts available in certain fields in order to facilitate procedural clearance. The first pre-requisite was, however, to develop the terms of reference. Once these had been developed, depending on the type of expert required, the Regional Office could provide the bio-data of experts available at the scheduled time to the countries concerned.
(2)
SEA/RC37/19 Page 8 (3) Implementation of the fellowships programme could be facilitated by the early identification of the national officials to be trained and intimation of their nomination, along with the information required in the prescribed WHO form to the Regional Office, in order to enable it to arrange for their timely placement. In this connection, some countries faced the problem of their nationals having to pass an English-language proficiency test as a pre-requisite for securing placement abroad. In order to avoid placement problems cause@ by this test, some countries are now utilizing intra-country fellowships to train their health personnel within the country.
(4) The implementation of the activities under the local-cost subsidy was entirely under the control of the national authorities and the full utilization of the allocation under this component would depend on timely planning and execution of detailed steps by the national manager concerned. (5) The Committee suggested that the Organization should avoid duplication of requests for the same information from countries which caused unnecessary work for the countries and WPCRs. The Committee was informed that the Organization was aware of the possibility of such duplication of requests for information and had been trying to avoid this by adopting careful screening methods.
( 6 ) The acquisition and use of funds from voluntary agencies fell into two categories, viz., (i) funds intended for undertaking specific activities in specific countries, and (ii) funds for carrying out specific programme activities without any limitation to specific countries. In the case of ( i ) , the Regional Office concerned was informed of the allocation of funds and the names of countries where the activities had to be carried out. The Regional Office then prepared the workplans fn consultation with the countries concerned. Once the funds were transferred to the Regional Office, activities could be implemented according to the workplan. WHO Headquarters controlled the allocation of voluntary funds for specific programme activities. Depending on priorities in different countries, the Regional Offices were given these funds, and they, in turn, drew up workplans in consultation with the countries concerned.
(7) HRGlCRU review, which had taken place in some countries of this Region. had not yet resulted in the mobilization of external resources, though it had produced useful information on resource availability, resource gaps and utilization patterns in the country concerned. This exercise was still in an early stage and only after a successful meeting of donors would one be able to see the results. (8) The Committee wiehed that, in future, information regarding the source of funds ( e . g . . Regular Budget, UNDP. UNFPA) should be indicated at the top of the financial statement, rather than in the middle, as had been done in the working paper.