Regional Committee for the Eastern Mediterranean
Sixty-eighth session
Provisional agenda item 4(b)
EM/RC68/12
October 2021
Update on implementation of the WHO Transformation Agenda in the Eastern Mediterranean Region
Introduction
1. The Transformation Agenda of WHO in the Eastern Mediterranean Region aligns with the overall WHO
Transformation Agenda as part of the all-inclusive reform initiative of the Director-General.1 Moreover, the
regional vision, Vision 2030, includes WHO Transformation as one of its four main strategic priorities.2 The
vision and its implementation are anchored in WHO’s Thirteenth General Programme of Work, 2019–2023
(GPW 13),3 aligned with the 2030 Agenda for Sustainable Development, and pursued as a joint commitment
with partner agencies through the Global Action Plan for Healthy Lives and Well-being for All.4
2. The three main regional strategic priorities have been further elaborated in WHO’s strategy for the
Eastern Mediterranean Region, 2020–2023: Turning vision 2023 into action.5 Regional strategic priority 4 is
transforming WHO to make it into an accountable, catalytic leader in health in the Region by making
fundamental changes in the WHO working business model, systems and culture. Of the five strategic
objectives outlined to achieve strategic priority 4, three are the focus of this report. These are: a) align the
work of all staff to a common strategy; b) ensure a fit-for-purpose structure and processes by improving
strategic positioning, engagement and capacities to efficiently respond to the country needs and priorities;
and c) expand partnerships and strengthen strategic communications as core functions. The remaining
strategic objectives are streamlining the evidence base for informed health policy and streamlining
measurement approaches to ensure WHO functions and country achievements. Progress in these areas is
reported to the Regional Committee in other documents.6
3. WHO Transformation has been undertaken in four phases, beginning in July 2017. The first phase of
consultation and analysis took place from July to December 2017, leading to a WHO Transformation plan
and architecture. The second phase, from January 2018 to March 2019, focused on the design of a strategy,
processes and operating model, and the development of GPW 13. The third phase, from March 2019 to
December 2020, aligned and initiated changes to organizational structure and ways of working, and saw the
development of the WHO Values Charter. In the fourth phase, which started in January 2020, the process has
focused on implementation and continuous improvement. The ongoing COVID-19 pandemic has been a
challenge to the implementation, but at the same time has provided an opportunity to refine and adjust
priorities and has accelerated the process of the Organization becoming fit for purpose to better deliver value
1 WHO Transformation [website]. Geneva: World Health Organization; 2021 (https://www.who.int/about/transformation, accessed 16 September 2021). 2 Vision 2023: Health for all, by all in the Eastern Mediterranean Region, 2020–2023. Cairo: WHO Regional Office for the Eastern Mediterranean; 2018 (https://applications.emro.who.int/docs/RD_Vision_2018_20675_en.pdf?ua=1&ua=1, accessed 16 September 2021). 3 Thirteenth General Programme of Work 2019–2023 [website]. Geneva: World Health Organization; 2021 (https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019---2023, accessed 16 September 2021). 4 Stronger collaboration, better health. Global Action Plan for Healthy Lives and Well-being for All [website]. Geneva: World Health Organization; 2021 (https://www.who.int/initiatives/sdg3-global-action-plan, accessed 16 September 2021). 5 WHO’s strategy for the Eastern Mediterranean Region, 2020–2023. Turning Vision 2023 into action. Cairo: WHO Regional Office for the Eastern Mediterranean; 2021 (https://applications.emro.who.int/docs/EMRPUB-RDO-014-2019-EN.pdf?ua=1, accessed 16 September 2021). 66 Major developments in relation to both areas are outlined in the Annual Report of the Regional Director (EM/RC68/3), and there is also a separate progress report on developing national institutional capacity for evidence-informed policy-making for health (EM/RC68/INF.DOC.7).
https://www.who.int/about/transformation https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019---2023 https://www.who.int/initiatives/sdg3-global-action-plan https://applications.emro.who.int/docs/EMRPUB-RDO-014-2019-EN.pdf?ua=1
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for money and transformative reform. Positive progress across the Transformation Agenda was reported in
The WHO Transformation 2020 progress report.7
4. The COVID-19 pandemic and its impact in all its dimensions have created high expectations and
demands of WHO globally on its capacity to act and respond efficiently and on the need to transform itself
into a fully fit-for-purpose organization. While the WHO Transformation has progressed well, with many
structural, functional and process improvements being made, the COVID-19 pandemic has raised additional
questions about the Organization’s mandate and purpose, and capacity to adjust to the new situation. These
have focused particularly on its funding mechanism, in which a large part of the budget is funded through
voluntary and earmarked contributions.
5. Several new recommendations have highlighted shortfalls across many services during the pandemic.
Recommendations have been received from the Independent Panel for Pandemic Preparedness and Response
(IPPPR)8, the Review Committee on the Functioning of the International Health Regulations (2005) during
the COVID-19 Response9 and the Independent Oversight and Advisory Committee for the WHO Health
Emergencies Programme10. These recommendations are highly relevant for the Transformation Agenda as
WHO adjusts its response to global health challenges, often in the very difficult context of worsening climate
change and situations of conflict.
6. As a consequence of the deliberations on these reports at the Seventy-fourth World Health Assembly in
May 2021, and to structure and facilitate the negotiations and decisions stemming from the recommendations
from these panels and committees, Member States agreed that the current funding mechanism was not
sustainable as it did not give WHO the level of flexible funding that was required to meet the demands it
faced. The Member State Working Group on Sustainable Financing and the Working Group on Strengthening
WHO Preparedness and Response to Health Emergencies have flagged the urgent need to better fund essential
functions of the Organization. At its third meeting (23–25 June 2021), the Working Group on Sustainable
Financing summarized the issue in five direct questions and transmitted them to Member States for
consultation and response during the 2021 season of regional committee meetings.11
7. A more efficient emergency response also requires becoming fit for purpose. The Incident Management
Support Team established internally to be the main entity in charge of the management of the COVID-19
response relies on a standardized structure and approach to manage its response to the health emergency and
follows best practices in emergency management through the six critical functions of leadership, partner
coordination, information and planning, health operations and technical expertise, operations support and
logistics, and finance and administration.
8. The WHO Transformation 2020 progress report states that demands from Member States, partners and
the general public have increased substantially and therefore implementing “best-in-class” processes to
support new ways of working is crucial, but that this is a moving target in scope and scale, requiring
continuous improvement cycles to remain fit for purpose.
7 The WHO Transformation: 2020 progress report. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/9789240026667, accessed 16 September 2021). 8 COVID-19: Make it the last pandemic. The Independent Panel for Pandemic Preparedness and Response (IPPPR); 2021 (https://theindependentpanel.org/mainreport/, accessed 16 September 2021). 9 Report presented to the Seventy-fourth World Health Assembly on WHO’s work in health emergencies. Strengthening preparedness for health emergencies: implementation of the International Health Regulations (2005) (A74/9 Add). Geneva: World Health Organization; 2021 (https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_9Add1-en.pdf, accessed 16 September 2021). 10 Report submitted to the Seventy-fourth World Health Assembly of the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (A74/16). Geneva: World Health Organization; 2021 (https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_16-en.pdf, accessed 16 September 2021). 11 Working Group on Sustainable Financing, 23–25 June 2021 [website]. Geneva: World Health Organization; 2021 (https://apps.who.int/gb/wgsf/e/e_wgsf-3.html, accessed 16 September 2021).
https://www.who.int/publications/i/item/9789240026667 https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_9Add1-en.pdf https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_16-en.pdf https://apps.who.int/gb/wgsf/e/e_wgsf-3.html
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9. This report builds on the previous progress report on the Transformation Agenda presented to the Sixty-
seventh session of the Regional Committee for the Eastern Mediterranean (EM/RC67/11)12, which described
the progress made by the WHO Regional Office for the Eastern Mediterranean and WHO country offices in
the Region as part of Transformation across all levels of the Organization.
Progress update
Governance of WHO Transformation
10. Transformation is a whole-of-WHO initiative that has country, regional and global dimensions. The work
is closely coordinated by the Global Transformation Team at WHO headquarters and a regional
transformation team in each region, including the Eastern Mediterranean Region. The Regional
Transformation Team collaborates with country offices through focal points in the network of Change
Supporters. The Regional Transformation Team engages closely with the Global Transformation Team
shouldering the main roles and responsibilities for managing and coordinating transformation initiatives,
developing appropriate solutions to implement Global Policy Group (GPG) decisions, orchestrating staff
engagement and initiating culture change in the workplace. Close and participatory collaboration between the
Global and Regional Transformation Teams takes place during regular biweekly joint meetings, as well as
outside them. The Regional Transformation Team is housed in the department of the Chef de Cabinet and is
overseen by the senior management team chaired by the Regional Director. The Regional Office has reviewed
its Transformation governance to better respond to the increasing demands in the Region and the requirement
to drive Transformation through the next phase. In this regard, the Office has recruited a Transformation Team
lead to manage the Team and coordinate with the relevant departments and units at the Regional Office and
WHO headquarters.
Evaluation of WHO Transformation
11. An external evaluation of WHO Transformation13 has taken place as a formative exercise, forward-
looking in its orientation, providing key stakeholders with an independent assessment of progress, identifying
gaps and informing the Transformation moving forward. Five recommendations were made that called for
clear and comprehensive outcome-level milestones, better engagement with Member States and investing
resources at country level. The evaluation also recommended the intensification of efforts to build a motivated
and fit-for-purpose workforce and accelerate the pace of change in organizational culture.
12. As per United Nations (UN) codified standards, WHO has prepared a management response14 to the
evaluation, whereby the Organization accepted all recommendations and made a commitment to specific actions
for each of them, with transparent public reporting to Member States identifying implementation actions and
timelines, responsible entities in WHO, and the tracking and reporting of progress. The Evaluation Office at
WHO headquarters tracks implementation for organizational learning purposes and reports annually to the
governing bodies. The management response and follow-up are publicly available, along with the evaluation
report and associated documents, as part of building better transparency and accountability of the Organization.
Country functional reviews
13. Transformation in the Region has made progress despite challenges in many areas. There has been an
enhanced focus on country offices and their capacity to deliver and meet external demands, collaboration
across all the levels of the Organization and strengthening partnerships. The country functional reviews
(CFRs) are one of the components that provide information for the Transformation workstreams.
12WHO Regional Committee for the Eastern Mediterranean progress report EM/RC67/11 on Transforming for enhanced country impact: progress in the Eastern Mediterranean Region. Cairo: WHO Regional Office for the Eastern Mediterranean; 2020 (https://applications.emro.who.int/docs/EMRC6711-eng.pdf?ua=1, accessed 16 September 2021). 13Report presented to the 149th session of the Executive Board on Evaluation annual report: Evaluation of WHO transformation (EB149/5 Add.1). Geneva: World Health Organization; 2021 (https://apps.who.int/gb/ebwha/pdf_files/EB149/B149_5Add1-en.pdf, accessed 16 September 2021).
14 Management response. Geneva: World Health Organization; 2021 (https://cdn.who.int/media/docs/default-source/evaluation-
office/who-tranformation-evaluation_-mgmt-response_8july2021.pdf?sfvrsn=29e482cc_5, accessed 16 September 2021).
https://applications.emro.who.int/docs/EMRC6711-eng.pdf?ua=1 https://apps.who.int/gb/ebwha/pdf_files/EB149/B149_5Add1-en.pdf https://cdn.who.int/media/docs/default-source/evaluation-office/who-tranformation-evaluation_-mgmt-response_8july2021.pdf?sfvrsn=29e482cc_5 https://cdn.who.int/media/docs/default-source/evaluation-office/who-tranformation-evaluation_-mgmt-response_8july2021.pdf?sfvrsn=29e482cc_5
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14. The Regional Office has carried out extensive, innovative and large-scale CFRs. This major process has been
a fundamental aspect of the Transformation Agenda in the Region, as part of workstream 3.3 and in line with Global
Policy Group aspirations for a new, aligned 3-level operating model and fit-for-purpose WHO country-level
presence. These reviews serve as a baseline for continuous quality improvement cycles to ensure that country offices
and the Regional Office are fit for purpose in a rapidly changing environment. The baseline CFRs have highlighted
interdependencies between specific WHO Transformation initiatives and the Organization’s work to optimize its
ability to deliver results at country level, in line with the needs and expectations of Member States and partners.
15. The CFRs have exposed a need for concerted action at Regional Office and headquarters levels to ensure
that all country offices are fit for purpose. Making a country office fully fit for purpose requires a corresponding
ability and capacity in the Regional Office to support them in this process. One of the key findings is that a
purely short- and medium-term focus on strategic alignment, planning and budgeting has constrained long-
term strategic positioning and engagement by country offices. There is also a need to develop a risk maturity
model and integrate risk management with planning and budgeting processes. The establishment of a CFR
implementation committee headed by the Regional Director along with the development of an actively
monitored and updated implementation dashboard will help on the implementation of the findings and ensure
a sustained and regular mechanism for continuous country offices ‘improvement
16. A key principle of the CFR implementation process is to ensure that it is integrated with existing planning
and review mechanisms. Hence, the Regional Office calls for the CFR process to transition into a continuous
quality improvement cycle for country offices, ensuring an ongoing process of alignment and adjustment for
the Organization to remain fit for purpose. This continuous quality improvement/fitness calibration process
is to be aligned with periodic strategic framework reviews at country level through the country cooperation
strategies and the United Nations Sustainable Development Cooperation Framework, which inform the WHO
biennial programme budget plans for each WHO budget centre, and WHO/ministry of health biennial
workplans and country support plans. These instruments provide WHO with a strategic framework to guide
its work in and with a country to responds to the country’s national health and development agenda and to
identify priorities for WHO collaboration in the areas where it has a comparative advantage to assure public
health impact, based on GPW 13 and the health-related SDGs.
17. In terms of resource mobilization and partnerships, there is a need for long-term engagement in a
systematic way and for building a more holistic approach to partnerships and resource mobilization. Major
challenges to business operations relate to inadequate operational capacity, the delegation of administrative
and financial authority to country offices and suboffices, and security. It is proposed that organograms are
structured and aligned with the GPW 13 framework and re-capacitated based on technical and functional needs.
18. Member States have been engaged with the process to better align with national priorities. A strategic
retreat, chaired by the Regional Director, was held with all WHO Representatives on 21 February 2021. It
provided an opportunity to present the findings of all 18 CFRs to the Representatives, country office teams
and regional teams and to obtain their feedback on the way forward, including the support required by country
offices from the Regional Office for implementation of CFR recommendations.
19. Reflecting the high value of the baseline CFRs for country offices, most are now requesting updates that
take into account the changing environments in countries, especially given the added responsibilities and
additional staffing requirements of the COVID-19 response. Addressing this increased demand and the need
to shorten the turnaround times of repeat CFRs now and in future, the Regional Transformation Team has
developed a new integrated CFR concept. The purpose is to provide additional information that contributes
to organizational change and leads to a continuous quality improvement cycle for fit-for-purpose country
offices instead of a one-off investment triggered by the baseline CFRs. A new integrated approach that
includes technical programme aspects has been adopted for the new CFR cycle to ensure that it fully
contributes to continuous quality improvement and adds value to ongoing organizational processes during the
biennium. The opportunities provided by the reviews of country cooperation strategies for assessing the
progress and impact achieved in strategic objectives will be key to harnessing examples of country successes,
issues and gaps.
20. Furthermore, programming and reporting milestones for the biennial programme budget from biennium
workplans development, harmonized three-level country support plans, programme budget 2020–2021 mid-
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term reviews and end-of-biennium evaluations, with the relevant inputs on resource allocations and uses,
including in human resources, offer ongoing and regular occasions to review the technical expertise required
as part of WHO staffing to deliver on the purpose. There may also be triggers for full or partial CFR reviews,
depending on changes in context (such as in Afghanistan or Lebanon), which would require WHO to adjust
its priorities and amend its approaches to implementation and operations. A second updated version of the
CFR in Yemen has been completed and other reviews are being initiated based on major changes in context
and needs.
Partnerships and communication
21. WHO Transformation also seeks to leverage partnerships and the global community. Successful results
have been achieved under the “New approach to partnerships” workstream. The successful work of WHO
would not been possible without intensive and committed work with its partners. WHO has co-chaired the
regional UN Issue-based Coalition on Quality Social Services together with UNESCO since June 2020. The
Coalition was established in the Arab States under the umbrella of the Regional Collaborative Platform, which
comprises the regional directors of UN agencies and coordinates UN agency support to United Nations
Country Teams (UNCTs) and resident coordinators as part of the UN reform. Efforts are also ongoing at the
regional level to enhance WHO’s contribution to UN processes and support WHO country offices in leading
on the health inputs to UNCT country programming activities, including the Common Country Assessments
and the new cycle of UN Sustainable Development Cooperation frameworks.
22. Additionally, the Regional Office has deepened its work with existing networks through the Regional
Health Alliance, a partnership of multilateral health, development and humanitarian agencies launched at the
end of 2020 to promote harmonized and accountable support to countries to accelerate progress towards the
health-related SDGs and facilitate implementation of the Global Action Plan for Healthy Lives and Well-
being for All. It has been crucially important in facilitating collaboration for the COVID-19 emergency
response. The Regional Office has not only built partnerships with other UN sister agencies but also with
other key stakeholders across the Region, resulting in greater efficiencies. Successful resource mobilization
has also secured more resources for the Region.
23. Communication has been essential during the COVID-19 pandemic for providing reliable, transparent
and accurate information, thereby building trust and engaging partners and stakeholders, including Member
States. Transformational initiatives introduced at the Regional Office have made it possible to outline an
innovative regional communication for health (C4H) strategy and programme. C4H draws insights from
social, behavioural and communication sciences to inform and change attitudes and behaviours for defined
public health outcomes at the individual, community and societal levels. By building and harnessing C4H,
the Regional Office can better communicate both technical and non-technical health information and stories,
from and for a wider range of initiatives, departments and programmes.
24. To implement a priority action identified in Vision 2023, the Regional Office has established a new
Department of Communications, Resource Mobilization and Partnership (CRP) at the Regional Office to
streamline its communication work in the interest of maximized harmony, synergy and alignment at regional
and country levels. This is yet another important transformational paradigm shift from vertical to integrated
structures and programmes, making them more strategic, productive and efficient. The Office has recognized
strategic media communications as a core technical function to foster C4H so that its trusted voice continues
to be heard throughout the Region, particularly during public health emergencies. The value of using both
traditional and digital communications channels has been demonstrated in the response to the COVID-19
infodemic.
Staff well-being
25. Part of the Transformation Agenda is to improve human resource management within the Organization.
The gender distribution statistics for August 2020 compared with August 2021 show a slight improvement,
with the percentage of female professional staff in the Regional Office and country offices increasing from
32.5% to 33.5%. At the director and WHO Representative level, the increase has been more significant from
25% to 34.4%. Staff mobility is also an important component for building staff experience and knowledge
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and contributing to career development. There was an increase from only three mobility cases in 2020 to eight
cases in 2021.
26. WHO has continued to invest in its staff to ensure that staff are aware of where and how they can access
mental health and psychosocial support services during the COVID-19 pandemic. The Regional Office has
provided updated and accurate information and implemented flexible working arrangements through distance
working. Professional development opportunities have been provided through online capacity-building tools.
The Office bases its organizational culture on the WHO Values Charter, reflecting the principles of human
rights, universality and equity established in WHO’s Constitution as well as in the ethical standards of the
Organization.
Culture of transparency and accountability
27. Transforming WHO is about changing mindsets, revising and simplifying processes and procedures, and
aligning structures and functions to make WHO a fit-for-purpose organization. Establishing the right tone
involves much more than having a system of compliance. The Regional Director emphasizes ethical
behaviour, accountability, compliance and risk management, setting a strong tone at the top and providing
advanced tools to support monitoring. Considerable progress has been achieved with the establishment of the
high-level Compliance and Risk Management Committee, chaired by the Regional Director in the Regional
Office and by the WHO Representative in country offices. This reflects the importance the Regional Director
has placed on enhancing accountability through improved compliance and risk management at both Regional
Office and country office levels as part of WHO Transformation, inculcating a culture that is risk-aware but
not risk-averse.
28. Technology is being used to support compliance monitoring through a risk management dashboard, audit
dashboard, pre-audit self-assessment checklist and expansion of the mandatory key performance indicators
(KPIs) as the basis for a thorough evaluation of country office performance, requiring strong monitoring and
data collection from all country offices. The KPIs were developed in consultation with country offices and in
line with the applicable rules and regulations, as well as by studying the lessons learned in other regions.
29. The Regional Office is now using a new mechanism based on the GPW 13 Triple Billion output score
card combined with the KPI measurement framework at the Regional Office level to demonstrate
performance and strengthen accountability. It measures WHO’s contribution in the Region in terms of outputs
and outcomes to measure the achievement of GPW 13 targets. Under the leadership of the Regional Director
and the participation of senior Regional Office management, an external review of the progress made in
implementing Vision 2023 was conducted in March–August 2021. Called the Mid-term push forward (MPF)
review, it provides the Regional Office and Member States with further analysis of results, achievements and
barriers and includes important information on the further action needed to prioritize and accelerate
Transformation processes at the regional and country levels. The MPF review report will be made available
at the 68th session of the Regional Committee for the Eastern Mediterranean.
Next steps
30. Transformation is a dynamic and ongoing process of change and evolution. It is an important process
for a learning organization with a future outlook such as the Regional Office.
31. In the upcoming months, the Regional Office is committed to addressing each recommendation of the
independent evaluation of WHO Transformation through the published management response, committing
itself to the highest level of transparency and accountability. Several actions require regional and country
level input and effort to ensure that the action plan for the implementation of the recommendations in the
management response is taken forward within the suggested timeline. The Regional Office is very keen to
share the progress made in its implementation with Member States through regular briefings and annual
reporting to enable their engagement and commitment to the Transformation process as it moves forward.
32. The Regional Office will also intensify its efforts to build a motivated and fit-for-purpose workforce and
accelerate the pace of the desired changes in organizational culture. Transformation has benefited from the
many recommendations of the various evaluations, working groups and assessments, and these are shaping
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and enriching the approach and informing future directions. This includes, for instance, building stronger
ownership among staff members across all levels of the Organization, taking into account their needs and
well-being during these challenging times, and stronger coordination and leadership of country offices. The
Regional Office will ensure it continues to support country offices during the Transformation process and to
reinforce WHO’s values and organizational culture in the Region.