Forty-fourth Meeting of the Regional Director with the WHO Representatives New Delhi, 6-15 November 1995

SEAJWR44lB 4 Forty-fourth Meeting of the Regional Director with the WHO Representatives New Delhi, 6-15 November 1995 Report of the Meeting World Health Organization Regional Off ice for South-East Asia New Delhi November 1995 1. 1 . 1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. CONTENTS Introduction Opening Address by the Regional Director Statement by the Representative of UNDP Statement by the Representative of UNICEF Statement by the Representative of UNESCO Statement by the Representative of UNFPA Statement by the Representative of Asian Development Bank Statement by the Representative of IL0 Statement by the Representative of UNIC Reforms in the Programme Budgeting Process for the Ninth General Programme of Work and Lessons learnt in the Preparation of Detailed Plans of Action Approaches and Strategies for Monitoring and Evaluation of WHO Collaborative Programme at Country Level WHO Collaboration with World Bank for National Health Development General Policy Guidance on WHO Programme Development and Management Progress on WHO Response to Global Change Review of Emerging Health Problems and Strengthening of Epidemiological Surveillance Emergency and Humanitarian Action for Health Update on WHO/GPA and UNAIDS Leadership and WHO Meetings and Special Addresses Closing Session . . . . . . ..* . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 1 1 2 3 3 3 4 4 5 5 5 7 . . . 9 . . . 11 . . . 14 . . . 16 . . . 18 . . . 20 . . . 22 . . . 23 . . . 24 ANNEXES 1 Agenda . . . 25 2 Programme . . . 26 3 List of Documents . . . 28 4 Group Responses on Leadership and WHO . . . 29 1. INTRODUCTION The Forty-fourth meeting of the Regional Director with the WHO Representatives was held in the Regional Office, New Delhi, from 6 to 15 November 1995. The WHO Representatives from all the countries of the Region and the staff of the Regional Office attended. In addition, Dr Y. Kawaguchi, Director, INA/HQ, and Dr M. Fernando, ICO/HQ, as also Dr Salim Habayeb and Dr Anthony Measham from the World Bank, participated in the meeting. The Agenda and Programme of the meeting are given in Annexes 1 and 2 respectively. Annex 3 gives the list of documents issued for the meeting. 1.1 Opening Address by the Regional Director In his inaugural address, the Regional Director, Dr Uton Muchtar Rafei, referred to the global changes of the past decade, which had created new challenges and new opportunities for health development. He said that multi-disciplinary and multisectoral orientation of health programmes, increasing participation of other agencies in the health sector, and decentralization of aid operations by major donor agencies had necessitated the diversification and enhancement of the role and functions of WHO. In response to global change, WHO had taken a number of measures to improve its efficiency and effectiveness through its reform processes. In this context, he referred to the work of the various Development Teams and said that their recommendations needed to be implemented without delay. In the Regional Office, a Management Working Group had been established. It had made a number of recommendations to bring about cost-effectiveness, enhance administrative efficiency, strengthen accountability and eliminate waste. Most of these recommendations were in the process of being implemented. He also referred to the reorganization of the technical divisions in the Regional Office in accordance with the revised managerial requirements. WHO had played its role in attracting development partners in health, such as the World Bank, the Asian Development Bank, and other bilateral and multilateral agencies in the mobilization of resources for health development. Such efforts would continue to integrate health and human development with its place in the centre of national socioeconomic development. Reporting on the outcome of the Regional Committee-meeting, the Regional Director said that the Committee had approved additional resources through intercountry programmes in order to tackle problems of common concern to the Member Countries in the context of strengthening of regional approach and solidarity. He urged the WRs to ensure the implementation of these supplementary proposals. He said that the Regional Committee had also discussed the subject of Renewing of the Health-for-All Strategy, and urged Member States to undertake country consultations on health challenges and major policy orientations which would promote consensus and serve as a basis for the elaboration of new national, regional and global strategies for Health for All. The Committee, which took up “Alternative Financing of Health Care” as the subject for its Technical Discussions, recommended that the 2countries should study and explore alternative financing of health care and introduce appropriate reform measures while fostering integration, complementarity and partnership between the public and the private sectors. Reporting on the recent meeting of Ministers of Health, he said that it had reviewed the achievements of its past meetings and considered new modalities of operationalizing TCDC as also various aspects of health in social development. In this context, he emphasized the need for the Regional Office and the country offices to shoulder greater responsibility in effectively helping to implement the recommendations and action points arising out of the meetings of Ministers of Health. Highlighting the concerns of urban health that needed to be addressed, the Regional Director said that a workable methodology in the Healthy Cities approach was already available. He urged the use of this modality for mitigating multisectoral causation of decay of urban environment. The Regional Director said that one way to reach the unreached, the underserved, and the urban poor was to exert WHO’s technical leadership and commitment to the achievement of EPI diseases reduction goals. The launching of National Immunization Days/weeks in the Member Countries was not only a remarkable success, but also gave WHO a tremendous opportunity for creating public awareness. It brought forth WHO’s leadership role in organizing extraordinary intersectoral coordination in extending EPI activities to reach the underserved and unreached segments of populations. The WRs were in a position to spearhead such campaigns and coordinate the ever-increasing support of the international partner agencies. In the context of the ongoing reform process in WHO, he urged the WHO Representatives to assist the Member States to develop realistic plans of action based on identified programme priorities and attainable targets and .products as well as in the monitoring’ implementation of the plans of action. 1.2 Statement by the Representative of UNDP Mr Bayani S. Aguirre, Senior Deputy. Resident Representative, appreciated the opportunities given by WHO to women in regard to appointments. Congratulating WHO for its excellent World Health Report 1995 - Bridging the Gaps, he expressed his happiness that UNDP’s main mission of poverty reduction had been greatly, strengthened by WHO’s recognition of poverty as a ruthless killer. The World Summit on Social Development had accorded high priority to health. Reiterating the need for the two organizations to work more closely towards the attainment of health’ for all, he requested WHO to adopt the UN system of coordinated programming approach. UNDP had recently undertaken a major review of regional HFA programming and the lessons learnt would be,assimilated. UNDP’s sustainable human development paradigm not only focused on the expansion of human capabilities, but also on the health of the environment, which was basic to human wellbeing. He called upon WHO to make use of the disaggregated data of a recent national household sample survey, carried out in India with UNDP support, for research. UNDP had also supported an expert group meeting of prominent social scientists in India to make recommendations to increase 3access to health and on means of financing of health. The outcome of a review of India’s health provision schemes in organized and unorganized sectors in the light of successful NGO experiences, would also be shared with WHO. He expressed the hope that UNDP and WHO would move forward from the stage of analysis and understanding to a stage of concrete cooperation. 1.3 Statement by the Representative, of UNICEF Dr Jon E. Rohde, Country Representative, said that UNICEF was committed to continue the close working relationship it had with sister agencies. Reiterating UNICEF’s close collaboration with WHO, he said that in their quest for health for all, the two organizations could reach the unreached and underprivileged in the countries. UNICEF considered polio eradication not merely as the elimination of an old public health scourge, but also as an opportunity for showing that, with concerted public action and mobilization of efforts from other sectors, health for all could be delivered on the same lines. While UNICEF was committed to assisting the countries in achieving polio eradication, he called upon the countries to work with UNICEF not only in eliminating immunizable diseases but also in tackling other pressing public health problems, such as micro-nutrient deficiencies. He appreciated WHO for its excellent epidemiological surveillance work related to guineaworm eradication in India. The endorsement by the WHO/UNICEF Joint Committee on Health Policy of the recommendations of the World Summit for Children was a big boost for UNICEF’s activities for children. In the wake of increased funding pressures and high expectations of the international community, collaboration was the only way to achieve the objectives of the two organizations. In this context, he looked forward to intense collaboration between WHO and UNICEF. 1.4 Statement by the Representative of UNESCO Dr Warren Mellor, Ag. Director, Regional Office, said that the UNESCO Sub-regional Office in New Delhi and the Regional Office in Bangkok covered all the countries in SAARC, excluding Pakistan and Bangladesh. Though not directly concerned with health, UNESCO welcomed partnership with WHO in the context of complementarity of roles to make a greater impact. The goal of UNESCO was education for all, just as WHO’s goal was health for all. Education, particularly of women and children, was an important component of the education-for-all concept. UNESCO was in the process of developing a major programme for learning without frontiers, which would be a major driving force for the next five years. Learning without frontiers was meant to break the barriers of social inhibition and social pressures and to deliver education, ,both formal and non-formal, through alternative ways, including distance learning. UNESCO was actively involved with WHO in the UNAIDS initiative, health and environment issue and in general health education. 1.5 Statement by the Representative of UNFPA Dr Wasim Zaman, Country Director (India-and Bhutan), said that one of the outcomes of the recent Inter-agency meeting, which reviewed the post-Cairo situation, was the emphasis 4given to collaboration between different agencies. UNFPA’s work necessitated close collaboration with WHO at different levels in the countries, particularly in technical backstopping. UNFPA had benefited from the knowledge, technology and operationalization of the technical guidelines for the distribution of contraceptives, and in regard to reproductive health, AIDS, etc. The International Conference on Population and Development had broadened this frontier further, particularly in addressing morbidity among women and adolescents. Reproductive health approach addressed not only the question of providing contraceptives but also the issues of rights of women, particularly the right to health and the right to quality of care. WHO could collaborate with UNFPA and the countries in defining quality and institutional systems for measuring the quality. This provided a vast,opportunity for collaboration between WHO and UNFPA. 1.6 Statement by the Representative of Asian Development Bank Mr Richard 0. Wada, Resident Representative, India, said that a regional conference on health sector reforms and a round table were organized, by‘ the Bank in Manila in May 1995, which was attended by policy-makers and research experts from 17 Member Countries. The Conference stressed the need for health sector reforms in the countries. It also emphasized that adequate resources to improve health services must be made available through reforms and alternative financing, such as health insurance, user charges and decentralization. WHO contributed both to the conference, and the round table. The Bank had also updated its policy on health to provide overall guidance on the Bank’s policy for assistance to the health sector. ADB’s assistance to the health sector hadrisen from a modest US$ 45 million in the 1980s annually to about 75 million in the 1990s. There had been a notable shift towards assistance to primary health care services targeted to the poor, children and women. In the process of developing a policy paper on health, the Bank proposed to organize workshops where representatives from the countries concerned and agencies such as WHO would be invited. WHO had assisted the Bank in-its ,recent ‘mission to Nepal, and regular contact was being maintained regarding health sector development projects in Indonesia. The complementarity of theroles of the Bank and WHO should be exploited fully. He sought WHO’s support and advice in carrying out studies and in drafting the Bank’s policy paper on health and expressed the hope that the fruitful interaction and collaboration existing between the Bank and WHO would be further strengthened. 1.7 Statement by the Representative of IL0 Mrs L. Tegmo-Reddy, Deputy Director, IL0 Office in India, stated that IL0 had many common areas of concern with WHO, particularly in the field of occupational safety and health. IL0 had promoted a number of international standards and technical conventions concerning workers’ health. There was also a major project on the networking of occupational safety and health centres in Asia covering 22 countries. One of the key objectives of IL0 in India was the promotion of occupational health of workers in the unorganized sector in order to improve their safety and working conditions. ILO-was a partner in WHO’s International Programme on Chemical Safety. It had continued to work closely with WHO on AIDS. IL0 had multi-disciplinary teams to take the programme closer to its constituents. IL0 was also 5involved in studying social protection for the unorganized sector, particularly women. IL0 would continue to collaborate with WHO in all these and other areas. 1.8 Statement by the Representative of UNIC Mr Feodor Starcevic, Director, congratulating WHO on the successes achieved so far, said that in his public speaking activities, he tried to highlight activities of UN agencies such as WHO, whose contributions over long periods of time had led to achievements lending credence to the UN system. Yet, many of such achievements did not get the recognition that they deserved. UNIC would continue to highlight such activities through its weekly newsletters and public speeches. Cooperation already existed between UNIC and the WHO Information Office. UNIC would do its best to promote WHO’s efforts in the countries and thus contribute to WHO’s useful work. 2 . REFORMS IN THE PROGRAMME BUDGETING PROCESS FOR THE NINTH GENERAL PROGRAMME OF WORK (Item 2.1) and LESSONS LEARNT IN THE PREPARATION OF DETAILED PLANS OF ACTION (Item 2.2) Introducing these items, Director, Programme Management, said that changes in the programme budgeting process flowed from World Health Assembly resolution WHA46.35 on Budgetary Reform, which, inter alia, emphasized reduction in the lead time between the beginning of preparation of the programme budget and its adoption, strategic programme budgeting, identification of priorities, etc. The general principles of programme management, set out in the Ninth General Programme of Work, made it clear that henceforth WHO resources must be used to make expected outputs the main considerations rather than the type of activity and resources. Under the new scheme of things, “products” were required to be clearly defined in each plan of action, which would be used for the monitoring and evaluation of achievement of products. The lessons learnt during this exercise would be used to improve the programme budgeting process for 1998-1999 and PoA for 1996-1997. The procedural guidance for formulating the programme budget for 1998-1999 was expected from HQ shortly. The plans of action would be supported by AMS as part of the world-wide WHO Management Information System. Discussion The commitment of high-level decision makers in the Ministry of Health is critical for adopting the changes advocated through the new planning process. It was ,found that this was forthcoming in most countries. At discussions with senior officials there was agreement on proper focusing of WHO resources towards high priority national programmes. This allowed operationalization of the concept of umbrella project in some countries. There was some reluctance to accept the concept of strategic and integrated programming at the project level where a sense of ownership exists. 6Prioritization in some cases was not easy. Consequently, in some countries, the former project concept prevailed and their number remained more or less the same as in 1994-1995. Some countries are not ready for the umbrella project idea. A better approach would be to promote the idea of “shared targets/products”. The new approach to programme budgeting has another positive effect in that this process would result in more interaction among high-level decision makers who have previously worked in their own “water-tight” compartments. The Procedural Guidance for the Preparation of Plans of Action, together with SEARO’s interpretation of this guidance, was received rather late this year. However, there had been constant communication between the Regional Office, WRs’ offices and national authorities regarding the critical change from an input component-oriented budgeting process to a product-oriented one. Therefore, countries had already started making preliminary plans of action and, when the final guidance was received, it was easy to improve them. The reference list of programme from HQ went down to the programme component level (four digit), which allowed the national Programme/Project Directors and WHO staff to put forward the case for retaining their regular traditional small technical areas for getting allocations. On the whole, however, most of the countries have been able to prepare a smaller number of plans of action at the level of specific programme (three digit). Implementation needs to be closely monitored paying more attention to technical aspects. The concept of umbrella programme, which is related to specific programme areas but aims to achieve the same target using similar strategic approaches, could be promoted. The idea of maintaining unprogrammed funds is not acceptable. WHO is a technical agency with staff resources and is in a position to catalyze developmental activities without using much financial inputs. Therefore, WHO resources at the country level .will be used in complementarity and supportive of other inputs for health development. There is a need to recognize the value of documenting staff input, including that of technical staff of the Regional Office. Action Points (1) Plans of action should be finalized by 15 December 1995. (2) Continuous improvement in the management of WHO collaborative programmes, including programme development and management, should permeate throughout the Organization. 7(3) Orientation training on the practical application of “strategic programme budgeting” process and preparation of plans of action should be organized for staff, both in the Regional Office and in the WRs’ offices. The 1996-1997 biennium being a transitional period in the preparation of PoAs, it is imperative that such orientation training of WHO staff should continue throughout 1996 and 1997. 3. APPROACHES AND STRATEGIES FOR MONITORING AND EVALUATION OF WHO COLLABORATIVE PROGRAMME AT COUNTRY LEVEL (Item 2.3) Director, Programme Management, introduced the subject, stating that mechanisms for monitoring and evaluation at the country level had existed since the 1980s. However, recent reforms in programme development and management had necessitated a review of the approaches and strengthening of monitoring of WHO collaborative programmes. The reforms also called for an evaluation of WHO collaborative programmes in order to identify the impact of WHO inputs in national health development. Director, Health Policy and Management, recalling the recent decision of the Governing Bodies, stated that the managerial process under a structured framework of the Ninth General Programme of Work (GPW), the strategic programme budget and annual operational plans of action demanded systematic monitoring and evaluation of WHO collaborative programmes. The existing mechanisms for review included detailed plans of action and six-monthly country reporting system. However, such reviews were broadly financial review of programmes rather than qualitative technical review of implementation of programmes activities. The present Programme Management Information System (PMIS) had, therefore, to be adapted to meet the requirements of the Governing Bodies, which had endorsed a new strategy through a federated information system incorporating improved communication technology. A WHO Management Information System (WHO/MIS) was being developed for use throughout the Organization As part of this, the Activity Management System (AMS) would be in operation by March 1996 while the RO/AFI system would be functional shortly thereafter. It was not easy to evaluate the impact of WHO contribution to national health development. In this process, two tiers, viz., the countries, and the secretariat should be actively involved. At the country level, it was imperative to know how WHO inputs had been used, whether the national goals had been achieved and what contribution WHO had made to achieve those goals. At the secretariat level, the evaluation should be limited to the review of WHO technical cooperation through its collaborative programme per se as well as the evaluation of strategies and mechanisms for such cooperation. Questions were raised as to whether the existing mechanism was adequate and how a simple, user-friendly and country- specific mechanism and methodology could be established to evaluate WHO collaboration with national health strategies and programmes. Discussion The WRs’ offices have been pursuing the strengthening of WHO/MIS in their offices as well as advocating a strong MIS within the government set-up. Any evaluation system, in order to sustain itself, ought to be simple and user- friendly. A minimum information content needs to be identified for effective evaluation. A well-built Activity Management System (AMS), as part of the worldwide WHO Management Information System, would be able to support the evaluation system. Initially, process evaluation, rather than impact evaluation, would be necessary for the managerial process. Since WHO technical and financial inputs for national health development is relatively smaller, impact evaluation of WHO inputs in national health development would be difficult. However, such an evaluation would be considered at the end of a six-year period, i.e., on completion of one GPW. There is a need to identify gaps in the evaluation process. The emphasis sometimes was on activities performed rather than on achievements. It would be more appropriate to evaluate how crucial, catalytic, technical and financial inputs with proper technical input could account for maximum return. Such an evaluation should be supported by the information system. WHO professional staff are the best resources available to countries. Their competence in providing technical cooperation in countries needs to be weighed in terms of cost-effectiveness. Monitoring and evaluation of financial implementation is still essential to understand the relative inputs provided to various activities and products. The existing accounting system will be further streamlined with the introduction of the RO-AFI system, which is expected to become functional in early 1996. An evaluation of programmes dealing with diseases or a particular health problem is relatively easy to set up. However, it would be difficult to evaluate the impact of a theme or integrated programme (at one or two digit level) because of broader framework and complexity of cross-programme issues. Experience has shown that some formative and process evaluation can be done. Evaluation is undertaken with a view to applying its results to policy and programme management and redefining strategies. Therefore, the results of the evaluation should convince end-users (planners and decision-makers). The existing monitoring and evaluation system for WHO collaborative programme in the South-East Asia Region needs to be reviewed in the light of the changes in programme development and management as well as in programme budgeting reforms. The experience of other Regional Offices in should take this as anthis area should be-shared. The Regional Office important development work. 9Action Points (1) The Regional Office should involve WRs in the development of an appropriate monitoring and evaluation system as a contribution to the global system. (2) WHO programme monitoring at the country level (WR Information System) should be adapted suitably/replaced in line with the new MIS and RO/AFI-BFI s y s t e m . 4 . WHO COLLABORATION WITH WORLD BANK FOR NATIONAL HEALTH DEVELOPMENT (item 2.4) The Regional Director welcomed the representatives from the World Bank and said that at a time when many countries of the Region were undergoing structural adjustments, a unique opportunity existed for the World Bank and WHO to work together and bring their comparative advantages closer to the countries. Referring to the epidemiological situation, he said that the emergence and re-emergence of diseases and other conditions today demanded a fresh overhaul of health policy. An important initiative between the two organizations was the Review Meeting, held in October 1994, and the informal briefing session, held during the Forty-eighth World Health Assembly. He expressed the hope that the current meeting would provide an opportunity to the WHO Representatives and. the Regional Office staff for facilitating better understanding of each other’s complementarities and support capabilities. Presenting the regional overview of WHO/World Bank collaboration in health development, Director, Health Policy and Management, highlighted the main characteristics of this partnership as emerging from the experiences in Bangladesh, India, Indonesia and Nepal. He informed the meeting that WHO and the World Bank worked closely at the country level, initiated effective health development and reinforced the complementary nature of each other’s work. WHO facilitated dialogues on health development between the Ministry of Health while providing staff support to World Bank appraisalmissions in the countries. WHO also provided technical support to the countries in the formulation of World Bank-financed projects and assisted the national authorities in the implementation, monitoring and evaluation of such projects. WHO had parallel financing of selected technical components of the World Bank projects in India. It was further mentioned that the, role of the Regional Office was basically supportive and coordinative. It provided updated information and advice, facilitated dialogues and interactions between the Bank, WHO/HQ, and WHO/World Bank country offices, and provided technical back-up support to WHO country offices. Discussion Collaboration between WHO and the Bank should be established at the early stage of any health-related activity in the countries. ,, Early involvement of WHO from the preparatory and planning stage of formulation of World Bank funded .projects has tremendous implications for subsequent implementation, monitoring and evaluation of these projects. It is also necessary for WHO to get involved upstream in order to bring about positive -influence on the 10 government and co-financiers and provide qualitative technical inputs in the formulation of technically sound projects for funding by the Bank. Two distinct modalities emerged from WHO/World Bank collaboration in India and Bangladesh. In Bangladesh, a consortium approach operates with a multiplicity of donors under the umbrella of the World Bank, and WHO has substantial executing role in it. In India, the projects are funded primarily by IDA and WHO primarily has a technical support role through individual projects. Vision and commitment of the government, and a continuing dialogue among the parties concerned are important pre-conditions for the success of a partnership initiative between the World Bank, WHO, and the government. The World Bank highly values the participation of UNICEF in its health sector activities. WHO should be viewed more as a technical agency rather than as an executing agency. The technical experience of WHO and financial resources of the World Bank can be combined in a complementary partnership to provide support to national capacity build-up in the health sector. The preparation of a World Bank project is increasingly becoming participatory and the Bank can benefit greatly from WHO’s experience at the grassroots. Although different perspectives of different organizations may generate conflicting ideas at times, yet a mutually beneficial partnership can be developed from one another’s experience while accepting disagreements in certain matters. Free exchange of information and ideas between WHO and the World Bank at the country level, where Bank support is focused, is a prerequisite for healthy partnership between the two organizations. In the broader context of health as a central component of the development process, interaction with the Ministry of Finance/Planning, and other development ministries is unavoidable. WHO and the World Bank should come together to jointly influence these ministries on health issues, particularly those having implications for poverty eradication and environmental programmes. Additionally, the process of liaison and consultation with other development partnerships, such as bilateral donors, UN agencies, NGOs etc. are also important to pool the comparative advantages and complementarities in support of national capacity building in the health sector. IDA resources are basically reserved for social sector activities. Therefore, it is often difficult for the Bank to support preparatory activities. WHO and UNICEF can play a very significant role in supporting preparatory activities, such as pilot studies, feasibility studies, project formulation etc., as has been done by WHO in India. The Bank recommends institutionalizing such support by incorporating them in the WHO programme budget documents. The World Bank has no funds for technical assistance either’and cannot fund salaries of long-term WHO staff. However,. it can pay for WHO staff time and the cost of travel of WHO staff. In exceptional circumstances, the Bank can also provide lump-sum funds for preparatory activities, which can be used for technical consultancy services but not for the recruitment of individual staff. 1 1 Sectoral analysis is critical for World Bank funding in the countries. It provides the basis for dialogue with the government, formulation of good projects and commitment of funds. The Bank is willing to work with WHO in health sector analysis in the countries. WRs will need advance information of sector analysis exercises for making meanin-gfuk contributions. Developing countries are often reluctant to take loans even at such a low rate of interest as that of IDA. The World Bank and WHO, can work together to convince governments about the usefulness of loans in the context of long-term benefits of health. However, it is an encouraging sign that many countries of this region, which were previously hesitant to accept loans for social sector activities, are now increasingly taking loans from development banks for health programmes. Although WHO has reasonably succeeded in overall national capacity building, it has not been equally successful in health policy development and in building national capacity for coordinating national and international resources. A modest effort has been made in Bangladesh with the support of ICO/HQ to explore appropriate means of accomplishing this task. A clear policy for coordination is necessary to realize the full benefits of complementarity of the development partners in the countries. Concluding the discussion, the Regional Director said that a beginning had been made for further strengthening partnership between the World Bank and WHO. Both the organizations had their strong as well as weak points, yet they could provide valuable support to the countries by combining their strengths. Action Points (1) The Regional Office should, in consultation with WHO/IIQ and WRs, periodically review and update WHO/World Bank relationship. (2) The WRs should exchange timely information on health and health-related development activities that are financed by the World Bank. 5 . GENERAL POLICY GUIDANCE ON WHO PROGRAMME DEVELOPMENT AND MANAGEMENT (Item 2.5) This item was taken up at a Special ACP meeting. Initiating the discussion, Director, Programme Management, said that this item had been included in the Agenda in order to provide an opportunity to the WRs to raise matters of general concern relating to programme development and management. 12 Discussion The change in programme development and management, including the budgeting process, is a learning experience for WHO as well as national programme managers. There is a sense of ownership at all levels and the solution lies in proceeding with the preparation of strategic programme budget and annual operational plans of action and improving them through continuous dialogue. The new managerial and budgeting process is essentially meant to improve procedures and mechanisms. It is also expected to provide more flexibility. There is however a need for caution to avoid implications in programme implementation. There are some difficulties in defining priorities, products or even activities at the level of programme manager due to various reasons, such as different interpretation of terms, e.g. targets, products, components, budget estimates etc.; sense of ownership; inability to accept the concept of integrated programme, etc. PoA should clearly describe the “product(s)” and indicate the activities to achieve them. There is no need to budget each activity. If the WRs feel necessary, they could prepare separate internal documents with budget for each activity for their monitoring. Budgeting by component (e.g. S&E, STC, FEL, CSA) may be avoided to retain flexibility of implementing activities in the most timely and cost-efficient way (activities are not components). It was clarified that budget allotment would be given at the level of specific programme, which has been identified with different products with budgetary estimates. It was also clarified that the implementation of activities could start as soon as the plans of action have been finalized, which was expected by early December. If necessary, an agreed upon activity can be initiated citing “advance implementation against finalization of PoA”. It was emphasized that plans of action were formulated through a series of consultative process between WHO country offices and the national health authorities and they are also reviewed and evaluated through the joint government/WHO coordination mechanism. Changes in programme development and management should permeate throughout the national process and mechanism. 13 procedural guidance already provided. Budget allotment would be provided for each PoA, which should detail the products to be achieved. Each product (or an intermediate product) would have a time-frame and should.describe the activities that would lead to the achievement of the product. Staff time would have to be indicated for each product if it is related to the inputs of WHO long-term staff. The implementation of activities would be monitored through the RO-MIS/RO-AFI system. It is essential to maintain the goodwill developed with the national authorities in the process of preparation of plans of action. Action Points (1) Technical units should review the plans of action submitted by each country and provide to HPM technical comments and suggestions for improvement, by 24 November 1995. (2) An “orientation kit” on WHO programme development and management, should be developed prior to the orientation workshop for WHO country staff, and then further improved. (3) Whenever a senior staff from the Regional Office visits a country, he should take this orientation kit for briefing the WHO field staff and interested nationals. WRs will be informed well in advance. (4) The forthcoming meeting of CCPDM in April 1996, etc. could include agenda item to draw lessons from experience. The annual meeting of WRs in 1996 should also include this item on its agenda. At the ACP meeting, the WRs were also briefed on developments in regard to the renewal of the HFA Strategy and in the field of reproductive health. RENEWING THE HEALTH FOR ALL STRATEGY The subject of renewing the Health-for-All Strategy-was thoroughly discussed at the twenty-eighth meeting of CCPDM, especially in relation to the country level processes and mechanisms. The recommendations of the CCPDM were submitted to the forty-eighth session of the Regional Committee, which debated this subject further. The Regional Committee adopted a resolution urging MemberStates to take all initiatives. and actions necessary to raise the awareness of the general public in order. to place human health at the centre of development; to undertake a comprehensive review of their health policies; and to ,undertake country consultation on health challenges and major policies orientations (resolution SEA/RC48/Rl). Action Point WRs should further pursue consultative processes according to the time schedule agreed by the World Health Assembly. 1 4 REPRODUCTIVE HEALTH The WRs were briefed on the strengthening of reproductive health at the country level, the changes in the Organization responsible for this area and the need for functional integration and operationalization of those objectives and strategies agreed by the Ninth General Programme of Work and the International Conference on Population and Development. It was mentioned that there was a need to prioritize essential reproductive health services to reorientate existing fragmented programmes, such as family planning, safe motherhood, adolescent health, women’s health, etc., through functional integration, and to organize action-cum-research programmes. Action Point WRs should promote a holistic concept and life-cycle approach to reproductive health and assist in reformulating reproductive health programmes by reorientation and functional integration of existing programmes. 6. PROGRESS ON WHO RESPONSE TO GLOBAL CHANGE (Item 3.1) Director, Administration and Finance, introduced this item and traced the developments relating to this item. He said that the Forty-eighth World Health Assembly had called upon the Regional Directors to pursue the implementation of reforms in a number of areas and to report regularly to the Executive Board on progress and any obstacles encountered in the implementation. In response to this, the Regional Director had already prepared a report on the progress to be submitted to the ninety-seventh session of the Executive Board. Among the important topics were budgetary reform; need for review of the WHO Constitution; WHO Management Information System; and HFA Strategy, and the issue of regional allocation. The meeting was informed that an ad hoc working group of the Regional Committee had critically discussed all aspects of the issue of regional allocations and its report would constitute the input of the Regional Office to the agenda item on Regional Allocations at the ninety-seventh session of the Executive Board, to be held in January 1996. The need for initiating the consultation process related to renewing the HFA Strategy was also stressed. The meeting was also informed that the final reports of the Development Teams on WHO Country Offices, and Personnel Policy would be discussed at the forthcoming session of the Executive Board. WRs would be kept posted of developments on these two issues. Director, Programme and Management, informed the meeting that the Regional Committee had looked at its own method of work and decided that in future a summary record of the meeting would be maintained instead of summary minutes. The attention of the WRs was focused on the need to involve the members of the Executive Board from the SEA Region more actively in matters relating to the Regional Committee, as well as issues of regional importance prior to meetings of the Executive Board. . 15 Discussion Action Points The main thoughts of the proposals’on WHO’s personnel policy would be on selection/recruitment of technically competent people, based on candidates’ profile, and a more focused and practical appraisal system and recruitment of National Professional Officers. The advocacy at the country level on WHO response to global change is having beneficial effects. The staffing of WRsy offices has been strengthened. There is now a positive attitude regarding WHO and~countries .are now more and more appreciative of the functioning of the WHO 6ountry offices. The suggestion to structure the grade of WRs ,frorn P5 to D2 provided an excellent chance for staff development. It was regrettable that the idea now seems to have been modified. The issue of separating the budget of the WHO country office from the country budget, which has been discussed in the past also, has still not been resolved. It was pointed out that such a step must be taken with utmost caution in the context of technical, ‘political and managerial implications. In addition to providing the:WRs with complete sets of documents related to the Executive Board and the World Health Assembly, it would be useful if the Programme Directors concerned provided annotated briefing notes indicating the important issues on which country delegations should be briefed. In addition, there was a need to brief WRs on the Organization’s thinking on “sensitive issues”. This, was being done by other UN agencies. (1) (2) (3) (4) The Regional Office should provide information updates and support WRs in implementing the reform process. In order to brief national-level officers on important developments, especially those that take place in the Regional Committee and global governing bodies, it may be timely to study thepossibllity of WRs’attending such sessions of the governing bodies. A small working group may be appointed to study the various implications of separating, the budget of the WHO country’ office. from the WHO country budget. / _ The Regional Office staff should provide annotated‘briefing notes on important issues to the WRs for the purpose of briefing country delegations to Executive Board meetings and the World,Health Assembly. 16 7. REVIEW OF EMERGING HEALTH PROBLEMS AND STRENGTHENING OF EPIDEMIOLOGICAL SURVEILLANCE (Item 3.2) Introducing the agenda item, Director, Integrated Control of Diseases, highlighted the emergence and re-emergence of infectious diseases in the Region as well as those that might pose a threat to the Region in the near future (e.g. ebola, yellow fever). He described the major factors responsible for the emergence of these diseases and stressed the need for intersectoral and multi-disciplinary collaboration to tackle this problem. He said that WHO’s strategies to combat these diseases included strengthening surveillance of infectious diseases, infrastructure to recognize, report and respond to new disease threats, and development of applied research. An Inter-regional Meeting on the Control and Prevention of Plague Epidemic and an Intercountry Meeting on New, Emerging and Re-emerging Infectious Diseases were held in the Regional Office during 1995. Country level meetings on emerging diseases were held in Thailand and one is planned in Indonesia during 1996. Other counties might also follow suit. A new division had been recently created in WHO/HQ for the surveillance and control of emerging viral and bacterial diseases. He then briefly reviewed the epidemiological surveillance systems in the countries and presented suggestions for strengthening surveillance. He stressed-the importance of starting from what the countries already had and the importance of adopting’ an integrated, broad-based approach. The role of WRs included advocacy, information exchange and facilitation of technical support. The following issues were brought to the consideration of the meeting viz. rapid response mechanism at HQ and regional levels, epidemic preparedness at all levels, application of International Health Regulations, need for regional and global networking and the role of WHO collaborating centres, public information and public relations, and economic and political implications of reporting outbreaks. Discussion Control and prevention of new, emerging and re-emerging infectious diseases is still very much in the conceptual stage. They need to be operationalized urgently. Following outbreaks of plague and ebola, Thailand has developed model scenarios and simulation exercises on how to respond to emerging disease problems. These could be shared with other countries. Modern technology, such as new electronic media and communication, should be utilized to obtain rapid information on emerging infectious diseases. Creating a SEAR0 home page in World Wide Web should be explored. Governments should be advised to make use of these programmes. A system of sharing of surveillance and other information, especially for monitoring drug resistance in TB and malaria, and geographical mapping of polio, using the electronic media, is being explored by Thailand and China. 17 The International Health Regulations should be reviewed and revised. Reporting of cholera, plague or yellow fever is counter-productive forcounnies because of the economic losses suffered by affected countries consequent to reporting. India is one of the few countries reporting cholera regularly, but because of the economic sanctions now being imposed, there is a possibility of not reporting. Deferred reporting (after two incubation periods have elapsed since the last case) should be considered. . An integrated approach to the reporting of communicable diseases within the context of the overall health information system should be developed. WHO should help countries to meet their global responsibilities in the prevention and control of communicable diseases. Cross border issues relating to the importation of infectious diseases should be addressed bilaterally by the countries concerned. Information provided to the public should be simple, easy to understand and not too technical. Various means of communication should be used for dissemination as well as collection of information. Where communication is difficult because of the terrain, strengthening of radio communication should be supported. The strengthening of infrastructure for epidemiological surveillance is very important. Countries should build on what is already available. Laboratory support for the confirmation of diagnosis is necessary in most countries. Networking of the WHO collaborating centres will ensure quality, economy and quick response. Guidelines and modules are required for training. HQ could develop and provide these to the countries. A unified reporting form will also be useful. There should be collaboration among the countries, WHO and other specialized agencies (e.g. Naval Medical Research Unit in Indonesia) on new emerging and re-emerging infectious diseases. Armed forces have mechanisms for dealing with emergencies. WHO can learn from them. In the Regional Office, a Rapid Response Team, comprising officers from several units, depending on the nature of the outbreak, will be constituted. For emergency preparedness, drills/exercises will be very useful. Summing up, the Regional Director said that WHO should respond quickly to any outbreak. To facilitate this, the Organization should have a. 24 hours availability response mechanism. Simulation models or drills could be used to maintain alertness for emergency preparedness. However, there should be continuity and regularity in these exercises. Since 18 events such as arsenic poisoning, oil fires and others would continue to occur, the Regional Office should be prepared to provide the necessary information to WRs with minimum delay. Action Points (1) WRs should advise the countries on the problem of new, emerging and re- emerging infectious diseases and advocate the need to strengthen the existing infrastructure for epidemiological surveillance and for early detection and prompt response to these diseases. (2) (3) (4) The Regional Office should collaborate with the new Division of Emerging Viral and Bacterial Diseases Surveillance and Control in HQ in obtaining and providing the countries with guidelines and training materials for the prevention and control of these diseases. Steps should be taken to establish a Rapid Response Team in the Regional Office. The Regional Office should make available simulation exercises, developed in Thailand, and emergency preparedness plans, developed in Bangladesh, to other countries. 8 . EMERGENCY AND HUMANITARIAN ACTION FOR HEALTH (Item 3.3) In his introduction, Director, Health Services Development, gave a brief account of the programme in the Region and emphasized the international context in which the Organization’s response to emergency situations in the South-East Asia Region was being strengthened. This was followed by a presentation explaining the restructured Division of Emergency and Humanitarian Action (EHA) in WHO headquarters for better international collaboration in major humanitarian crisis and the delegation of authority to Regional Offices for support to national emergency preparedness programmes. A brief account of WHO response to the emergency in DPR Korea and the recent floods in Bangladesh was given. WR Bangladesh presented a short history of disaster management in the country and the role played by WHO. He emphasized the future plans and briefed the meeting on progress towards developing the Bangladesh National Centre for Health Emergency Preparedness. Discussion Although Bangladesh is a disaster prone country, it has well-developed plans for emergency preparedness in times of disaster. WHO has been very active in supporting the MoHFW over the last four years. ‘The Disaster Preparedness Programme in India is a well-organized structure ~. within the government. The MoHW has a network of ,collaborating centres which it- is developing. The Ministry is also working with the Red Cross to 19 develop a Disaster Training Centre, which will provide continued inputs in emergency preparedness and training. In Indonesia, disasters provide an opportunity for WHO to show its leadership in providing emergency relief during disasters. Stress was laid on the value of planning and preparedness during emergencies. WHO’s response- to the Mt Merapi disaster is a good example of the Organization’s role in a disaster. The Asia Pacific Conference ‘on Emergency and Disaster Medicine, planned to be held in Indonesia from 15-19 October 1996, would provide a good opportunity to understand the planning and preparedness of countries during disasters. The University of Hawaii is offering places to candidates from the Region to receive training in EPR in January 1996. Efforts would be made by the WHO office in Indonesia and the Regional ,Office to get places for candidates from Indonesia. Plans for WHO collaboration with UNHCR in Myanmar for support to returning refugees were detailed. UNDP has an active role in Myanmar and plans for immediate action when requested. Even though the government has mechanisms for managing disaster-related activities, WHO is still in the phase of initiating dialogue with the government and deciding how WHO can complement its activities. Sri Lanka has few natural disasters but suffers from large-scale emergency. The HEDIP programme was outlined as an example of the inputs into the emergency that WHO had supported in the country. A workshop will be held in the country shortly to evaluate the programme. This would lay stress on the impact of disasters on internally displaced people and assist in coping them to cope with the effects of stress and trauma and the experiences undergone. It was hoped that the outcome of the programme would have a direct impact on the national planning process regarding displaced people. Thailand does not have many health problems associated with the current floods. However, the country has a~problem with man-made disasters. It was clarified that there was no ,formal relationship between ADPC and WHO but that the latter has enlisted the support of ADPC several times for training courses and that the possibility of increasing that collaboration was being explored. It was further felt that the EHA programme had to create the capacity for countries to meet emergency” situations themselves through strengthening preparedness. The Regional Office, which worked in close collaboration with DHA and WHO headquarters, should not be constrained and should respond quickly to disasters and work as a UN team. The role of WRs to act as bridges of communication during emergencies was stressed. Summing up, the Regional Director said that it was important .to identify where WHO assistance was needed for direct action and where WHO, had to work with others. It was necessary to be clear on this aspect so that the efforts put in by WHO -were clear and made 2 0 the .best use of by the country. He emphasized the importance of quick and appropriate action in emergencies, and said that the Regional Office should respond within 24 hours, wherever possible. The response could take the form of funds, information or technical advice. WRs’ offices could count on Regional Office support during emergencies. Action Points (1) The Regional Office should respond to disasters with utmost speed and work in coordination with other UN agencies. (2) During emergencies, rapid exchange of accurate and appropriate information is vital. Each WR should have a designated EHA focal point in his office, who should maintain regular contact with other focal points in other UN agencies and in the national structure. The WR should work closely with the UN disaster management team. (3) The Regional Office/HQ should provide guidance to Bangladesh in combating the problem of arsenic poisoning. 9. UPDATE ON WHOGPA AND UNAIDS (Item 3.4) Introducing the item, the Regional Director stated that the issue related to the Joint and Co-sponsored United Nations Programme on AIDS (now called UNAIDS) had been discussed in the past, including at the Global Policy Council meeting in Geneva and at the last session of the Regional Committee. The issue was an important one and all WHO Representatives were well-versed with the latest developments. Given that many practical issues were still to be resolved, he emphasized the need for continued dialogue between the WRs and the Regional Office, particularly in regard to issues that were relevant to the Organization. Director, Integrated Control of Diseases (ICD), invited the ‘meeting to focus on issues, such as UNAIDS working mechanisms at the country level, administration of UNAIDS funds, UNAIDS staff supervision, working mechanism between UNAIDS and the government, WHO country support to UNAIDS during this period, status of ongoing projects funded by the various cosponsors, and the division of responsibility between the six cosponsors. He also highlighted other practical issues that needed to be addressed, as for example, how WHO would mobilize resources at the country level; how WHO would fulfil country support needs during the transition; whether the WR should report directly to UNAIDS or through the Regional Office; and, finally, what would be the administrative and logistical support requirements for the WR to carry out additional responsibilities as chairman of the theme group. Discussion In many countries, theme groups have yet to be established, although inter- agency groups are in place in a few countries. Concern was expressed that some agencies had more access to information from UNAIDS while others had no information at all. Some were receiving specific briefings from their 2 1 respective headquarters regarding theme group chairmanship and their actions reflected the wishes of their organizations. Moreover, trends appear to indicate that commitment and support for many cosponsors at the country level are unlikely to increase and, in some cases, might even decrease in the future due to budgetary cuts and staff reductions. According to the Memorandum of Understanding signed by the heads of six cosponsors, UNAIDS should be considered as a test case for the success of reform in the UN system. Under UNAIDS, coordination of UN response at the country level will occur through the theme groups mechanism. However, there cannot be a single strategy for all countries. In some countries, UN groups are more cooperative and want to be complementary to each other, while elsewhere the case was different. Moreover, the process is still evolving. The chairperson of the theme group will have to report to the Executive Director, UNAIDS, directly while keeping the Resident Coordinator informed. It was also pointed out that the WR or any other agency chairing the theme group will report through his/her own channels. This issue must be resolved by the Organization as a whole. In the interim, WRs who chair the theme group, can report directly to UNAIDS while keeping the Regional Office informed. UNAIDS’ direct financial support to countries is very small compared to that provided by GPA. These funds are likely to be channelled through UNDP. Regarding resource mobilization by WHO at the country level, this needs further discussion because WRs must mobilize funds for other health problems too. Moreover, WHO resources, mobilized at the .country level, have to be routed through HQ. This also needs to be looked into. UNAIDS is to be administered by WHO. The implications of what it means, particularly at the country level, are not clear because the signed agreement between WHO and UNAIDS in this regard is yet to be available. Since WHO country offices are in the forefront in providing administrative support, it is not known how this can be done if WRs have neither been consulted nor have seen this agreement. Experience from selected countries show that the lack of clarity on administrative and logistical support was expected to lead to difficulties for WHO country offices. The point was also raised as to how the theme groups can function if there is no provision for secretarial support. UNAIDS procedures at the country level should also be clarified as soon as possible. The programme should, besides stating what it would do, also explain clearly how these will be carried out; how the UNAIDS staff, who are not WHO staff, will be supervised; and who will be responsible for providing them administrative, logistical and operational support. 2 2 Concern was also expressed on how WHO will maintain its technical support to the countries since GPA will cease to exist as of 1 January 1996. The role of WHO, given its mandate and comparative advantages, was clear; it will continue to provide technical assistance to Member Countries. WHO should restrict its support to areas of its competence. Action Points (1) (2) (3) (4) WHO/HQ should develop a position paper on HIV/AIDS, including the UNAIDS programme, articulating the role of WHO in dealing with the complex problem of HIV/AIDS. WHO has a crucial role to play in supporting national STD and AIDS programmes. WHO should maintain and strengthen its technical capacity at all levels, including provision for LTS as well as other activities in the regular country budget. WHO should continue to work closely with Member Countries and UN and bilateral agencies, in developing national plans of action on HIV/AIDS. WRs should also assist in the coordination of external. donors at the country level. WHO should keep ministries of health informed on UNAIDS, and advocate that they take a lead role in HIV/AIDS prevention at the country level. 10. LEADERSHIP AND WHO (Item 3.5) The session was conducted as a workshop by Dr W. Pigott. Introducing the session, he emphasized the fact that people felt uncomfortable even when they had control over change. The contents of the working paper were summarized. The paper highlights what people are saying about leadership, the importance of the “process of leadership” rather than the definition of a leader; that people in all sorts of situations emerge to assume responsibility for change; leadership as articulating a vision for the future, guiding, mobilizing, overcoming resistance; developing leadership by cultivating the values, vision and leadership skills of those with the opportunity to mobilize others; views on leadership and its characteristics; distinguishing between “leadership” and “management”; and differentiating between “leadership” and “leadership development”. The attention of the meeting was drawn to the three aspects of leadership in the WHO context: First, the transformative, empowering leadership called for to achieve HFA; secondly the demonstration of leadership by WHO as an organization amongst organizations by being effective and being excellent; and thirdly, within WHO, practising the values and principles of the PHC approach, with their emphasis on participation, equity and self-reliance; achieving a more participatory process, by which people work together to achieve a shared vision. This means finding new ways of both reflecting the vision and behaving, so that others experience what it means to be treated with respect, have their traditions and contributions recognized, be empowered to be responsible participants in their own development, with dignity and increasing self reliance. 2 3 The various aspects of leadership were then illustrated after which the meeting divided itself into seven working groups and addressed two sets of question, each for fifteen minutes, with each group making brief reports to the plenary (see Annex 4). Director, Programme Management, drew attention to the need to balance idealism with realism, to “live and let live” and enable others to progress. The Regional Director spoke of leadership as the management of positive change, an important component of which is the capacity to’anticipate events and consequences. This is especially important in health, so that changes may be planned for and managed in the right direction. He said that the WRs had the opportunity to influence top decision makers before they made decisions which might lead in another direction. Every one had a role to play in this. With this exercise, the Regional Director hoped that the staff would be inspired to move ahead with leadership development, because unless they were prepared to make together a strong commitment towards positive change, there would be difficulty. This was a start and the staff now needed to move on so that these ideas and issues permeated WHO culture. Action Point The dialogue and discussion on leadership should continue in the Regional Office and WRs’ offices in order to enable the required commitment to be generated and appropriate action to be initiated. 11. MEETINGS AND SPECIAL ADDRESSES In addition to having discussions on the various Agenda items, the WRs attended a presentation on recent developments in the International Programme on Chemical Safety, by a staff member of WHO/HQ Programme for the Promotion of Chemical Safety. At this presentation, the multiple roles of poisons information centres were described. The key features of IPCS INTOX, a computerized, data-based management system developed by the International Programme on Chemical Safety, were presented. This system would be made available to the WRs and the countries. The WRs also attended (a) an address to the staff by the Regional Director; (b) a meeting of the WHD core group; and (c) a presentation on the WHO/MIS and the RO/AFI system. The WRs individually met with the Programme Directors, along with the staff of the various technical units, to review programme developments and to exchange experiences on the preparation of plans of action for 1996. The WRs also had a confidential session with the Regional Director, separate meetings with the staff of Administration and Finance on administrative matters, and with the representatives of the Staff Association on staff matters. 2 4 11. CLOSING SESSION WR Sri Lanka, speaking on behalf of all the WRs, expressed his appreciation of the new method of work of the WRs’ meeting, which allowed free, open and lively discussion as well as intensive participation by the WRs. This method should be followed for future meetings also. He said that the working papers for the meeting were very concise and provided a good basis for discussion. He welcomed the idea of presentation of papers and initiation of discussion by the WRs but felt that it might not be necessary for each WR to speak on every subject. The discussions brought out a number of important issues. The programme of the meeting itself could be modified to include an informal training session. He pleaded for more time to be allotted for individual discussions with the Programme Directors, as well as for discussions with individual technical units. In his concluding address, the Regional Director expressed his happiness at the successful completion of the meeting. He was glad to note that the change in the method of work of the WRs’ meeting was well accepted, and appreciated the high standard of the working papers. The atmosphere during the meeting had been unconventional but more relaxed, which enabled active participation by all concerned. A number of burning issues had been brought forth during the discussion and experiences shared. There was now a need for WHO at the country level to strongly advocate health, not only to the Ministry of Health but more to the Ministries of Finance and Planning, in view of the fact that there were now more agencies in the field. On the question of leadership and WHO, the Regional ,Director pointed out that it was not important how the issue was discussed but how leadership was practised, particularly at the country level, in order to respond to new and future challenges. In response to the suggestion made by WR Sri Lanka, the Regional Director said that in future two half days would be set apart for the WRs to have individual discussion with the units in the Regional Office as also for an informal gathering, outside the Regional Office, where a training workshop might be organized. Finally, he expressed his appreciation for the active participation of the WRs in the meeting and gratitude to the staff of the Regional Office for their ‘hard work and cooperation. 1 . 2 5 Annex 1 AGENDA’ Inauguration 2. 2.1 2.2 2.3 2.4 2.5 2.6 3. 3.1 3.2 3.3 3.4 3.5 4. 4.1 4.2 4.3 * 5. Programme Development and Management Reforms in the programme budgeting process for the Ninth General Programme of Work Lessons learnt in the preparation of detailed plans of action for 1996-1997 Approaches and strategies for monitoring and evaluation of WHO collaborative programme at country level WHO collaboration with World Bank for national health development General policy guidance on WHO programme development and management! Informal meeting of WRs Technical Subjects Progress on WHO response to global change Review of emerging health problems and strengthening of epidemiological surveillance Emergency and humanitarian action for health Update on WHO/GPA and UNAIDS Leadership and WHO Administrative Matters Confidential session with RD Meeting with Staff Association WRs’ Meeting with A&F group Closure ‘Originally issued as document SEA/WR44/1 dated 13 October 1995. ?his was discussed at the special ACP meeting. 2 6 Annex 2 PROGRAMME’ ____________________------------------------------------------------------------------------------------------------------------ Date Timing Agenda Item 6-8 November 1995 Individual Meetings with PDs and staff (Fe separate programme) Thursday, 9 November 0900-0945hIx 0945 - 1015 1015 - 1130 1130 - 1230 1400 - 1630 Friday, 10 November 0900 - 1100 hrs 1100 - 1230 1400 - 1430 Presentation on recent developments in the International Programme on Chemical Safety 1430 - 1 5 3 0 Item 3.3 - Emergency and humanitarian action for health 1530 - 1630 Item 3.4 - Update on WHO/GPA and UNAIDS Item 1 - Inauguration - Opening address by the Regional Director and statements by Agency Representatives Tea/coffee break Item 2.1 - Reforms in the programme budgeting process for the Ninth General Programme of Work Item 2.2 - Lessons learnt in the preparation of detailed plans of action for 1996- 1997 Item 2.3 - Approaches and strategies for monitoring and evaluation of WHO collaborative programme at country level Item 3.1 - Progress on WHO response to global change Item 3.2 - Review of emerging health problems and strengthening of epidemiological surveillance ‘Originally issued as document SEA/WR44/2 dated 13 October 1995. 27 Date Timing Agenda Item ___---__-----___-_-------------------------------------------------------------------------------------------------------------- Satur&y, 11 November 0900- 1130hrs Special ACP Meeting 1130 - 1230 and 1400 - 1500 1500 - 1700 Monday, 13 November 0900 - 1030 hrs 1030 - 1200 ‘1330 - 1430 1430 - 1630 Item 3.5 - Leadership and WHO Tuesday, 14 November 0900 - 1630 hrs Item 2.4 - WHO Collaboration with World Bank for national health development - Regional Overview Wednesday, 15 November 0930 - 1200 hrs (kern 2.5 - General policy guidance on WHO programme development and management) Item 2.6 - Informal meeting of WRs Item 4.1 - Confidential session with RD Item 4.2 - Meeting with Staff Association Item 4.3 - WRs’ Meeting with A&F group Presentation on development in WHO/MIS and RO/AFI - Presentation by World Bank representatives - Presentation of country experiences: WR Bangladesh WR India WR Indonesia WR Nepal - Role of WHO Regional Office and country offices in further strengthening WHO/WB partnership - Wrap-up session Item 5 - Closure 2 8 Annex 3 LIST OF DOCUMENTS Working Papers SEA/WR44/1 SEA/WR44/2 SEAfWR4413 SEAfWR4414 SEA/WR44/5 SEA/WR44/6 SEAlWR44/7 SEA/WR44/7(a) SEA/WR44/7(b) SEA/WR44/8 SEAlWR4419 SEA/WR44/10 SEA/WR44/ 11 SEA/WR44/12 SEA/WR44/13 Information Documents SEA/WR44/Inf. 1 SEAlWR44lInf.2 SEA/WR44lInf.3 SEAlWR44JInf.4 SEA/WR44/Inf.S Provisional Agenda Tentative Programme Schedule of WRs’ individual meetings with Senior Staff Reforms in the Programme Budgeting Process for the Ninth GPW (2.1) Lessons learnt in the preparation of detailed plans of action for 1996- 1997 (2.2) Approaches and strategies for monitoring and evaluation of WHO collaborative programme at country level (2.3) WHO collaboration with World Bank for national health development (2.4) WHO and World Bank - Partnership in Health Development - Regional Overview (2.4) WHO Collaboration withWorld Bank for National Health Development in Bangladesh (2.4) General Policy Guidance on WHO programme development and management (2.5) Progress on WHO Response to Global Change (3.1) Review of emerging infectious disease problem and strengthening of epidemiological surveillance (3.2) Emergency and humanitarian action for health (3.3) Update on WHO/GPA and UNAIDS (3.4) Leadership and WHO (3.5) WHA resolution and Report by the Director-General on Emergency and Humanitarian Action (3.3) The role of WHO in Emergency Preparedness Programmes (3.3) Procedural strategies for implementation of recommendations for health development (2.4) Renewing the Health-for-all Strategy (3.1) Review of emerging infectious disease problem and strengthening of epidemiological surveillance (3.2) 2 9 Annex 4 GROUP RESPONSES ON LEADERSHIP AND WHO Q.l: Reactions/responses to the paper and introductory remarks on leadership. A variety of responses emerged, each group identifying both positive reactions and reservations. The groups used such terms as interesting, enthusing, inspiring, challenging, reinforcing and provoking self-analysis. However, they also found it too conceptual, hypothetical, academic and theoretical. Some felt it to be irrelevant while another noted that the spiritual dimension of health was missing. Some- were curious to read more, and most agreed that it was an important issue to discuss, which must be given more time and made operational. Q.2: What do you mean by leadership ? Please prepare a group definition. The group reports recognized that every one has the potential to exercise leadership; leadership as getting things done together, translating vision and imagination into goals and motivating and mobilizing people to achieve these goals, enabling them to achieve visible results; differentiating between “leaders” and the “process of leadership” with its invisible hand, its sensitivity to the situation and its flexibility; being an effective conductor, working with a team, facilitating, drawing out qualities in others, promoting self-reliance, getting the job done through the people and getting them on the right track. 4.3: What are the implications for us as an organization and as individuals? The issue is a serious one, needs more time, a more practical focus and a more appropriate forum, with a need to change the mind-set, look within ourselves, accept and adapt to change, share and contribute to a common vision, and foster the belief that every one can contribute and that good potential exists. The issues are broad, higher than individual effort. There is a need for clear vision, commitment to it and its transparent translation. We need to pull together the bureaucratic and democratic/political leadership in the Organization. We need to rebuild leadership within, build confidence and develop the leadership process through participation and consensus. Since individuals’ performance relates to organizational performance, we need to relate leadership to technical competence/performance, and through improving that, restore WHO’s leadership. We must recognize leadership capabilities at the different levels of the organization. There are consequences of being without the required leadership. We must shift from “serving countries” to “mobilizing” and “empowering”, and from “imposing” to “facilitating participation”. There is a need for honesty and openness and for participation in decision making. Spiritual aspects should be included. Q.4: action to enhance the leade;rshi~~~~,~srre~~~~ leadership and leadership development; ‘conti&he’thb aal&gGg. ‘: -r,’ it”.ii.~ 0’ : ., ,!.,. >, .--<.,, .I‘ f