Forty-seventh Meeting of the Regional Director with the WHO Representatives, WHO/SEARO, New Delhi, 14-24 October 1998

Forty-seventh Meeting of the Regional Director with the WHO Representatives, WHO/SEARO, New Delhi , 14-24 October 1998 Report of the Meeting World Health Organization Regional Office for South-East Asia New Delhi December 1998 Section 1 INTRODUCTION The forty-seventh meeting of the Regional Director with the WHO Representatives was held in the Regional Office, New Delhi, from 14 to 24 October 1998. The WHO Representatives (WRs), technical and administrative staff, from the country offices, as also staff from the Regional Office attended the meeting. Also, the representatives from several UN agencies in New Delhi attended the inaugural session. In addition, Dr Diego Buriot, Chief, Liaison Office for Support to WHO country offices (LSC), Dr Kamini Mendis and Dr Pene Key from the Roll Back Malaria (RBM) unit at WHO Headquarters, participated. Prof. Wadie W. Kamel, Clinical Professor of Family and Community Medicine; Director, Healthy Borders 21 Global Initiative, WHO Collaborating Centre for Border & Rural Health Research & Development, Phoenix Area, Tempe, Arizona (USA) was specially invited by the Regional Director to participate as Temporary Adviser. The meeting was inaugurated by Dr Uton Muchtar Rafei, Regional Director. Sections 2 and 3 contain the proceedings of the meeting, section 4, the conclusions and recommendations, and section 5, the closing session.

2 Report of the Forty-seventh Meeting of the RD with the WRs Section 2 INAUGURAL SESSION 2.1 Regional Director’s Inaugural Address (Agenda item 1) In his inaugural address, the Regional Director, Dr Uton Muchtar Rafei, welcomed the participants and the representatives of the UN and its sister agencies. He said that WHO had completed 50 years of service in the Region, providing technical support to strengthening national health development in the Member countries. The most outstanding achievement in this period was the eradication of smallpox. Now, WHO was poised to eradicate poliomyelitis, eliminate leprosy and control tuberculosis and malaria. In 1997, the Health Ministers had adopted the Declaration on “Health Development in the South-East Asia Region in the 21st Century”, which would form the basis for WHO’s collaborative efforts in the Region in the next few decades. WHO, he said, was in the process of reforming its structure and its functioning, and therefore must change to make a difference. The approach to health development by governments, UN agencies, bilateral donors, and others must also change. The formidable health challenges in the Region, like the HIV/AIDS pandemic, tuberculosis, malaria and other new communicable diseases, had to be addressed by all in a spirit of partnership and solidarity. WHO’s mission should be to take the lead and, together with other partners, improve the quality of life of the peoples of the Region. WHO would cooperate fully in the formulation of the UN Development Assistance Framework (UNDAF) within the United Nations Resident Coordinator System in the countries in a spirit of equal partnership, he added. 2.2 Statement by the Representative of UNDP Mr Niels Maagaard, Deputy Resident Representative, UNDP, said that since the International Conference on Primary Health Care at Alma-Ata in 1978, remarkable achievements had been recorded all over the world. However, the goal of HFA appeared difficult to reach especially in the South-Asia Region due to the prevailing poverty, political and economic unrest, and environmental degradation. The global health policy recognized the need for stronger partnerships for health between the private and public sectors, as well as civil society in order to provide a strong joint action in support of health for all. WHO and other concerned agencies should, therefore, support the governments in translating this policy into action. UNDP with its mandate to work towards sustainable human development would continue to work closely with WHO at the global and regional levels. UNDP, with WHO as the executing agency, was in the process of establishing a mechanism for efficient information flow during emergencies in India. As part of the Government- UNDP country cooperation framework, UNDP has also agreed to support the Indian Report of the Forty-seventh Meeting of the RD with the WRs 3 Government initiatives in the health sector, like community health care financing, school health programme, and multi-sectoral approach to health as a follow-up to the Regional Health Declaration in 1997. In the area of HIV/AIDS, UNDP was working with WHO. Also, it was working towards mainstreaming gender concerns in design, implementation, monitoring and evaluation of policies and programmes at all levels. 2.3 Statement by the Representative of UNICEF Mr Alan Court, UNICEF Representative to India, said that WHO and UNICEF have enjoyed very close cooperation for five decades in finding solutions to various health problems in the Region. The HFA initiative of WHO and the outcome of the World Summit for Children with its goals for the year 2000 were coming up for review. The gains arising from these initiatives should be sustained. Presently, UNICEF, together with other agencies, was working towards polio eradication. He said that the cooperation between WHO and UNICEF towards this goal was outstanding. Also, with regard to the measles control programme, UNICEF was focusing on the urban areas to reduce the transmission rates. There were other challenges requiring attention, like infant and maternal mortality. Not much progress had been made in the area of maternal mortality, which required special attention. The problem of HIV/AIDS was of utmost importance. This was an area where all the partners must work together and push forward to solve the present problems. Another important area of cooperation related to approaches towards integrated management of childhood illness. The focus here should be on the female health worker, and in helping her to perform more effectively through appropriate training etc. 2.4 Statement by the Representative of FAO Mr Peter Rosenegger, FAO Representative for India and Bhutan, said that the issue of food quality and safety which posed a threat, especially to the poorer sections of the population, were areas for joint action for WHO and FAO. For effective coordination in this area, it would be helpful if the two agencies pooled their knowledge and information to provide technical backup services. Interacting at different levels with a view to establishing a coherent and coordinated programme of activities in the countries of the Region was also desirable. 2.5 Statement by the Representative of UNESCO Prof Moegiadi, Director and Representative to India, UNESCO, said that UNESCO was committed to building and strengthening the capacity of the education system to respond to new challenges posed in the next century (by the society). Following the Asian Region Policy Seminar on AIDS Education organized by UNESCO and WHO in 1993-1994, UNESCO, together with other UN agencies including UNAIDS and the Government of India, had been striving to integrate 4 Report of the Forty-seventh Meeting of the RD with the WRs preventive HIV/AIDS education into the school system in the country. The task of addressing the needs and concerns of youth would be formidable in the South-East Asia Region. UNESCO was also engaged in enhancing the capacity of NGOs to design innovative outreach programmes using peer-education models. UNESCO was committed to the protection of the Human Rights of people infected and affected by HIV/AIDS. Report of the Forty-seventh Meeting of the RD with the WRs 5 Section 3 BUSINESS SESSION 3.1 Regional Director’s Opening Remarks While addressing the business session, the Regional Director emphasized the need to utilize WHO funds and manpower in areas where the Organization was at a comparative advantage. The Regular budget country allocations in the South-East Asia Region, amounting to 75% of its regional allocation, were not being utilized in the most effective and efficient way. These were spread thinly over too many programmes of doubtful technical quality, resulting in the lowest rate of obligation among all the Regions. With the absorption capacity of the Member countries being inadequate, other Regions questioned the rationale behind allocating such large amounts of funds to the countries in the Region. Considering the implications arising out of the World Health Assembly resolution WHA51.31, and to protect the regional allocations, it would be desirable to depend increasingly on the inter-country mechanism. This had also been highlighted by the Health Ministers at their meeting in September 1998. The effort should be to convince the decision-makers at the country level of the advantages in enhancing the intercountry allocations for the benefit of the countries. After the recent meeting of the Consultative Committee for Programme Development and Management (CCPDM) and the 51st session of the Regional Committee, it was clear that the countries wanted to be more closely involved in the planning and formulation of the intercountry programmes. With greater transparency in the work of WHO, the WHO Representatives should encourage the countries’ involvement in this process. The Regional Director stated that the budget and the programme should be separated from each other in as much as the Organization’s budget was biennial, whereas a programme developed in collaboration with the countries continued beyond a biennium. The country planning figure did not mean that the WHO funds belonged to a country. Referring to the need for a critical look at the present management environment of WHO in the Region, the Regional Director said that at the request of the Regional Committee, a Working Group would be established soon to study the subject of efficiency at the Regional Office and in the country offices. Reiterating that WHO would cooperate fully with UNDAF in the countries in a spirit of equal partnership, he urged the WHO Representatives to approach this partnership in a balanced manner and justify the position of WHO as the lead agency in health development in the country. The Director-General’s message in this context should be borne in mind, quote “A WHO that can engage where the needs are greatest; a WHO that is trusted to maximize its resources; A WHO with excellence and a WHO that can truly make a difference” unquote. 6 Report of the Forty-seventh Meeting of the RD with the WRs 3.2 Country Specific Experiences in Implementing 1998-1999 Programme Budget (Agenda item 2) Introducing the agenda item, the Regional Director reiterated the need for ensuring timely and technically sound implementation of WHO collaborative activities at country and regional levels. He invited WRs to make a short presentation on the implementation of WHO collaborative programmes in their respective countries. They should focus on the facilitating factors and constraints encountered, particularly with regard to the technical quality of programme implementation, and experiences gained and the lessons learned in the development and management of the 1998- 1999 programme budget. The common issues raised during their presentations were as follows: •= Frequent changes in the decision-making levels (political and technical) contributed to low implementation. Separate wings within the Ministry of Health, one dealing with WHO and the other with UNFPA or other agencies, created procedural difficulties and delays. •= Further support from technical units in the Regional Office to strengthen respective programme areas in the country was needed. In some countries, national consultants were being involved to ensure the technical soundness and acceptability of the programme proposals. •= Letters of Agreement should be signed only if there is a good Plan of Action as otherwise, WHO would be at a disadvantage during implementation. Where no Letters of Agreement are signed, the Plans of Action could, in the meantime, be accepted, to be improved in the process of implementation. •= It was difficult to efficiently plan to spend large allocations within a short time, especially in countries where the necessary support staff was not available. •= Delays in finalizing fellowships, consuming the bulk of the budget, affected the rate of implementation. Fellowships processed after June of the second year of the biennium should be implemented using funds from the next biennium. •= Devaluation of local currency had added a new dimension to financial implementation. It would take time to properly develop new proposals to utilize increased local currency available especially since WHO’s comparative advantage was in technical areas and not in operational costs. •= There was a need to strengthen the cooperation with NGOs and UN agencies to make optimal use of available resources and avoid duplication of efforts. •= More attention should be paid to advocacy, dissemination of information on WHO programmes and policies and strengthening public relations through use of modern communications technology, wherever feasible. •= Activity Management System has not measured up to expectations especially with regard to monitoring of the technical quality of programme implementation. Report of the Forty-seventh Meeting of the RD with the WRs 7 •= Direct communications with nationals, without informing WR’s office, created problems and should be avoided. The WRs should be kept informed of all communications between the Regional Office staff and the nationals. Discussions •= In some countries, programmes supported by extrabudgetary funds occasionally showed a more efficient implementation rate than the Regular budget funds allocated for the same activity. This was because the priority needs of the programme were first identified, and then funds were mobilized for such activities. •= Rapid inflow of substantial donor funds, in the aftermath of the economic crisis in some countries, had created concerns that these large resources might reduce the opportunities for prioritization of activities and improving efficiency. There was a need to carefully balance timely implementation with quality. •= The implementation process could be further accelerated with increased government’s continued commitment, frequent and direct contacts with the programme managers, an improved monitoring system and a proactive role being played by the Regional Office and the WHO country staff. •= WHO support to the countries should be viewed in terms of the programme’s technical content and not in financial terms alone. The programming and the budgeting should be separated. •= In view of the changing socio-economic and political scenarios, largely because of the economic crisis, WHO collaborative activities should be constantly reviewed and modified according to a country’s shifting priorities. 3.3 Group Discussions on Issues of Concern at Country Level (Agenda item 3) Five groups comprising WHO Representatives and their staff as well as Regional Office staff were formed for an in-depth review of five issues of common concern at country level. The discussions and the recommendations that emanated from these five groups are summarized below: 3.3.1 Enhancing WHO Support to National Capacity-building to ensure Sustainability The group classified the subject into five broad areas, namely: (1) human resource development (HRD), (2) strengthening of institutions, (3) information network, (4) policy measures, and (5) resource allocation and mobilization. As regards HRD, progress was impeded due mainly to lack of proper planning and management, absence of a national policy, and inappropriate training. Inefficient planning, non-availability of proper equipment, lack of training and standards, and 8 Report of the Forty-seventh Meeting of the RD with the WRs paucity of funds were some of the other problems. As regards information network, the problems related to insufficient infrastructure, lack of skilled personnel, and incomplete and poor flow of data for decision-making. Inadequate legislation or regulations and weak enforcement mechanisms also contributed to poor policy measures. The problems were further aggravated by an inflexible and reactive bureaucracy, the vertical nature of both Government and WHO supported programmes, and lack of political vision and frequent political and administrative changes. The brain-drain caused by the turnover of trained personnel to the private sector and also the increasing privatization of health care services had impeded the development of human resources. Discussions •= In most WHO supported programmes, training for national capacity-building was included. •= Capacity-building through institutional strengthening needed to be sustained especially in countries where resource constraints were a major impeding factor. •= Human resource development should be viewed in a broader context and not only through the WHO fellowships programme. •= Several agencies other than WHO were providing assistance in capacity- building. Also, some countries were now in a position to provide the required expertise in capacity-building to other countries. 3.3.2 Rationalization of the Use of WHO’s Resources in Countries The group identified four major areas, namely: activities, weaknesses, strength, and strategies. Concerning activities, the group considered it important to pay attention to efficiency, effectiveness, relevance and sustainability in relation to the common needs/priorities of the country. WHO resources were mainly in the form of human resources, institutional support, dissemination of knowledge and technology, financial inputs, and collaborative mechanisms in institutional strengthening. Some of the weaknesses at the country level identified pertained to the lack of a framework for collaborative process, absence of developed criteria, political pressure, changes in political leadership, a misconception that countries “owned” WHO funds, and lack of technical expertise. The group identified human resources, institutions (WHO collaborating centres), knowledge and technology in health, collaborative mechanism, institutional structure, a clear mandate as a specialized agency in health and the Ministry of Health as the focal point, as the strengths of the Organization. Trust in WHO, as an “honest broker”, the WR and the country staff at the country level, an assessed Regular Budget and WHO’s vast experience in countries were some of the additional strengths. Report of the Forty-seventh Meeting of the RD with the WRs 9 Discussions •= The health ministry, as the nodal ministry, should be the main contact point between WHO and the country. •= The collaborative process should be based on an understanding of WHO’s strategies and policies, and also the criteria for proper use of WHO resources. •= Lack of technical expertise at the country level inhibited the rational use of WHO’s resources. •= For the optimal use of WHO’s resources, it might be better to jointly identify the programmes in the first instance, and then agree on funding and in what proportions to use either the country or the intercountry mechanism for implementation. •= Programming and budgeting should be separated. Countries should identify needs/priorities and prepare programmes as per WHO guidelines rather than being given a fixed budget. Proposals that are not acceptable or are weak should be reviewed jointly by WHO and the country for improvement in line with WHO priorities. This would lead to building national capacity. 3.3.3 Strengthening Regional Office and Headquarters Support to Countries •= The purpose of support to countries was to enable them to build capacity for health development, improve health services delivery and health status. It was also to focus on priorities and improve the efficiency and effectiveness of implementation, coordination, synchronization and collaboration between various levels of WHO and other partners. •= The group identified a number of strengths such as WHO’s technical expertise, its publications, flexibility in the use of funds, advocacy, and its network of collaborating centres and national centres of excellence. •= The group also identified the weaknesses. There were WHO’s planning process; differences in perception of the need and role of WHO; programme being budget driven; and its scarce resources spread thinly over too many programmes. •= To ensure the technical quality of staff, steps should be taken to reduce the “politicalisation” in staff selection. In selecting Staff, there should be provision for consultation and feedback, especially concerning the suitability of consultants. Rates for STCs should be increased and made consistent throughout WHO. •= Greater use should be made of fax, phones and E-mail (with action to reduce existing barriers to the use of telephones, and increase the number of entry points for faxes in the RO). Teleconferences should be held regularly. 10 Report of the Forty-seventh Meeting of the RD with the WRs 3.3.4 WHO’s Role and Involvement in Inter-agency Coordination and Cooperation within the UN System For detailed proceedings, please refer to agenda item 5.3. 3.3.5 WHO’s Role in Enhancing Resource Mobilization for Health The discussions focused mainly on strategies for addressing the main constraints affecting resource mobilization for health. Discussions •= In most countries there was a need to increase capacity within Ministries of Health in the area of aid negotiation and aid coordination. Ministries of Finance/Planning needed to be involved in this process. •= A problem faced by WHO in the countries was the absence of good coordination among development partners leading to duplication of efforts as well as mismatches in priorities between donors and Member States. Information dissemination on donor policies and priorities was therefore necessary. 3.4 Review of 1998-1999 Programme Implementation and Strategies and Approaches for its Improvement (Agenda item 4.1) Introducing the subject, the Regional Director emphasized that the qualitative and technical soundness of the implementation of the WHO collaborative programmes in the Region, should be ensured. The status of programme implementation in the current biennium, as compared to other regions, was very poor. The Regional Committee had repeatedly emphasized the need to accelerate the pace and improve the quality of implementation with a target approach. The low absorption capacity and poor quality of obligations had been adversely commented upon by the auditors. The Regional Director stressed the urgent need to accelerate obligation of funds prior to the review by the Executive Board in January 1999, as otherwise, the funds could be shifted to other regions by the Director-General. Mr J.J. Kobza, Ag. Budget and Finance Officer, referring to the financial aspect of implementation, stated that for activities, only 38% obligation had been reached at country level as of 30 September 1998. If earmarkings were also taken into account, the percentage would increase to 48%. Unliquidated obligation figures remained high. These figures will decrease as implementation rates reach higher levels. Monitoring in this area will be increased in the future. Dr M. Khalilullah, Programme Development Officer, informed the meeting that the Plans of Action (PoAs) were developed at the country level with the support of the Regional Office staff. There was still scope for further refining the products and activities while implementing the PoAs. He pointed out that programme implementation, particularly in priority areas had registered a low implementation. Report of the Forty-seventh Meeting of the RD with the WRs 11 Therefore, steps had been taken to improve the programme implementation through effective follow-up and monitoring both at country and Regional levels. Discussions •= The responsibility for the formulation and execution of the WHO collaborative programmes lay entirely with WHO. •= The Ministry of Health alone should not be responsible for implementation of the WHO collaborative programmes. It should be a joint responsibility with other related Ministries. The WHO country office should facilitate implementation management. Besides, WHO collaborating centres, universities, NGOs and other health-related institutions should be actively involved in WHO collaborative programmes. •= Programme changes should be kept to the minimum and any alternative proposal should be technically justified. •= In the Activity Management System, progress had been slow. It was being used only for financial monitoring and not for monitoring activity implementation in technical terms. •= SEAR had the lowest rate of financial obligation among all the regions. •= Funds obligated under the delegated authority of WRs did not always conform to the provisions made in the WHO Manual and SEARO guidelines. The inadequacies noted could be shared with the respective WRs. 3.5 Implications of Resolution WHA51.31 on Regular Budget Allocations to the Regions, and Policies on the Management of Future Programme Budgets (Agenda item 4.2) Introducing the agenda item, the Regional Director said that resolution WHA51.31 represented a temporarily improved scenario for the Region on allocation of resources. It was vital for the Region to demonstrate its ability to effectively use the financial resources. The Executive Board would review the implementation during the current biennium at its session in January 1999. The Region was very vulnerable due to its poor implementation. The Regional Office efforts during RC51 to convince the countries on the advantages of shifting funds to ICP had not succeeded. The WHO Representatives should, therefore, play a more proactive role in sensitizing the countries on this issue, and of the risk involved. Mr R. Spina Helmholz, Director, Administration and Finance, briefly explained the global and regional implications of resolution WHA51.31. The following actions had been taken since the adoption of the resolution: •= A Working Group met in Bangkok in July 1998 to initiate work on alternative models for resource allocation. 12 Report of the Forty-seventh Meeting of the RD with the WRs •= A communication had been sent to the regions by the Director-General providing the revised regional planning allocations; RC51 had accordingly modified the regional proposed programme budget for 2000-2001. •= A Working Group would be established as recommended by RC51 to review the efficiency of the Regional and country offices. The risk of a further regional cut was explained with reference to the low level of SEAR financial implementation compared with HQ and other regions. The relatively large size of several SEAR country budgets compared with countries of other regions was also a ‘risk factor’. It was stated that the budget to be presented by the Director-General to the EB103 in January 1999 was likely to reflect revisions of priorities and perhaps, resource distribution. The budget would have 10 appropriation sections for Headquarters (corresponding to DGO + 9 clusters), the six traditional appropriation sections for the regional/intercountry programmes, and two lines for country programmes: country offices, and country programmes. Discussions •= Monitoring of programme implementation should emphasize results, achievements and activities carried out. A beginning could be made in this respect in the elaboration of the PoA for 2000-2001. •= Programmes should be planned on a ‘rolling’ basis with the close involvement of the country offices, concerned national officials and the Regional Office •= ‘Service delivery’ under Regular budget programmes should be discontinued. •= Any component for provision of management support to the Ministry of Health should be separated from the budget of the country office, in the new budget format. 3.6 Recent Changes at WHO HQ and their Implications to the Regions (Agenda item 4.3) Introducing the agenda item, the Regional Director said that the main thrust was on WHO making a difference. The organizational structure at Headquarters had undergone a radical change. The establishment of nine clusters, the management support units within the clusters, and the decentralization of administrative functions was expected to facilitate quick and smooth implementation of activities. The Roll Back Malaria and Tobacco-free Initiatives were identified as the important areas for urgent action. Staff development and staff rotation were the other issues under consideration. A HQ team would be visiting the Regional Office soon to advise on the change process in the Regional Office. Dr Samlee Plianbangchang, Director, Programme Management, in his presentation, highlighted the process of change taking place at WHO Headquarters and their implications to the regions. The Director-General would announce the new Report of the Forty-seventh Meeting of the RD with the WRs 13 organizational structure at Headquarters on 1 November 1998. The following are the highlights of the presentation: •= The programmes at Headquarters numbering around 50, would be regrouped into nine clusters, each headed by an Executive Director reporting to the Director-General. Management support units would provide administrative and managerial support to the technical programmes within the respective clusters. •= The clusters were being structured to ensure the application of an inter- programme and multi-disciplinary approach, resulting in the merging of some programmes with others and creation of some new units. •= So far, the only mechanism through which the Regional Directors were to be involved in the decision making process was through ad-hoc retreats or through tele-conferences. •= In the new staffing reorientation the focus would be on four key areas, namely: (a) filling of the senior posts, (b) rotation and mobility, (c) senior executive service, and (d) mutually agreed separation. The post descriptions of the staff in the clusters were being reviewed and revised. •= A Headquarters Team would visit SEARO in December 1998 to help in an in- depth analysis of the situation and recommend on how to improve the efficiency and effectiveness of WHO collaboration with Member States. •= The Director-General had established a Working Group on Partnership with countries to review in-depth the situation regarding country offices, and make recommendations for action. •= Headquarters had critically reviewed the 1998-1999 programme budget, and made a major adjustment to release funds (US$ 30 million) for priority areas and activities according to the newly changed situation. The Regional Offices would have to follow suit to ensure the most rational use of available resources, especially RB funds. •= Regarding the Programme Budget for 2000-2001, the HQ Task Force on Budget had already recast the budget without involving the regions. •= Headquarters were now examining how to incorporate the two different systems of programme classification into a single PB document for submission to the Executive Board in January 1999. The Regional Offices had also been asked to look into these issues critically. The principle behind all the programme budget exercises on budget was based on “one WHO, one budget” with no regional distinction, and no distinctions in the activities at the three levels. Discussions 14 Report of the Forty-seventh Meeting of the RD with the WRs •= A cadre of senior executive service staff at P.6 level would be developed and established sometime in 1999. HQ were presently working on filling senior level posts including those in the Regional Offices and the WRs’ offices. Some staff in the regions at other levels might be rotated to work in HQ, and vice-versa. •= HQ would be involved in the Regional Office staff selection, which, as a policy issue would have great implications for the Region. The Global WHO Staff Management Meeting proposed a selection panel consisting of senior staff and the Staff Association. The same pattern would apply to the Regional Offices also. •= The Director-General would like to have direct contact with the WRs. She would convene a meeting in February 1999 with all the WRs. •= There was a need to define the role of the WRs, and also that of the country offices. WRs’ functions should be rationalized with adequate resources to support their work. They should not be seen merely as administrative head of the country office. Their function was more of a technical nature involving programme planning, formulation, monitoring and evaluation of WHO collaborative programmes. In view of this, the budget of the country offices should be maintained to provide the needed country support. As has been done in AFRO, it would be useful to establish a liaison unit for WRs at the Regional Office. •= It was important that the Regional Directors should be involved in the global agenda and in the changes taking place. One WHO without any regional distinction and a global exercise on staff selection marginalizing the Regional Director and the Regional Office were matters of concern to the Region. 3.7 Lessons Learned during Evaluation of WHO Country Collaborative Programmes in 1998 (Agenda item 4.4) Introducing the item, the Regional Director referred to the evaluation exercises carried out in Maldives and Nepal. The evaluations were “process” oriented and were not intended to measure “impact”. They examined how countries coped with the change to a “product” and result-oriented approach to programme budgeting and implementation. Since the evaluations were carried out with the involvement of all levels concerned in programme implementation, it would be easy to follow-up on the recommendations in the countries. WR Maldives said that WHO’s contribution in Human Resource Development in the health sector was highly appreciated. The evaluation exercise had also revealed that new approaches in programme formulation as well as reporting, frequent changes in deadlines by SEARO not allowing enough time to meet the deadlines, had resulted in confusion and inefficiency in implementing programmes at the country level. The evaluation had also indicated that there was a need for improved coordination with other Report of the Forty-seventh Meeting of the RD with the WRs 15 agencies in order to operationalize WHO’s complementary partnership and to avoid duplication and wastage of scarce resources. Referring to the evaluation process undertaken in Nepal and the inter- disciplinary nature of the team that participated in the exercise, WR Nepal presented a summary of the important recommendations. These were: recognizing the effect of the socio-economic and political contest; impact of government salary levels, and staff deployment and transfer. Also, the value added by WHO staff members beyond their technical inputs, collaboration and cooperation within WHO, the impact of decision from elsewhere on WHO and the worth of the evaluation exercise were the other points highlighted. He presented the positive and negative features in each of these areas and elaborated on the recommendations made. Discussions •= The methodology used during the evaluation exercises encouraged detailed and positive exchange of ideas. This resulted in outcomes and recommendations which can be “owned” by the decision-makers in the country. •= A field visit to obtain first hand knowledge of the specific programme being evaluated was a positive innovation. This may be considered for inclusion in future evaluation exercises. •= The Regional Office had initiated evaluation exercises in four countries in 1997 as well. In addition, the in-depth reviews of programmes in Bangladesh, DPR Korea and Myanmar could also be considered as evaluations initiated by the Regional Office. •= The issue of the “value added” to the country programmes by WHO staff in country was very important. It was necessary to develop a method to quantify and demonstrate this. •= The government-WHO coordination mechanism when optimally used helped in the development and effective implementation of the programme budget. •= Evaluation exercises should preferably be carried out immediately after the completion of a biennium. •= The right type of nationals who have had some technical interface with the technical staff of WHO, might be inducted into the evaluation team. 3.8 Highlights of 16th Meeting of Health Ministers of SEAR Countries [Agenda Item 5.1(a)] Introducing the agenda item, the Regional Director emphasized the importance of the Declaration on Health Development in the South-East Asia Region in the 21st Century, adopted by the Health Ministers and endorsed by the Regional Committee in 1997. The Declaration provided clear guidelines and action points for 16 Report of the Forty-seventh Meeting of the RD with the WRs health development in the next two or three decades. WHO needed to work as one Organization in order to make the Region self-reliant in the areas of public heath, manpower training, production and supply of essential drugs and vaccines, national capacity and health research. Mr B.S. Lamba, Health for All Officer, presented the highlights of the discussions and the recommendations of the Ministers of Health on the various agenda items. Discussions •= The purpose of the Health Ministers’ Meeting was to strengthen and enhance political advocacy for health development and health for all. The meetings were also utilized for creating awareness regarding the critical health issues. •= Normally, recommendations of the Ministers were not linked to the resolutions of the Regional Committee. However, the Regional Health Declaration, adopted by the Ministers in August 1997, was endorsed by the 50th session of the Regional Committee held in September 1997. •= The recommendations of the Ministers were generally covered within WHO programmes. Accordingly, various activities undertaken by the Organization towards implementation of its programmes also constituted follow-up actions on the recommendations of the Ministers. 3.9 Highlights of 51st session of the Regional Committee [Agenda item 5.1(b)] In his introductory remarks, the Regional Director stated that at the fifty-first session of the Regional Committee, the allocation of resources to the Region was a topic for discussion. The Regional Director reiterated that HQ was closely monitoring the obligations/implementation of country allocations in 1998-1999. A report would be presented to the Executive Board in January 1999 by the Director-General. Countries with a higher allocation would be closely scrutinized. He urged the WHO Representatives to concentrate on accelerating the pace of financial obligations in a technically sound manner. Mr R. Spina Helmholz, Director, Administration and Finance, referred to the salient points of the speeches of the Director-General and the Regional Director, and the recommendations emanating from the technical discussions. He also underscored the Regional Committee’s concern for monitoring the entire process of programme implementation. The following specific issues emerging from the decisions/discussions of the Regional Committee were highlighted: •= A time-bound plan should be submitted to the CCPDM in April 1999 concerning the implementation of the Activity Management System. •= A Working Group to be formed with the active involvement of Member countries, to study the efficiency of the Regional and country offices. Report of the Forty-seventh Meeting of the RD with the WRs 17 •= The Regional Office would report to the CCPDM in April 1999 on the prioritization of programmes. •= The Technical Discussions, preparatory work on budgetary issues, and reports from countries attending meetings of the management bodies of Special Programmes, would be covered by CCPDM from 1999. The Regional Committee would continue to consider the report on programme budget, and review the recommendations arising from the Technical Discussions. •= The adoption of the revised scales of assessment for 1999 would result in only two countries being entitled to receive reimbursement for travel to the Regional Committee, as per resolution WHA34.4. Discussions •= It is desirable to coordinate programme budget strategies with WRs, to help achieve successful implementation. •= The proposed Working Group to study the efficiency of the Regional Office and country offices should be viewed seriously, as it would have an important bearing on the work of the Regional Office and the WRs’ offices. •= The modifications to the method of work of the Regional Committee would imply a longer meeting of the CCPDM prior to the Regional Committee, and the CCPDM playing a more important role in the future. 3.10 Global Project on Roll Back Malaria [Agenda item 5.2 (a)] Introducing the agenda item, the Regional Director said that the Roll Back Malaria (RBM) Initiative had been identified by the Director-General as a priority programme area for Africa. It was also relevant to other regions as malaria was a major public health problem. The basic philosophy of the RBM was to involve other sectors, particularly those which were contributing to malariogenic conditions instead of the health sector alone striving to contain the situation. The Initiative also emphasized the importance of the district health system for effective delivery of the programme. Malaria control should be addressed as an ecological and environmental issue. It required an inter-sectoral, multidisciplinary and inter-agency approach. There was a need to develop a consensus on broad-based control efforts for the RBM in SEAR countries. Presenting the agenda item, Drs Kamini Mendis and Pene Key of RBM Team/HQ highlighted the need for global partnerships. The malaria activities within the health sector would be a pathfinder for other priority health outcomes. The approach would be global, spearheaded in Africa. Recognizing that WHO had ‘earned the right’ to lead on RBM, WHO should be the global ‘hub of the partnership wheel’ providing support for: political advocacy, 18 Report of the Forty-seventh Meeting of the RD with the WRs technical endorsement, partnership maintenance, brokering technical assistance, brokering finance and monitoring and reviewing progress. Although the global partnership for RBM focused on effective action at country level, it needed an international coordination and review mechanism to help partners maintain momentum, synchronize strategies and action, and promote coherence. RBM would operate through: a small core group of staff recruited internally or externally, or seconded, an expanding “virtual” group of dedicated people within and outside WHO, and approved resource networks for technical guidance and facilitation. RBM would be guided by an Advisory Group of stakeholder representatives who would meet as required. The objective of RBM was to significantly reduce the global malaria burden through interventions adapted to local needs and by reinforcement of the health sector. Based on situation analysis and feasibility assessment, the national goals would be set by countries. Global targets would be set from aggregated national goals at the end of RBM’s preparatory phase. The preparatory phase, up to the end of 1999, was needed before RBM is launched in 2000. Dr P.R. Arbani, Regional Adviser, Malaria, presented the relevance of RBM to the South-East Asia Region. The high morbidity among vulnerable groups and its impact on the family, the increasing problems of multi-drug resistance and border malaria, and the opportunity for optimizing regional expertise through resource networking indicated the need for strengthening the existing health system. Discussions •= To secure ownership, the district level operations must be involved in the development of RBM. The district health system should be used as the main thrust in maintaining partnership at local level. Under certain situations, NGOs should also be involved. •= Considering the importance of maintaining partnerships at the ministerial level, the role of the Ministry of Planning should be recognized as an important partner in RBM. •= Presently, the South-East Asia Region has a very good network of imparting training on malaria control. Since its inception, it has proved successful not only for Member States but also for countries in other regions. Other collaborative programmes such as the bi-regional collaborative programme on control of malaria in areas with multi-drug resistance, as well as WHO Collaborating Centres and ACT Malaria in Thailand, should be utilized to support RBM. •= Countries with specific problems like Myanmar with an increasing incidence of severe malaria, would require assistance from potential donors. Report of the Forty-seventh Meeting of the RD with the WRs 19 •= The Regional Director might request the Director-General to write to the Heads of Member Governments in SEAR securing their firm commitment to RBM. 3.11 Global Project on Tobacco-Free Initiative [Agenda Item 5.2 (b)] Introducing the agenda item, the Regional Director said that the problem of tobacco use was a cause for grave concern. The extensive use of tobacco in both its smoking and smokeless forms was affecting the health of people in the Region. Despite the magnitude of the problem and WHO’s advocacy efforts, most governments in the Region had yet to put in place effective control measures. The Tobacco-Free Initiative (TFI), recently launched by the Director-General, was aimed at increasing global and regional commitment to tobacco control and fostering effective and sustainable partnerships to reduce tobacco consumption worldwide. The Regional Director said that there was a need to vigorously support this Initiative at the country level to place tobacco issues high on the development agendas. He suggested the integration of tobacco control activities into relevant WHO-supported programmes. During her presentation, Ms Martha R. Osei, Regional Adviser in Health Promotion and Education (RA-HPE) highlighted the major elements of the Tobacco- Free Initiative, the organizational arrangements, the South-East Asian perspective and the critical implementation issues which need to be addressed by WRs’ offices. The Initiative had major relevance for the South-East Asia Region where smoking and the use of smokeless tobacco had increased the health risks such as cancers, cardiovascular and lung diseases as well as spontaneous abortions. RA-HPE stated that, with the participation of all Member Countries, the Region would implement the TFI focusing on three main target groups: children, women and the poorer sections, with a view to preventing and reducing the use of tobacco. WHO/SEARO would provide strategic guidance and technical support as well as a forum for coordination and networking among Member Countries. The WRs’ offices would extend technical and managerial support towards the formulation, implementation and evaluation of country programmes. Partnerships and advocacy with participating agencies such as UNICEF, the World Bank and NGOs as well as other UN and bilateral agencies would need to be fostered to ensure resource mobilization and concerted action at the country level. Discussions •= In view of the heavy workload in the WR’s office and the Ministry of Health, it was necessary to consider how the proposed interventions could be carried out effectively. •= The power of the tobacco lobby had to be recognized with appropriate and effective strategies adopted to counteract them. This could be done with the active involvement of NGOs at the country level. 20 Report of the Forty-seventh Meeting of the RD with the WRs •= The selection of Sri Lanka by WHO Headquarters as one of the countries for the project on children in view of the political support demonstrated by the President of the country was appreciated. •= Control strategies should place more emphasis on the economic and behavioural aspects. •= It was clarified that the role of WHO in tobacco control related primarily to the use of the substance. 3.12 Inter-agency Coordination within the UN System at Country Level – Current Situation (Agenda item 5.3) The Regional Director, in his introductory remarks, mentioned that since the adoption of the UN General Assembly Resolution 44/211, efforts were being made to further improve coordination among the UN agencies, including the Specialized Agencies. The Resident Coordinator system and the various measures introduced from time to time within its framework such as the Country Strategy Note (CSN), the UNDAF, the common premises and common services etc. were all part of these efforts. The main concern was to see how best WHO could contribute to the process of coordination within the UN system and also effectively utilize it to the benefit of national health development programmes. He said that in the changed environment of a complex interface with health, WHO could not operate alone. It needed partners both within and outside the UN system. The two critical issues involved in inter-agency coordination within the UN system, especially with the UN Resident Coordinator framework were UNDAF and Common Administrative Network. Presenting the Common Country Assessment (CCA) exercise undertaken in Thailand, Dr Han Tun, representing WR Thailand, mentioned that the CCA exercise was launched through the existing Government-UN collaborating mechanism as a prelude to initiating UNDAF process. The main tasks of the CCA Committee (a joint committee of the UN agencies) were the identification of issues and indicators. The government’s eighth plan was the basis for identification of issues and the agencies had jointly identified seven clusters. WHO was designated as the lead agency for the Health and Nutrition cluster, and prepared the issue paper on emerging and re- emerging health problems, quality use of drugs and health care financing. WHO and UNICEF jointly prepared the issue paper on nutrition. WHO and UNFPA prepared the paper on reproductive health. UNDP undertook to define the linkages of these issues to the World Conferences. Thailand thus presented an example of what could be achieved in terms of inter-agency cooperation and coordination given the commitment to genuine partnership. Discussions •= The Resident Coordinator system was working well in most of the countries and the WRs were fully cooperating with it. In many countries, the WRs Report of the Forty-seventh Meeting of the RD with the WRs 21 chaired the theme groups or donor coordination groups on health and took the lead in coordinating health sector inputs from the other agencies. •= The Resident Coordinator system had been particularly useful in promoting inter-agency cooperation and coordination. One major concern was that the system tended to create an inner circle of UN agencies. There were also proposals for co-financing from the Resident Coordinator which, if used too frequently, might disrupt the objectives of the Organization’s collaborative programmes in the countries. •= The UNDAF process was being tested in 18 pilot countries all over the world, including India. WHO was actively participating in this trial process without committing any funds. The results were likely to be available by early 1999. Bangladesh had also initiated the UNDAF process. •= Indonesia and Nepal were the only countries in the Region with common premises for UN Agencies. Common premises were not always cost-effective though services like legal advice, common travel facilities, cargo, security matters, etc., might be beneficial. Therefore, the issue of common premises should be considered carefully. The location of WRs offices in the Ministry of Health would be preferable. •= One important purpose of inter-agency coordination was to avoid duplication and improve complementarity among the programmes of different agencies, like reproductive health which was a common priority, both for WHO and UNFPA. In spite of a common framework for cooperation, WHO’s role in reproductive health was not always adequately recognized. Investment of massive funds by UNFPA and other agencies at times overshadowed WHO’s technical contributions. Many of these problems would be resolved with the finalization of the terms of reference of the joint WHO/UNFPA/UNICEF Coordinating Committee soon. •= WHO was one of the co-sponsors of UNAIDS and therefore had the responsibility to cooperate with it within the framework of the understanding reached between the co-sponsors. •= The progress in the implementation of UNGA resolution 44/211 had been slow despite the adoption of a large number of successor resolutions emphasizing the need for quick action. •= The reform measures of the Secretary-General were mainly targeted towards speedy implementation of the recommendations of UNGA 44/211. According to the UN Charter, UNGA resolutions were not building for the Specialized Agencies. The Secretary-General, therefore, was trying to pursue the reform measures through a dialogue at the Administrative and Coordination Committee (ACC) which consisted of all the heads of UN Agencies. 22 Report of the Forty-seventh Meeting of the RD with the WRs Section 4 CONCLUSIONS AND RECOMMENDATIONS 4.1 COUNTRY SPECIFIC EXPERIENCES IN IMPLEMENTING 1998-1999 PROGRAMME BUDGET (Agenda item 2) (1) Technical Units in the Regional Office should work jointly with the WHO Representatives and national focal points in the development and management of WHO’s collaborative programme. (2) To implement the idea of separating programming from budgeting, countries should be asked to formulate programmes and activities. The necessary funds would then be identified, either using the country or the intercountry mechanism. WRs should be given clear guidance in this regard. (3) Capacity in the WHO managerial process should be further strengthened, guidelines for programme budget planning should be developed and countries should be provided additional support to develop the Activity Management System. (4) WHO Regular budget funds should be used to develop technical programmes in collaboration with the countries. Extrabudgetary funds should be used for developing infrastructure, and for procuring supplies and equipment, etc. 4.2 GROUP DISCUSSIONS ON ISSUES OF CONCERN AT COUNTRY LEVEL (Agenda item 3) (a) Enhancing WHO Support to National Capacity-building to Ensure Sustainability (1) Shorter-term technical support was required to improve planning and managerial capability in specific areas. (2) Funds earmarked for capacity building in specific areas should not be used to promote other activities. (3) For capacity-building, expertise available within the country for training should be explored and utilized prior to seeking training abroad. (4) For institution strengthening, linkages between WHO collaborating centres should be established, and facilities for network services strengthened. Report of the Forty-seventh Meeting of the RD with the WRs 23 (5) The infrastructure for information network being insufficient in some countries, there was need to strengthen the information system through technical support from WHO. (b) Rationalization of the Use of WHO Resources in Countries (1) A sound and acceptable criteria and a framework for allocation of WHO resources to the countries would need to be developed. WHO support to country specific activities for health development would be in line with WHO’s policies and priorities. (2) An appropriate use of ICP mechanism to supplement the country activities for rational use of WHO resources should be made which should focus on strengthening national capacity building. (3) Measures should be initiated to enable the WHO Representative to function with more flexibility whenever required, for example, to hire technical expertise at short notice (NPO, STC etc.). (c) Strengthening Regional Office and Headquarters Support to Countries (1) In order to improve the content and quality of WHO technical support, a team of core staff should be established in the WHO country office (WCO), with sufficient budget for WCO to be proactive. Training and staff development for WCO staff and proper briefing of staff when new procedures are introduced should be ensured. (2) The ‘Team Approach’ should be strengthened by inclusion of HQ/RO colleagues with WCO and nationals in planning, which will lead to better understanding and ownership of programmes. Support should be timely and usable. Visits of RO and HQ staff should be planned, but should be also on request. There should be a cycle of planned “familiarisation visits”. (3) Communications should be improved. Web pages should be established to access information in both RO and WHO country offices. (4) Advocacy should be strengthened, ensuring that it is ‘evidenced based’. It should be documented with outreach strategies and plans which avoid internal competition and conflict. (5) Priorities for cooperation should be established. There should be more focused support with more attention to cross-cutting themes with fewer activities and greater attention to quality. Activities should be time-bound . WHO should let others do what they do better and ”Let go” what WHO no longer needs to do or what is no longer a priority. 24 Report of the Forty-seventh Meeting of the RD with the WRs (6) Action to achieve greater collegiality should include more collaborative ways of working together, mirroring the collaboration within WHO at the country level, rotation of staff within as well as between levels and temporary/short-term staff exchanges. (d) WHO’s Role and Involvement in Inter-agency Coordination and Cooperation within the UN System Please see agenda item 5.3. (e) WHO’s Role in Enhancing Resource Mobilization for Health (1) SEARO should organize training workshops on aid negotiation, technical resource mobilization, conflict management, programme planning, monitoring and evaluation for both government officials and concerned WHO staff. (2) SEARO should disseminate information to donors/development partners at the regional level on regional health priorities, and assist WHO country offices to negotiate with development partners on WHO’s assistance in programme planning and coordination, implementation, financing and monitoring. (3) SEARO should assist Member States, proactively, to develop health policies, formulate priority health sector programmes and to mobilize/coordinate resources. (4) WRs should organize, and co-chair regular meetings of WHO, development partners and Government to review the health situation, coordinate resource mobilization, and jointly support the development and management of health sector programmes. 4.3 REVIEW OF 1998-1999 PROGRAMME IMPLEMENTATION AND STRATEGIES AND APPROACHES FOR ITS IMPROVEMENT (Agenda item 4.1) (1) The Regional Office should provide full support, and respond quickly to the WR’s requests during programme budget formulation, preparation of plans of action, implementation and monitoring. (2) Increasing use of the joint programming mechanism by the countries should be encouraged. This would help accelerate programme implementation at the country level benefiting more than one country in the context of regional cooperation and solidarity. The WRs and the nationals should be actively involved in this process. Report of the Forty-seventh Meeting of the RD with the WRs 25 (3) Joint programme review missions to countries, led by a Senior Staff of the Regional Office and supported by concerned technical, programming and budgeting staff, should be undertaken to facilitate speedy implementation. (4) There is a greater need for orienting all WHO staff on the WHO reforms and the managerial process for WHO programme development and management. 4.4 IMPLICATIONS OF RESOLUTION WHA51.31 ON REGULAR BUDGET ALLOCATIONS TO THE REGIONS, AND POLICIES ON THE MANAGEMENT OF FUTURE PROGRAMME BUDGETS (Agenda item 4.2) (1) Programmes should be identified on the basis of technical merit with funding to be allocated at a secondary stage. (2) Implementation should be timely, obligations of good quality, and liquidation pursued vigorously to enable effective follow-up of conclusion of activities such as training, consultants/reports, etc. 4.5 RECENT CHANGES AT WHO HQ AND THEIR IMPLICATIONS TO THE REGIONS (Agenda item 4.3) (1) The EB members from the Region and the country delegations, especially Ministers, attending WHA should be thoroughly briefed by the WRs. They should be requested to protect the Region’s interest at the governing bodies. Some of the EB members might be invited to visit two or three country offices for an on-the-spot study of the situation and the need for WHO’s presence at the country level. 4.6 LESSONS LEARNED DURING EVALUATION OF WHO COUNTRY COLLABORATIVE PROGRAMMES IN 1998 (Agenda item 4.4) (1) WRs should participate in evaluations to be carried out in other countries. (2) Evaluation exercises should preferably be carried out immediately after the completion of a biennium. 4.7 HIGHLIGHTS OF 16TH MEETING OF HEALTH MINISTERS OF SEAR COUNTRIES [Agenda Item 5.1(a)] (1) Efforts should be made for more systematic follow up actions towards implementation of the recommendations. 26 Report of the Forty-seventh Meeting of the RD with the WRs 4.8 HIGHLIGHTS OF 51ST SESSION OF THE REGIONAL COMMITTEE [Agenda Item 5.1 (b)] (1) In view of the CCPDM assuming a wider and more important role, representatives nominated by the Governments to attend its meetings should be adequately briefed, particularly on programme development and management matters. 4.9 GLOBAL PROJECT ON ROLL BACK MALARIA [Agenda Item 5.2 (a)] (1) South-East Asia Region should collaborate with the Member States in mainstreaming RBM into the country’s health system and securing highest level political commitment for broad-based and sustainable efforts through partnerships and intersectoral collaboration. (2) SEARO should urge Member States to focus RBM in addressing the challenges of multi-drug resistance, focal epidemics and border malaria and to work through district health system in improving access of vulnerable groups to quality diagnosis and treatment and personal protection. (3) Appropriate steps should be taken by SEARO to establish a core group to manage RBM at the Regional Office level. 4.10 GLOBAL PROJECT ON TOBACCO-FREE INITIATIVE [Agenda item 5.2(b)] (1) Member countries should prepare Tobacco-free Initiative programmes, for which funds should be made available. WHO should support the mainstreaming of TFI into national programmes such as non- communicable diseases, safe motherhood and primary health care. (2) The intercountry programme for tobacco control activities should focus on children, adolescents, women and the poorer sections of the community. Schools as one of the effective settings can be used as entry points. Also, a study to cover the socio-economic impact of tobacco in the Region should be carried out. (3) The criteria adopted for nominations for the Tobacco or Health Award should be clarified to the national authorities concerned. (4) HQ should be asked to work jointly with the Regional Office and the counties in TFI. Sustainable partnerships with NGOs and other sectors such as labour, finance and economic planning should also be fostered. Report of the Forty-seventh Meeting of the RD with the WRs 27 4.11 INTER-AGENCY COORDINATION WITHIN THE UN SYSTEM AT COUNTRY LEVEL – CURRENT SITUATION (Agenda item 5.3) (1) WHO should continue to cooperate with the Resident Coordinator system as an equal partner and contribute to its success without compromising the Organization’s interests, policies and strategies. WRs’ should take the lead in coordinating health sector inputs from other agencies. WRs might also promote broadening the scope of the theme groups/donor coordination groups on health to include agencies outside the UN system where appropriate. (2) WRs should actively participate in the UNDAF and CCA processes and provide feedback to the Regional Office on their experiences. Where necessary, the Regional Office would provide technical support as well as information to the WRs in this regard. (3) WHO can participate in joint planning and programming but not in co- financing with other agencies. Co-financing can be considered only in very special circumstances, depending on the merits of the individual case. (4) The WR’s office should preferably be located in the Ministry of Health premises. If this is not possible, location in joint UN premises and lastly, in separate premises may be considered. WRs might consider joining common services in respect of communication facilities such as FAX, courier services, travel facilities, car pool and security service, etc., if these were found reasonably cost-effective. (5) WHO will utilize the funds available to continue its technical collaboration with the countries and the concerned partners in the promotion of reproductive health. (6) WHO will cooperate with UNAIDS as one of its co-sponsors. However, as the specialized agency in health, WHO will continue to play a leadership role in the health aspect of HIV/AIDS epidemics and provide technical support to Member Countries in these areas. 28 Report of the Forty-seventh Meeting of the RD with the WRs Section 5 CLOSING SESSION 5.1 STATEMENT BY REPRESENTATIVE OF UNICEF ROSA, NEPAL Expressing happiness at the continued collaboration with WHO in Nepal, Dr Monica Sharma, Ag. Regional Director, UNICEF ROSA, Nepal, referred to several common areas of concern between WHO and UNICEF. She specifically mentioned the area of health education and development where UNICEF has been working closely with the WHO Representative, Nepal. Joint collaboration existed already through the mechanism of JCHP which now included UNFPA also as a member. In the area of nutrition, WHO/UNICEF/World Bank were cooperating in the development of a framework to see how best to move forward and implement the activities in this priority area by addressing the common issues and finding solutions. UNICEF Executive Board had recently approved its medium-term programme for the period 1999-2001, which defined the priority areas for cooperation, namely: (a) reduction of child mortality and morbidity, (b) improving early childhood care, education, family level and nutrition, (c) preventing child disability, (d) access to basic education, (e) adolescent education, and (f) prevention of exploitation and child abuse. UNICEF’s activities were being programmed with a commitment both to the process and the results. As an example, the activities relating to safe motherhood and maternal mortality, and education as a social welfare issue were mentioned. 5.2 OBSERVATIONS BY WHO REPRESENATIVES Speaking on behalf of the WHO Representatives, Dr Klaus Wagner, WHO Representative, Myanmar expressed his appreciation for the excellent arrangements made for the conduct of the WRs’ meeting. He conveyed particularly his happiness at the innovative ideas introduced this year in the structure of the meeting, such as group discussions on topics of common concern to WHO, especially at the country level, as also the participation of the country staff of the WRs’ offices in the proceedings. The in-depth discussions on the important items included in the agenda and the free exchange of views among the WRs and the Regional Office staff on the chosen subjects of topical interest during the retreat contributed in a great measure to the success of the meeting. The WRs would return to their respective countries with a greater resolve and commitment to fulfil the Organization’s goals in the changing scenario. He thanked the Regional Director and DPM for their able guidance, and the staff of the Regional Office for all the cooperation extended to the WRs during their stay in Delhi. Report of the Forty-seventh Meeting of the RD with the WRs 29 5.3 CONCLUDING REMARKS BY THE REGIONAL DIRECTOR In his concluding remarks, the Regional Director appreciated the contribution made by the WHO Representatives and their staff as well as the Regional Office staff, which enhanced the quality of discussions at the meeting. He said that the concluding session coincided with the UNITED NATIONS DAY. He reiterated WHO’s desire to work as equal partners with other UN Agencies for the benefit of people everywhere. This spirit of cooperation was clearly demonstrated by the participation and involvement of many UN agencies in India at the inaugural session last week, the Ag. Regional Director of UNICEF, ROSA at the concluding session. He also thanked the staff of WHO/HQ for their participation, and appreciated their contribution to the success of the meeting. The deliberations had provided a good basis for WHO’s work at the country level with full transparency and renewed dedication. The “Retreat” with the WHO Representatives was very useful and productive, and as agreed, the Regional Office would set up a small working group to prepare a concept paper for briefing concerned staff members at all levels as well as concerned national health authorities on the new approach in programme planning for WHO collaboration in the Region. Wishing the WRs a safe journey back home he assured that the Regional Office would extend full support to them in their tasks. 30 Report of the Forty-seventh Meeting of the RD with the WRs Annex 1 AGENDA1 1. Inaugural Session 2. Country specific experiences in implementing 1998-1999 programme budget 3. Group discussions on issues of concern at country level: (a) Enhancing WHO support to national capacity-building to ensure sustainability (b) Rationalization of the use of WHO resources in countries (c) Strengthening Regional Office and Headquarters support to countries (d) WHO’s role and involvement in inter-agency coordination and cooperation within the UN system (e) WHO’s role in enhancing resource mobilization for health 4. Programme Development and Management 4.1 Review of 1998-1999 programme implementation and strategies and approaches for its improvement 4.2 Implications of resolution WHA51.31 on regular budget allocations to the regions, and policies on the management of future programme budgets 4.3 Recent changes at WHO HQ and their implications to the regions 4.4 Lessons learned during evaluation of WHO country collaborative programmes in 1998 5. Technical Briefing 5.1 Highlights of: (a) 16th Meeting of Health Ministers of SEAR countries, and (b) 51st session of the Regional Committee 5.2 Global projects on: (a) Roll Back Malaria, and (b) Tobacco-Free Initiative 5.3 Inter-agency coordination within the UN system at country level – current situation 6. Administrative and Other Matters 6.1 Informal meeting of WRs 6.2 Confidential session between RD and WRs 6.3 WRs’ meeting with WHD Group 6.4 WRs’ meeting with Staff Association 7. Conclusions and Recommendations 8. Closing Session Note: Programmes for Administrative Officers’ Meeting with DAF (12-13 October 1998) and individual meetings of WRs and the country office staff with the technical units (16 and 19 October 1998) will be arranged separately in consultation with the WRs. 1 Originally issued as document SEA/WR47/1 dated 24 September 1998. Report of the Forty-seventh Meeting of the RD with the WRs 31 Annex 2 PROGRAMME2 (Venue: Conference Hall, World Health House) Date 0900 to 1230 hrs (Tea/Coffee – 1030 –1100 hrs) 1230 to 1430 hrs 1430 to 1700 hrs (Tea/Coffee – 1530 - 1545 hrs) Wednesday 14 October Item 1 Inaugural Session •= RD’s inaugural address •= Statements by Representatives of UN Agencies Business Session •= RD’s opening remarks Item 2 Country specific experiences in implementing 1998-1999 programme budget Presentations by WHO Representatives followed by discussions (15 minutes presentation, and 10 minutes discussion for each country) Item 2 Presentations by WHO Representatives followed by discussions (contd.) General discussions on problems and constraints, and action points (45 minutes) Thursday 15 October Item 3 Group discussions on issues of concern at country level: (a) Enhancing WHO support to national capacity-building to ensure sustainability (b) Rationlization of the use of WHO’s resources in countries (c) Strengthening Regional Office and Headquarters support to countries (d) WHO’s role and involvement in inter-agency coordination and cooperation within the UN system (e) WHO’s role in enhancing resource mobilization for health L u n c h I n t e r v a l Group presentations, discussions, and action Points Friday 16 October Individual appointments with technical units Saturday 17 October Item 6.4 WRs’ Meeting with Staff Association Item 6.3 WRs’ Meeting with WHD Group Item 6.1 Informal Meeting of WRs Sunday 18 October Social Get-together 2 Originally issued as document SEA/WR47/1.1 dated 24 September 1998. 32 Report of the Forty-seventh Meeting of the RD with the WRs Date 0900 to 1230 hrs (Tea/Coffee – 1030 –1100 hrs) 1230 to 1430 hrs 1430 to 1700 hrs (Tea/Coffee – 1530 - 1545 hrs) Monday 19 October Item 6.2 Confidential session between RD and WRs Individual meetings of WRO staff with technical units (by prior appointment) Tuesday 20 October Item 4.1 Review of 1998-1999 programme implementation and strategies and approaches for its improvement Item 4.2 Implications of resolution WHA51.31 on regular budget allocations to the regions, and policies on the management of future programme budgets Item 5.2 Global projects on: (a) Roll Back Malaria, and (b) Tobacco Free Initiative Wednesday 21 October Item 4.3 Recent changes at WHO HQ and their implications to the regions Item 5.1 Highlights of: (a) 16th Meeting of Health Ministers of SEAR countries, and (b) 51st session of the Regional Committee I Item 4.4 Lessons learned during evaluation of WHO country collaborative programmes in 1998 Item 5.3 Inter-agency coordination with the UN system at country level – current situation Departure for Retreat at Suraj Kund (See separate programme) Thursday 22 October R e t r e a t R e t r e a t Friday 23 October R e t r e a t R e t r e a t Saturday 24 October Item 7 Conclusions and recommendations Item 8 Closing session L u n c h I n t e r v a l Report of the Forty-seventh Meeting of the RD with the WRs 33 Annex 3 LIST OF PARTICIPANTS3 Bangladesh Dr W. Hardjotanojo WHO Representative to Bangladesh Dhaka Dr Lokky Wai Management Officer C/o WHO Representative to Bangladesh Dhaka Mr Mohamed Rasheed Programme & Administrative Officer C/o WHO Representative to Bangladesh Dhaka Bhutan Dr Kan Tun WHO Representative to Bhutan Thimphu Mr Norbu Wangchuk Administrative Officer (NPO) C/o WHO Representative to Bhutan Thimphu India Dr N.K. Shah Ag. WHO Representative to India New Delhi Dr T. Walia Public Health Administrator C/o WHO Representative to India New Delhi Mr Manmohan Singh Administrative Officer C/o WHO Representative to India New Delhi 3 Originally issued as document SEA/WR47/2 dated 13 October 1998. 34 Report of the Forty-seventh Meeting of the RD with the WRs Indonesia Dr Robert J. Kim-Farley WHO Representative to Indonesia Jakarta Dr Russell M. Brooks Technical Officer (Health Planner) C/o WHO Representative to Indonesia Jakarta Ms Jacoba W. Sikkens Administrative & Programme Officer C/o WHO Representative to Indonesia Jakarta Maldives Dr Ei Kubota WHO Representative to Maldives Male Dr S. Puri Medical Officer C/o WHO Representative to Maldives Male Myanmar Dr K. Wagner WHO Representative to Myanmar Yangon Dr Lin Aung National Professional Officer C/o WHO Representative to Myanmar Yangon Nepal Dr William J. Pigott WHO Representative to Nepal Kathmandu Dr Harry Feirman Technical Officer (Health Planner) C/o WHO Representative to Nepal Kathmandu Report of the Forty-seventh Meeting of the RD with the WRs 35 Ms Patricia Brice Administrative & Programme Officer C/o WHO Representative to Nepal Kathmandu Sri Lanka Dr Peter Hybsier WHO Representative to Sri Lanka Colombo Dr A.S. Abdullah Medical Officer (Programming) C/o WHO Representative to Sri Lanka Colombo Mr Ananda Mohan Das Technical Officer (Management) C/o WHO Representative to Sri Lanka Colombo Thailand Dr Han Tun Representing WHO Representative to Thailand Nonthaburi Dr Somchai Peerapakorn National Professional Officer (Programme) C/o WHO Representative to Thailand Nonthaburi Ms Laksami Suebsaeng National Professional Officer (AIDS) C/o WHO Representative to Thailand Nonthaburi RESOURCE PERSONS HQ Dr Diego Buriot, Chief, LSC, WHO HQ Dr Kamini Mendis, RBM, WHO HQ Dr Pene Key, RBM, WHO HQ 36 Report of the Forty-seventh Meeting of the RD with the WRs SEARO Dr Z. Jadamba, Director, Health Promotion and Protection Dr George Fernando, Director, Health Services Development Dr Than Sein, Director, Health Policy and Management Dr Vijay Kumar, Director, Integrated Control of Diseases Dr (Ms) Rita Thapa, Director, Family Health and Research Dr A. Sattar Yoosuf, Chief, Environmental Health Dr I.S. Mochny, Ag. Chief, Expanded Programme on Immunization OTHERS Prof Wadie W. Kamel, Clinical Professor of Family and Community Medicine; Director, Healthy Borders 21 Global Initiative, WHO Collaborating Centre for Border & Rural Health Research & Development, Phoenix Area, Tempe, Az. 85283, USA (Temporary Adviser to the Regional Director) SECRETARIAT Dr Uton Muchtar Rafei, Regional Director Dr Samlee Plianbangchang, Director, Programme Management Mr R. Spina Helmholz, Director, Administration and Finance Dr N.T. Cooray, Planning Officer Dr M. Khalilullah, Programme Development Officer Mr J.J. Kobza, Assistant Budget & Finance Officer Mr S. Vedanarayanan, Administrative Officer to Director, Programme Management Mr J. Tuli, WHO Short-term Consultant Mr R.V. Narasimhan, WHO Short-term Consultant Mr R.L. Bhalla, Administrative Assistant, Programme Coordination Unit Mr M.R. Kanagarajan, Administrative Assistant to DPM Report of the Forty-seventh Meeting of the RD with the WRs 37 Annex 4 ADDRESS BY DR UTON MUCHTAR RAFEI, REGIONAL DIRECTOR, WHO SOUTH-EAST ASIA REGION AT THE INAUGURAL SESSION OF THE FORTY-SEVENTH MEETING OF THE REGIONAL DIRECTOR WITH THE WHO REPRESENTATIVES, SEARO, NEW DELHI Dear colleagues, ladies and gentlemen, I extend a warm welcome to all of you to this 47th meeting of the WHO Representatives in the countries of the South-East Asia Region. Of the several meetings we convene each year, I consider this meeting with the WRs as essential to ensure effective collaboration with our Member Countries. This year, in addition to WRs, we also have with us other colleagues from the respective country offices. We have many critical and urgent issues to discuss and I look forward to the active participation of all. I am also happy to see many of our friends from the UN and other agencies at this inaugural session. I sincerely appreciate your presence, and am grateful that you could find the time in the midst of your busy schedules. We have a heavy agenda. To get the best out of this meeting, I have changed the context and method of its work this year. This new approach, I believe, will encourage free and frank discussions. Together, I am sure, we will be able to address some important issues related to the health challenges facing the Region. Ladies and gentlemen, as you are aware, this year WHO completed 50 years of its collaborative activities in the South-East Asia Region. These activities, I am happy to say, have been carried out in close cooperation with the Member Countries. We all know that WHO is not a funding agency. Our resources, both human and financial, provide technical support to strengthen national health development in the countries. We work with the countries in the priority areas identified by them. Over the years, our collaborative efforts have led to many successes. The most outstanding of these was the eradication of smallpox. Today, support is being extended in several areas, including the efforts to eradicate poliomyelitis, eliminate leprosy and control tuberculosis and malaria. Activities in these areas ranging from vaccine production, development and maintenance of the “cold chain”, the development of multi-drug therapy for Leprosy and the Directly Observed Treatment – Short Course (DOTS) for Tuberculosis, are recognized as major achievements. As we enter the new millennium, we must acknowledge that the world today is not what it was 50 years ago. Rapid, and, at times spectacular developments in 38 Report of the Forty-seventh Meeting of the RD with the WRs travel and communications have made the world a global village. WHO has made maximum use of these new developments while working with our Member Countries in their march towards health for all. We have advocated health as being integral and central to health development at the highest political levels through the Health Ministers Forum which was established in 1995. The Health Ministers are now our strong allies in the war against poverty and ill health, of which our Region carries the biggest burden. At their meeting in 1997, the Health Ministers had adopted the Declaration on “Health Development in the South-East Asia Region in the 21st Century”. At their meeting this year, the Ministers agreed that this Regional Health Declaration should be the basis for our collaborative efforts in the next few decades. WHO has also realized that we are not the only actors in the field of health. That is why during the past few years WHO has been taking a close look at itself. WHO is in the process of reform. We are having a fresh look at the Organization’s Constitution, at its structure – indeed, at the way WHO functions. Today, we have a new Director-General, Dr Gro Harlem Brundtland. Her message is clear. WHO must change. WHO must work collectively to make a difference. To improve people's health, and the governments’ ability to improve it. In this context, I would like to say that in order to make this difference, it is not only WHO that would need to change. The approach to health development by governments, our sister UN agencies, our bilateral donors, development banks and, not least of all, by civil society must also change. Dear colleagues, ladies and gentlemen, the formidable health challenges facing the quarter of the world’s population inhabiting our Region have to be addressed in a spirit of partnership and solidarity. None of us can do everything by ourselves. We must decide what each of us can do best and then proceed with a unity of purpose. I believe that the time has come to vigorously foster a culture of partnership. This applies not only among the UN agencies, but also among all players and stake holders in the arena of health development. What should be the nature of this partnership? To me, the most important facet in any partnership is that one must not try to control or dominate the others. We are all, in the ultimate analysis, working for the amelioration of ill health and poverty in the countries. We work for the people and, with the people; not for ourselves. My mission, I believe, is to lead WHO in our Region in such a way that we contribute together with all other players, to improve the quality of life of our peoples. And, most important, the lives of all the people, and not just the privileged few. Our Region faces daunting health challenges. There is, for instance, the rapidly spreading pandemic of HIV/AIDS. There has been an enormous increase in the numbers suffering from tuberculosis. Malaria is still to be controlled. New communicable diseases confront us. There is also the issue of women’s health and gender inequality. We must strengthen our efforts with Governments to make quality health care accessible to all. Strenuous and urgent action is required to combat the Report of the Forty-seventh Meeting of the RD with the WRs 39 menace of tobacco-related diseases in the Region. In addition, noncommunicable diseases such as diabetes and cardiovascular problems are rapidly becoming public health concerns in most Member Countries. As I said earlier, no government alone can win the war against disease. All of us have to play our roles to the best of our abilities. I can assure you that WHO will cooperate fully in the formulation of the United Nations Development Assistance Framework within the United Nations Resident Coordinator System in the countries in a spirit of equal partnership. In conclusion, let me say that in the next few days, I will be discussing with our representatives and our colleagues in the country offices, the best way to make use of WHO’s scarce resources. The best way to work with our partners. The best way to make a difference. I am certain, that together we will succeed. Thank you, 40 Report of the Forty-seventh Meeting of the RD with the WRs Annex 5 OPENING REMARKS BY DR UTON MUCHTAR RAFEI, REGIONAL DIRECTOR, WHO SOUTH-EAST ASIA AT THE BUSINESS SESSION OF THE FORTY-SEVENTH MEETING OF THE REGIONAL DIRECTOR WITH THE WHO REPRESENTATIVES, SEARO, NEW DELHI Dear Colleagues, I have great pleasure in welcoming you all once again, and to share a few thoughts on issues of vital concern. A short while ago I placed before you and the representatives of our sister agencies, my views on the prime position of partnerships in health development. Partnerships, first with governments and then with other UN agencies, with civil societies and all those involved in the great task of building healthy communities. Before we proceed with our heavy agenda, I would like to inform you, as is customary, of the changes among staff in SEARO since our meeting held last year. I shall read out the names of the staff who have joined during the period, and I would ask them to raise their hand, so that they can be identified. S. No Name Title/ Location Date New Assignment/ Reassigned from Remarks 1. Dr Orapin Singhadej Regional Adviser, Community Health Services 01.12.97 Reassignment from the abolished post of MO-SMI. 2. Mrs H.B.K. Pandey Information Officer 01.12.97 New assignment. 3. Dr Sally A. Bisch Regional Adviser, Women Health & Development 01.12.97 Reassignment from RA-NUR . 4. Dr Rita Thapa Director, Family Health & Research 01.12.97 Reassignment from RA-CHS. On duty travel in Shenghai 5. Dr S.P. Jost Technical Officer, Health Systems Research 19.01.98 Temporary reassignment from Maldives. Report of the Forty-seventh Meeting of the RD with the WRs 41 6. Mr J.W. Fitzsimmons Technical Officer, Expanded Programme on Immunization 03.02.98 New Assignment . 7. Dr Sawat Ramaboot Medical Officer, Control of Diarrhoea and Respiratory Infections 06.05.98 Reassignment from RE. 8. Dr D. Sungkhobol Regional Adviser, Nursing 06.05.98 Reassignment from NUR-O. 9. Ms A. Chamchuklin Librarian 27.06.98 New assignment. On duty travel to Geneva 10. Dr Deoraj Caussy Regional Epidemiologi st. 15.07.98 Reassignment from Scientist, EPI. 11. Dr R. Montanari Medical Officer, Malaria 12.10.98 Temporary reassignment from Bangladesh. On leave in Dhaka During this period, the following left the Regional Office on retirement, reassignment. S. No. Name Title/ Location Date Remarks 1. Mr P.D. MacMillan Assistant Personnel Officer 01.12.97 Reassignment to AFRO. 2. Mr A.P. Hirano Regional Adviser, Environmental Health 01.07.98 Retirement. 3. Dr K. Olavi Elo WR, India 17.08.98 On secondment to UNAIDS/HQ. 4. Mr Y. Younan Administration & Finance officer 21.09.98 Reassignment to HQ. I would now like to share with you how WHO can initiate action in areas of vital concern. Action to ensure that we utilize our money and our most valuable asset 42 Report of the Forty-seventh Meeting of the RD with the WRs - our human resources - in areas that WHO can do best. Where we are at a comparative advantage and where we can make a difference? How can we set about this task? We must do some serious rethinking on how we can make the best use of our scarce resources. This has been said many times before: it however, bears repetition. We are spreading our resources too thinly on too many programmes in the countries. This represents over 75% of a regional allocation of almost one hundred million US dollars, the use of which, I am afraid, is not very well planned. What is the result? A very low rate of financial obligation – the lowest among the regions. Attempts to accelerate the spending of this huge amount of money has usually resulted in proposals and activities which are of questionable technical quality. We are presently reviewing the technical quality of some recent obligations. Therefore, we must rationalize the use of WHO resources in the countries Tomorrow, some of you will deliberate on this issue and I look forward to the outcome of your discussions. At this stage, let us look at another dimension of the use of resources. As I said, three-quarters of the regional allocation is for the country programmes. And, as we have seen, the countries find it difficult to absorb this in a technically sound manner. Let us, for a moment take a look at the other Regions. The country allocations range from 11% in the European Region to 66% in the Eastern Mediterranean. It is not surprising, therefore, that the other regions question the vast amounts of WHO funds allocated to the countries of our Region. The Executive Board resolution, EB101.R10, sought to address this issue. The “Background Information” on Regional Allocation gives a clear picture. I advise you to read it carefully. You will also be informed about the implications to the regional allocations as mandated by World Health Assembly Resolution WHA51.31. What should we do to both protect the regional allocation on behalf of our Member States, and ensure the absorption of these resources in a technically sound manner? I sincerely believe that we must depend increasingly on the intercountry mechanism. Time does not permit me to go into details. We will, however, be discussing this issue over the next few days. But I wish to make two points. The Health Ministers at their 16th meeting just a few weeks ago once again highlighted the effectiveness of intercountry mechanisms, underlining the benefits accruing to the countries. Therefore, when you talk about enhancing the intercountry mechanism with decision-makers in the Ministry of Health, you must remind them that your argument is based on guidance provided by their own Health Ministers. I believe some countries are favourable to this proposition. At the same time, some countries look at it differently. We must build on the enthusiasm of the first group while allaying the doubts of the second. To me, it became very clear at both formal and informal discussions during the CCPDM and Regional Committee meetings this year that the countries want to be more closely involved in the planning and formulation of the intercountry programme. They feel uneasy when they are presented with proposals developed in Report of the Forty-seventh Meeting of the RD with the WRs 43 the Regional Office for using a part of their country planning figure as a new intercountry programme. I cite the example of ICP II in 1996-1997 and 1998-1999. We must therefore devise mutually acceptable ways and means to involve the countries in the total process of formulation and implementation of the intercountry programme. Our commitment to be more transparent in our work demands that we do so and I fully endorse this suggestion made by some Member Countries. I also urge the WHO Representatives to give serious thought to this. Please discuss this issue thoroughly and suggest some practical action points. Even as we advocate for greater efficacy of the intercountry mechanism, we need to focus on another facet of the programme budget. We must separate the programme from the budget. The budget is biennial and is the WHO budget. The programme continues and it is developed by the countries with technical advice from WHO. We must impress on the government that the “country planning figure” is just what it says. It is a planning figure. It does not mean that the funds belong to the country. Secondly, we must take a critical look at the current management environment, both in the Regional Office and the country offices. This was an issue clearly highlighted during discussions on the regular budget allocations in the Sub- Committee on Programme Budget. Indeed, the Sub-Committee recommended that “a working group be established to study the subject of efficiency at the Regional Office and in the country offices”. I am now in the process of implementing this very important recommendation. Our Member Countries are sending a clear message. They are saying, “Don’t ask us to agree to enhance the intercountry programme without first putting your own house in order”. This I most certainly intend to do. Your inputs to these two issues – improving the use of resources and increasing the efficiency of WHO which are really two sides of the same coin - will be very useful to me. Next comes the challenging area of inter-agency cooperation at the country level. This will be an issue for group discussions tomorrow and will also be discussed in the plenary session on the 21st. At present, I will focus on a few important aspects to guide your deliberations. I reiterate what I said at the inaugural session. We will cooperate fully in the formulation of the United Nations Development Assistance Framework within the United Nations Resident Coordinator System in the countries in a spirit of equal partnership. I underline the words “equal partnership”. The WHO Representatives must approach this task in a balanced manner. While compIying, we must maintain our identity. Do not let it appear to the government that your time is more for the UN system and less with the Ministry of Health. At the same time, you should not be seen as the government representative in WHO and the UN System. This is what I mean by “balanced manner”. When you have established yourself in this manner, you can be an honest broker between the government and the UN agencies in the country, in the arena of health development. A trusted and competent technical person. A person who can justify the position of WHO as the lead agency in health development in the country. A person who is trusted by the government and listened to by the donors and UN agencies. Then surely you will be the spokesperson of WHO demonstrating the Organization’s 44 Report of the Forty-seventh Meeting of the RD with the WRs comparative advantage. You can demonstrate the true role and value of WHO in the country. We must, at all times, remember that WHO is not a service organization. But, regretfully, this appears to be how we are seen at the country level. I repeat that we cannot be health care providers. That is the government’s responsibility. We can be compared to an architect who provides the blueprint, as it were, for an efficient and effective health care system. In conclusion, let me summarize: Sensitize the governments to the danger of too large a country allocation. Rationalize the programmes and the use of resources. Separate the programme from the budget. Advocate the advantage of intercountry mechanisms. Improve our overall management practices and efficiency. Play our role in the UN system positively. Then, in the words of the Director-General, we can say that we are, and I quote “A WHO that can engage where the needs are greatest; A WHO that is trusted to maximize its resources: A WHO with excellence and a WHO that can truly make a difference” end of quotation. Dear Colleagues, your agenda has been structured to focus on these issues; sometimes repeatedly. As you would have noticed, the format of this meeting has been modified, in keeping with the suggestions received from some WRs and colleagues in the Regional Office. I am sure that this new arrangement will prove more effective in addressing issues of common concern. I look forward to your active participation and focused discussions. This is an in-house meeting. Please be frank and open. This applies to the Regional Office staff as well. Many of the topics discussed at this meeting will feature in the “Retreat”. At the end of our parleys, I hope that we will feel more confident to look to the future with hope and optimism. Thank you.