REGIONAL COMMITTEE Sixty-first Session SEARO, New Delhi 8–11 September 2008
Provisional Agenda item 9.2 SEA/RC61/5 18 July 2008
MATTERS RELATING TO PROGRAMME DEVELOPMENT AND MANAGEMENT: REVIEW OF IMPLEMENTATION OF WORKPLANS FOR PROGRAMME BUDGET 2008–2009 INCLUDING THE RESOURCE GAP ANALYSIS AND RESOURCE MOBILIZATION PLANS* The attached working paper on Programme Budget describes the budget situation for the 2008-2009 biennium in respect of both Assessed Contributions (AC) and Volunatry Contributions (VC). Overall the budget for 2008-2009 has increased by 38% as compared to the previous biennium. The major portion of increase is in respect of VC funding that is budgeted to reach US$ 387.6 million. During the first five months of the current biennium, about 47% of the budgeted VC funding was available for implementation, although the distibution of these funds was and continues to be uneven. So far in this biennium, the implementation rate is similar to that of the 2006-2007 biennium. The challenge is to mobilize resources to meet the planned budget and to ensure that these funds are implemented successfully. This paper was submitted to the First Meeting of the Sub-committee on Policy and Programme Development and Management (SPPDM), held in New Delhi on 4 July 2008 for its review and comments before being presented to the Sixty-first Session of the Regional Committee. The SPPDM made the following recommendations on this subject for consideration by the Sixty-first Session of the Regional Committee: (1) (2) The Regional Office should continue to provide support to country offices for improved resource mobilization. The Regional Office should strengthen its close coordination with headquarters to mobilize additional specified and unspecified funds from global health partnerships and initiatives, such as the Global Fund, GAVI, GAVI-HSS and TFI, etc. The disparity in distribution of resources for the underfunded programmes should be reduced through proper coordination and collaboration among programmes. Countries’ capacity to implement funds should be strengthened. Specific efforts should be made towards achieving enhanced implementation efficiencies. Efforts to build staff and country capacities should concentrate on country offices so as to ensure support for implementation of activities by countries. The Regional Director has already delegated the maximum authority to country offices in order that they can be more responsive to country needs. However, country offices should exercise such authority with appropriate oversight and accountability. Additional efficiencies should be achieved by WHO by enhancing its administrative transaction processing functions. The possible ways to move forward include use of standard transaction agreements and exploration of ways to contract on a larger scale so as to avoid multiple, small and costly transactions.
(3) (4) (5)
(6)
The paper is now submitted to the Sixty-first Session of the Regional Committee for its consideration. *Please refer to Inf. Doc. on Resource Mobilization in 2006–2007 and for 2008–2009
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1. The approved budget of US$ 103.9 million AC and US$ 387.6 million VC represents a 5% increase in AC funding and a 50% increase in VC funding compared to the 2006-2007 budget. 2. As of 11 June 2008, about US$ 181.7 million were available for VC funding, either from funds carried over from the previous biennium or from new agreements. This was about 47% of the approved budget. It is likely that the total funding for VC will be achieved and exceeded during the biennium. 3. Problems with uneven distribution of VC funding still persist, although efforts are being taken to support programmes and countries with low resource mobilization. During the first five months of the biennium, Bangladesh, India, Indonesia, Myanmar and Nepal had all received more than one third of the budgeted VC. On the other hand, Bhutan, Maldives and Sri Lanka had received less than one sixth of their budgeted VC funding. Table 1: PB 2008-2009 – VC budget and resources available (as of 11 June 2008) by office (in millions of US dollars) Country Bangladesh Bhutan India Indonesia DPR Korea Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste Regional Office Total Revised budget 41.2 4.2 89 57.9 29.9 3.7 48.6 19.3 9.2 8.9 6 112.4 430.3 Current VC resources 18.6 0.3 41.9 22.8 7.3 0.6 18.6 9.4 1.4 1.7 1.3 57.8 181.7 VC available 45% 7% 47% 39% 24% 16% 38% 49% 15% 19% 22% 51% 42%
4. The distribution of VC funds to Strategic Objectives (SOs) was also uneven as shown in Table 2. SO4, SO9 and SO11 have received one fifth or less of their revised budgets respectively.
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Table 2: PB 2008-2009 – VC budget and resources available (as of 11 June 2008) by Strategic Objectives 1 to 11 (in millions of US dollars) Strategic Objectives 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Polio, surveillance, IHR and neglected diseases AIDS, TB and malaria Noncommunicable diseases and mental health Health of mothers, children, adolescents and ageing Emergency preparedness and response Risk factors for health Determinants of health Health and environment Nutrition and food safety Health systems Medical products and technology Revised budget 157.4 81.3 8.8 31.5 54.1 10.9 3.6 6.8 7.4 28.1 9.9 Current VC resources 79.4 41.7 2.6 5.4 23.5 4.3 1.9 2.5 1.2 6.3 1.3 VC available 50% 51% 30% 17% 43% 39% 53% 37% 16% 22% 13%
5. The greatest risk the Region faces this biennium is the capacity to fully implement the planned budget. During the last biennium, US$ 317 million (AC plus VC) were implemented by countries and the Regional Office. In order to implement the total of US$ 491.5 million budgeted for this biennium, an increase in implementation of 55% will be required compared to 2006-2007. For the first five months of the current biennium, only about US$ 58 million were implemented amounting to was about US$ 13 million per month. If implementation for the rest of 2008-2009 continues at the same pace, total expenditures would be in line with 2006-2007 expenditures, clearly falling short of planned implementation. 6. The capacity to implement the WHO budget depends on the core technical and administrative staff needed to support and process activities in countries and in the Regional Office. It is difficult to recruit core technical staff with VC funding because donor support is often for a short period of time. Furthermore, donors are reluctant to support the administrative costs of WHO offices and the 13% Programme Support Costs do not reflect the full administrative costs to the Organization, estimated to be substantially higher. Finally, inflation and the falling exchange rates most acutely affect the core operating and staff costs of regional and country offices where there are severe limits in funding. A successful implementation of the rapidly increasing amount of VC funds needs to be supported by shifting AC funds to support the core
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technical and administrative capacity of WHO offices, as well as by efforts to ensure that donors pay more of the costs of implementation. 7. In conclusion, VC funds budgeted for the 2008-2009 biennium are likely to be mobilized, reaching the overall resource target for the Region. Efforts are needed to improve the distribution of VC funding to programmes and countries. More importantly, the Region faces the main risk that it will not be able to fully implement these resources, mainly due to inadequate core technical and administrative capacities of offices.
REGIONAL COMMITTEE Sixty-first Session SEARO, New Delhi 8–11 September 2008
Provisional Agenda item 9.2 SEA/RC61/5 Inf. Doc. 18 July 2008
RESOURCE MOBILIZATION IN 2006–2007 AND FOR 2008–2009 This information paper is prepared to facilitate the SPPDM if it wishes to discuss resource mobilization efforts and status of funding of the Regional Programme Budget as mandated by RC resolution – SEA/RC60/R2. The paper consists of six sections: In Section I, it addresses the main funding sources of Voluntary Contributions, types of funding, and main mechanisms and approaches for resource mobilization. Section II, which is the main part of the paper, highlights a number of key efforts made by each technical department in the Regional Office and country office in resource mobilization to achieve the target of Voluntary Contributions in the Programme Budget for 2006–2007. Section III indicates briefly the funding status of Voluntary Contributions for each office and for technical programmes, supported by two tables (annexes 2and 3) showing detailed funding figures. In Section IV, the paper includes examples of major WHO support provided to Member States for accessing funds from the Global Fund, GAVI and GAVI-Health System Strengthening (HSS). Section V indicates some of the opportunities, challenges and issues for the Region in resource mobilization. Section VI, which is the final part of the paper, highlights the key strategies and approaches of WHO in the Region for improved resource mobilization to achieve the considerably increased target of Voluntary Contributions for Programme Budget 2008–2009.
Contents Page Section I. Introduction ................................................................................................................1 Rationale for the Paper .................................................................................................................... 1 Increasing need for VC and resource mobilization efforts.................................................................. 1 Main funding sources of Voluntary Contributions ............................................................................. 2 Types of funding .............................................................................................................................. 3 Main mechanisms of resource mobilization ...................................................................................... 3
Section II. Efforts made by WHO in the SEA Region in 2006–2007.............................................4 Key objective, coordination and achievements ................................................................................. 4 Efforts of WHO offices in the Region during 2006–2007 .................................................................. 5 1. Regional office: Total amount of VC mobilized – US$ 80.3 million ............................................... 5 2. Country offices: Total amount of VC mobilized – US$ 246.1 million............................................. 8
Section III. Funding status .........................................................................................................12 Section IV. Facilitation to Member states for resource mobilization ...........................................13 Support for accessing funds from the Global Fund .......................................................................... 13 Support for accessing funds from GAVI for immunization and vaccines........................................... 13 Support for accessing funds from GAVI-Health System Strengthening (HSS) .................................... 13
Section V. Opportunities, challenges and issues ........................................................................14 Opportunities ................................................................................................................................ 14 Challenges ..................................................................................................................................... 14 Issues............................................................................................................................................. 15
Section VI. Key strategies and approaches for improved resource mobilization in 2008–2009 ............................................................................................................15 Annexes 1. 2. 3. Funding sources of Voluntary Contributions to the WHO SEA Region in 2006–2007 ...................................................................................................................17 Voluntary Contributions mobilized for each WHO Office in the Region in 2006–2007........................................................................................................19 Voluntary Contributions mobilized for major technical programme areas in 2006–2007 ...................................................................................................................20
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Section I. Introduction Rationale for the Paper 1. In a resolution adopted at its Sixtieth Session held in Thimpu, Bhutan, from 31 August to 3 September 2007 (SEA/RC60/R2), the Regional Committee for WHO South-East Asia established a Sub-Committee on Policy, Programme Development and Management (SPPDM) and decided that the SPPDM shall provide its views and recommendations to the Regional Committee, inter alia, on “Resource mobilization efforts and status of funding of the Regional Programme Budget” 2. The Regional Committee also requested the Regional Director to: (a) give priority, to the extent possible, to countries with the greatest need/smallest budgets in distributing funds in the form of unspecified Voluntary Contributions and enhance efforts to mobilize additional Voluntary Contributions for these countries; (b) strengthen resource mobilization efforts involving donors in the Region and with WHO headquarters to obtain adequate Voluntary Contributions to implement the workplans; and, (c) develop an appropriate scientific formula for the distribution of resources, including Assessed Contributions and core Voluntary Contributions. 3. This paper has been prepared in response to the above resolution of the Regional Committee. It gives an account of the efforts made by the Regional and country offices for resource mobilization and status of funding of the Programme Budget in 2006–2007. This period has been chosen because WHO’s Programme Budget follows the biennium cycle and funds are planned, mobilized and implemented accordingly. The paper also briefly states the support and facilitation offered to Member States for resource mobilization, addresses some challenges and issues, and spells out the strategic directions and key approaches to resource mobilization for 2008–2009. 4. The issue of developing a formula for the distribution of resources referred to in the resolution has been left out of the purview of the paper as a debate is on about this issue at other appropriate forums. 5. To address resource mobilization efforts, there is a need to clarify some relevant issues in WHO such as increasing requirements for Voluntary Contribution, major donors, funding types, mechanisms, strategic objectives and approaches to resource mobilization.
Increasing need for VC and resource mobilization efforts 6. The WHO Programme Budget is financed by two main funding sources – Assessed Contribution (AC) and Voluntary Contributions (VC). Traditionally, the VC was a far smaller component of the WHO Programme Budget than the AC. However, the situation has completely changed during the last decade, starting from the biennium of 1998–1999. The total amount of VC required for WHO as a whole in the biennium of 2008–2009 is US$ 3 268 million, which is more than four times the amount 10 years ago – US$ 804 million for 1998–
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1999. VC currently accounts for about 77% of the total WHO Programme Budget (US$ 4 227 million for 2008–20091). 7. For the Regional Office for South-East Asia, this change has been more prominent. The total amount of VC required for the 1998–1999 Programme Budget was US$ 67 million2. However this has grown to US$ 437.6 million for the 2008–2009 Programme Budget which is more than six times that of 1998–1999. VC accounts for nearly 81% of the total Regional Programme Budget for 2008–2009. 8. At the same time, the actual amount of VC mobilized by the SEA Regional Office has significantly increased: from US$ 63 million for 1998–1999 to US$ 114 million for 2000–2001 and to US$ 129.6 million for 2002–2003, US$ 301.6 million for 2004–2005, and to reach US$ 344 million for 2006–20073. 9. This increase in Voluntary Contribution is chiefly attributed to the frequent outbreaks in the Region of communicable diseases such as SARS and avian influenza, occurrence of natural disasters such as flood, earthquake and the tsunami; global and regional efforts to control or eradicate certain diseases such as HIV/AIDS, TB, malaria and polio; and for the achievement of MDGs.
Main funding sources of Voluntary Contributions 10. Global: The number of funding sources of Voluntary Contributions to WHO has been expanded in recent years to include government donors of Member States4, UN agencies and international financial institutions, foundations, NGOs, and corporate and private sectors. In 2004–2005, Member States contributed 62.7% of the total VC, whereas 16% came from UN and intergovernmental organizations, 9.4% was contributed by foundations, 2.9% by nongovernmental organizations and 1.1% by private sectors. 11. The situation changed in 2006–2007, when 51.5% was contributed by Member States, 25.2% by UN system, intergovernmental organizations and financial institutions, 13% by foundations and nongovernmental organizations and 1.2% by private and corporate sectors. The total number of contributors is currently more than 400. The contributions of less than a dozen different donors, however, account for more than 75% of all Voluntary Contributions to WHO globally. The remaining 25% comes from several hundred different funding sources. 12. Regional: During the biennium of 2006–2007, the South-East Asia Regional Office has been supported by 23 government donors, 14 UN system, international organizations and financial institutions, nine foundations and NGOs and more than 17 private and corporate sectors and institutions. The major part of the VC was from government donors (US$ 168.6 million or 51.7% of the total), followed by UN system, international organizations and financial institution (US$ 92.2 million or 28.3% of the total VC), foundations and NGOs (US$ 13.6 million 1 2 3 4
See Medium-term strategic plan, 2008–2013 and proposed Programme Budget 2008–2009 See Proposed Programme Budget, 2000–2001 Data from WHO Activity Management System
Government donors are those representing some Member States of WHO which include USAID for USA, DFID for UK, SIDA for Sweden, CIDA for Canada, AusAID for Australia, NORAD for Norway, etc.
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or 4.2% of the total VC) and private and corporate sectors (US$ 7.7 million or 2.4% of the total VC). 13. Ten top contributors are the United States of America, United Kingdom, UN Foundation for International Partnerships (UNFIP), Canada, Republic of Korea, Australia, the World Bank, Sasakawa Foundation, Japan and Norway (see Annex 1).
Types of funding 14. Level of specification of Voluntary Contribution to WHO : Donors provide voluntary contribution to WHO in four ways: fully flexible funds (1% of total VC); highly flexible funds specific to strategic objectives – SO level (5.6% of total VC); medium flexible funds specific to Organization-wide expected results – OWER level (10.6% of total VC); and specified funds for particular programmes or geographical areas (82.8 % of total VC). 15. Core Voluntary Contributions: There are some government donors contributing without earmarking or earmarked at a higher level according to the Organization’s priorities. The degree of earmarking differs among donors – fully flexible, flexible at strategic objective level and medium flexible. The number of these donors is less than a dozen and the total of this contribution, which is called “Core Voluntary Contributions (CVC)” is about US$ 300 million globally, or about 10% of the total VC of WHO. 16. In order to ensure more effective financing, WHO has recently established the Core Voluntary Contributions Fund (CVCF). The CVCF is designed to pool Core Voluntary Contributions which are fully and highly flexible and placed under the corporate management overseen by the Organization-wide Advisory Group of Financing Resources (AGFR). 17. Other Voluntary Contributions: In addition to the Core Voluntary Contribution, the Organization mobilizes other Voluntary Contributions intended for a specific purpose. This is a major part of WHO Voluntary Contributions. A high degree of specificity is attached to much of this VC. These funds are less predictable and their use in specific areas and programmes are determined by contributing donors, not by WHO. 18. These funds are raised on the one hand by the HQ-led resource mobilization activities from several mechanisms of international health partnerships and initiatives, such as STOP TB, Roll back Malaria, GAVI, etc. On the other hand, each regional and country office mobilizes funds from donors at the respective regional and country level to meet the funding needs for office workplans. This fund is “specified” in terms of project or activities and designated in terms of place where the fund is spent. This funding is also called “project funding”. 5
Main mechanisms of resource mobilization 19. Funding opportunities exist at every level of the Organization – global, regional and country levels. In order to take advantage of all these opportunities for raising resources, resource mobilization in WHO is taking place both at the regional level by regional and country 5
The rates of each type of funding mentioned are based on the figures in 2006–2007
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offices and at the global level by headquarters in coordination with regional and country offices. The latter is called also resource mobilization at the “corporate level”. 20. At both the levels, constant contact is being maintained with donors and other funding agencies to explore and capture opportunities for available funds: regional and country offices are working mainly with local offices of donor governments, financial institutions, foundations and corporate and private sectors, whereas headquarters is coordinating with head offices of donor agencies, international financial institutions, international foundations and international health partnerships.
Section II. Efforts made by WHO in the SEA Region in 2006–2007 Key objective, coordination and achievements 21. The objective of resource mobilization: The primary objective of WHO’s resource mobilization is to meet the funding requirement of its programme budget for technical support to Member States. 22. Key strategy: Intensified resource mobilization through enhanced regional and country initiatives for partnerships. This is in the premise that resource mobilization is not about money, but for a partnership process to identify those who can share the value of the Organization, develop and strengthen relationship with them to get support from them. 23. Strategic approaches: Decentralized and corporate approaches wherein each WHO office in the Region takes full mandate and responsibility for resource mobilization to make use of all resource mobilization opportunities existing at each level and work in close coordination with the Regional Office and headquarters. 24. Coordination: The External Coordination Unit (ECU) in the Regional Office plays a central coordinating role in WHO resource mobilization in the Region. It provides assistance in policy and strategic areas, as well as operational and technical assistance to the resource mobilization activities of all offices in the Region and ensures effective coordination at all levels of the Organization – country offices, regional office and HQ. 25. The ECU developed and provided a “Regional Business Plan for Resource Mobilization” for every office as policy, strategic and operational guidelines on resource mobilization, and assisted in the development of a plan of action for resource mobilization at country offices and departments in the Regional Office. 26. The ECU has arranged and facilitated several meetings with donors and partners’ forums for specific purposes and strategic partnerships at the regional and country levels; organized several training workshops for WHO staff and officials of Member States to strengthen technical capacity for resource mobilization; provided tools and regular donor information updates and initiatives to facilitate resource mobilization. It is also managing an information system of voluntary contributions. 27. The SEA Regional Office has provided overall coordination on the negotiations and conclusions of all donor agreements at the regional and country levels in close coordination with
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Budget and Finance which provides significant support for the review of financial and legal aspects in all project proposals and donor agreements. In 2006–2007, a number of donor agreements were negotiated and 183 donor agreements were concluded and signed with about 45 donors. ECU acts as the Regional Depository of all donor agreements and operates a Central Tracking System of Donor Agreements for monitoring the implementation process. 28. Overall, the Regional and country offices were able to mobilize Voluntary Contributions to the tune of US$ 344 million in 2006–2007 against their VC target of US$ 257.9 million in the Programme Budget approved by WHA, which represents a 33.3% increase.
Efforts of WHO offices in the Region during 2006–2007 29. Numerous efforts for resource mobilization have been made in 2006–2007 by every office of WHO in the Region (five technical departments, 11 country offices and one programme – IVD). For the purpose of simplification, however, this report includes only few efforts made by each office, limiting to a maximum number of five except the India and Indonesia Country Office where a significant amount of resources have been mobilized. 30. An attempt has also been made in this report to include only those efforts that led to tangible results in securing funding through agreements/formal commitments from donors and partners. Other efforts such as activities for strategic partnerships and collaborations, though having contributed to resource mobilization in different ways, have not been featured in this report. 31. In general, successful resource mobilization is achieved in most cases through three main processes – preparation of fundable project proposal; identification of potential donors and extensive negotiations with them; and concluding formal and legal documents to highlight each partner’s commitment and secure funds (donor agreements/contribution agreement/Memoranda of understanding (MoU)/exchange of letters, etc. Therefore, this paper describes each effort with these three benchmarks.
1. Regional Office: Total amount of VC mobilized – US$ 80.3 million Department of Communicable Diseases (CDS) 32. For the implementation of the Asia Pacific Strategy for Emerging Diseases (APSED), the Regional Offices for South-East Asia and the Western Pacific held consultations with the Australian Agency for International Development (AusAID) and concluded a donor agreement in 2007. The SEARO funding component of this agreement is 4 million Australian dollars. 33. SEARO has also developed a project proposal on avian influenza jointly with WPRO, negotiated with the Canadian International Development Agency (CIDA) and concluded a donor agreement on the implementation of APSED for 10 million Canadian dollars. 34. Negotiated with the US Center for Disease Control and Prevention (CDC) on three projects relating to avian influenza and made three cooperative agreements: Support for implementing key components of the Regional Pandemic Preparedness Plan (US$ 1.55 million), South-East
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Asia and Western Pacific Pandemic Influenza Stockpile Development (US$ 2 million) and Capacity Strengthening for AI (US$ 0.81 million). 35. CDS also negotiated with the United States Agency for International Development (USAID) for the prevention and control of TB, malaria, dengue and AI; and several projects were approved under the USAID umbrella grants for the year 2006 and 2007 (US$ 0.44 million for TB, US$ 2 million for malaria for SEARO/WPRO on malaria/Mekong, US$ 0.35 million for dengue, US$ 0.05 million for AI). 36. SEARO and the United Nations Office on Drugs and Crime (UNODC) developed a multiyear joint programme on prevention of transmission of HIV among drug-users in SAARC countries and concluded an MoU to implement the joint programme supported by AusAID with 9.5 million Australian dollars for UNAIDS. 37. The Global Leprosy Programme has mobilized US$ 1 250 000 from The Nippon Foundation for activities during 2007 for leprosy elimination in the Region.
Department of Family and Community Health (FCH) 38. In coordination with WHO headquarters a project agreement was made with UNFPA for US$ 150 000 from the UNFPA Strategic Partnerships Programme for the project on Building Technical Capacity in South-East Asia to support the health sector response in respect of HIV/AIDS among young people. US$ 75 999 from JHPIEGO (an international NGO affiliated with Johns Hopkins University) for training of trainers in essential newborn care was mobilized. 39. In coordination with WHO headquarters funds for activities under the FCH areas were mobilized, including US$ 102 511 for MPS from core Voluntary Contribution of AusAID and US$ 75 000 from USAID. 40. As a part of inter-departmental collaboration and in coordination with the Canadian International Development Agency (CIDA), a Gender-Related Issue was included in a CIDA supported project-Canada-Asia Regional Emerging Infectious Diseases (CAREID), mobilizing US$ 120 000. 41. In coordination with HQ, RHR area have mobilized more than US$ 400 000 from core voluntary contribution.
Department of Health Systems Development (HSD) 42. Fundings for several activities relating to health system strengthening such as health financing and social protection, health system policies and services delivery, and human resources for health, have been mobilized from core Voluntary Contribution of AusAID which has been coordinated and negotiated by headquarters. 43. Under the agreement made by headquarters, Regional Office has received about US$ 280 000 for GAVI-Health System Strengthening. 44. Nearly US$ 3.7 million has been mobilized through the allocation mechanism of WHO from pooled Core Voluntary contribution for the areas of Health Financing and Social Protection
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(HFS), Health Information, Evidence and Research Policy (IER), Health System Policies and Service Delivery (HSP), Human Resources for Health (HRH), and Essential Medicines (EDM).
Department of Noncommunicable Diseases and Mental Health (NMH) 45. About US$ 1.1 million has been allocated from unspecified contributions of core Voluntary Contributions for the areas under the NMH. 46. About US$ 1 million was mobilized from CDC Foundation and World Lung Federation in close coordination with and through headquarters for the implementation of the collaboration agreement for the Bloomberg Initiative. 47. Nearly US$ 1 million was mobilized for Health Promotion (HPR), US$ 0.5 million for Surveillance, Prevention and Management of Chronic Diseases (NCD) and US$ 0.7 million for Violence, Injuries and Disabilities (INJ) in close coordination with headquarters and through the allocation mechanism of WHO from pooled core Voluntary Contributions.
Department of Sustainable Development and Healthy Environment (SDE) 48. A project on the dissemination of information and best practices of the South Asia Regional Arsenic Mitigation Programme was negotiated with the Australian Agency for International Development (AusAID) and a Memorandum of Understanding (MoU) for 143 950 Australian dollars has been signed with AusAID. 49. About US$ 340 000 has been mobilized through allocation mechanism of WHO from pooled core Voluntary Contribution for the areas under the SDE.
Immunization and Vaccine Development (IVD) 50. Development of a proposal with headquarters in collaboration with National Polio Surveillance Project (NPSP), India, and conclusion of a donor agreement for US$ 2.6m for Vaccine Preventable Diseases (VPD) surveillance in November 2007. 51. Development of an emergency proposal and conclusion of a donor agreement of US$ 1million with the Republic of Korea through the Measles Initiative, March/April 2007. 52. Development, negotiation and conclusion of a funding agreement with AusAid for US$ 420 000 for polio eradication in Nepal in collaboration with IVD, January 2006. 53. Development, negotiation and conclusion of a funding agreement with UK Department for International Development (DFID) for US$ 405 797 for polio eradication in Indonesia in collaboration with IVD/HQ in April 2007.
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2. Country offices: Total amount of VC mobilized – US$ 246.1 million Bangladesh 54. Development of a project proposal on the strengthening of National Menstrual Regulation Programme for Reduction of Maternal Mortality and Morbidity, negotiations and agreement with the Netherlands (US$ 3.9 million). 55. Development, negotiations and conclusion of a donor agreement with DFID for US$ 1.1 million for the Demand Side Financing Pilot Maternal Voucher Scheme. 56. Development of project proposals for the recovery of cyclone-affected areas and receipt of approval of UNCERF (US$ 0.6 million), and grant from Norway (US$ 0.65 million in kind and cash) and Japan (US$ 1 million). 57. A project proposal on AI was developed and granted under the USAID umbrella grant for 2007 (US$ 0.15 million). 58. A grant of US$ 2.1 million was approved by the USAID on polio eradication activities in Bangladesh in support of the Regional office and HQ initiative.
Bhutan 59. Coordinated with the Ministry of Health to extend support for the Regional Office, which has negotiated with AusAID and signed a donor agreement for US$ 114 503 for the training of nurses in Australia. 60. With the support of the Regional Office, about US$ 120 000 was received from unspecified funds mobilized at the global level for the activities of GAVI-HSS, MPS, climate change and National Worm Control Programme. 61. The Regional Office has provided US$ 37 000 from core Voluntary Contribution for MPS activity in Bhutan.
DPR Korea 62. Development of a project on improving women and child health with the support of the Regional Office and a leading role played by headquarters in negotiation, two donor agreements of WHO with RoK were signed in 2006 (two-year project with about US$ 10 million in cash and US$ 10 million in kind) and December 2007 (US$ 36 million in cash and in-kind contribution for 2008–2010). 63. Through the regular annual appeals process through headquarters, funding support of Swedish Kroner 12 million (US$ 2.1 million) was received from the Swedish International Development Agency (SIDA) for strengthening public health for 2006–2007 64. A project for strengthening newborn care in Kangwon Province was developed and supported by the Italian Development Cooperation through an agreement in October 2007 for € 900 000 (US$ 1.41 million).
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65. Development of a project proposal on human resources development in health, distributed through headquarters which received US$ 365 000 from Norway in October 2007. 66. Development of a project on NCD prevention and control in coordination with the SEA Regional Office and conclusion of an agreement with World Diabetes Foundation in September 2007 for US$ 200 000.
India 67. Development of a project on strengthening surveillance and monitoring of communicable diseases in India for 2006–2007 in coordination with USAID-India and conclusion of an umbrella agreement for US$ 1 085 000 in September 2007. 68. Project Development on strengthening surveillance and response capacity for avian and pandemic influenza in India for 2007–2008 in coordination with USAID-India, and conclusion of the umbrella grant agreement for US$ 880 000 in September 2007. 69. A grant of US$ 3.4 million for the TB programme was negotiated and agreed with the Canadian International Development Agency (CIDA ). 70. A total grant of US$ 12.55 million from USAID (under three umbrella grant agreements) for supporting the TB field network, public-private collaborative projects, involvement of medical colleges, TB/HIV activities and collaborative research projects at the TB Research Centre, Chennai. 71. Development of a project in collaboration with UNAIDS on training of providers at the primary-care level to support HIV/AIDS care and treatment (using IMAI approach), HIV in adolescents, service availability mapping and support for staff. The project was agreed in October 2006 with an amount of US$ 561 000. 72. Continued work with Sasakawa Foundation for support to the National Leprosy Eradication Programme with an amount of US$ 1 375 800. This covered technical support to the Central Leprosy Division in the Ministry of Health and Family Welfare, States, states leprosy units, state leprosy societies, research and IEC activities. 73. Development and negotiation of a multi-year project on child health and conclusion of an agreement with Norway to support the Norway-India Partnership for reducing child mortality. The activity covered under this project included measles surveillance and outbreak response, vaccine management of routine immunization, pre-service IMNCI, quality assurance of training, accreditation of service providers, and training of skilled birth attendants (SBAs). For 2006–2007, the amount allocated was US$ 1 262 000. 74. US$ 6.5 million has been mobilized from USAID for National Polio Surveillance Project (NPSP) during 2006 and 2007. 75. Support from Bloomberg Global Initiative for Tobacco Control with an amount of us$ 322 000 was received in 2007, for building capacity on Tobacco control at the national and state level.
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76. Support was obtained from UNICEF India for implementing activities concerning psychosocial support and maternal and child health in the tsunami-affected areas. The grant amounted to US$ 700 000 was awarded in September 2006.
Indonesia 77. Development of an AI project in close coordination with the Ministry of Health, negotiation with the European Commission (EC) and conclusion of a European Community Contribution Agreement for € 13.5 million (US$ 17.3 million) to support the implementation of the National Strategic Plan for Avian Influenza, Indonesia. 78. Development of a project on rapid strengthening of the response capacity for AI in Indonesia, negotiation with CIDA and conclusion of a grant agreement for US$ 4.38 million. 79. Development of an annual activity plan (2006) on polio eradication and other relevant activities, in close coordination with WHO/SEARO and headquarters, and approval of US$ 3.2 million for 2006–2007. 80. Negotiations with DFID on a project for polio eradication activities in Indonesia for the funding of £ 2 334 333 and agreement on an MoU. 81. Development of a project for the provision of integrated life saving emergency health services for flood-affected areas in Indonesia and agreement on Central Emergency Response Fund (CERF) grant of US$ 535 000 from United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA). 82. Development of flash appeal proposals on the Yogyakarta earthquake and mobilized contributions from European Commission (US$ 1 million), Sweden (US$ 0.41 million), Canada (US$ 0.22 million), Australia (US$ 0.35 million), Monaco (US$ 0.13 million), and others. 83. Development of a joint project with UNICEF and conclusion of a donor agreement with DFID for £233 333 (US$ 405 797), and also development of a project for strengthening reproductive health/making pregnancy safer and conclusion of an agreement with GTZ, Germany, for US$ 263 879 in December 2007.
Maldives 84. In coordination with SEARO and headquarters, US$ 20 000 and US$ 10 000 were mobilized from Sweden and United Nations Foundation for International Partnerships (UNFIP) respectively for the tsunami recovery assessment and monitoring system and second expansion of the Measles Initiative. 85. In coordination with technical units in the Regional Office, about US$ 60 000 was received from unspecified funds mobilized at WHO/HQ level for the activities concerned with HIV/AIDS, laboratory supplies, vector-borne diseases and food safety. 86. US$ 16 000 was mobilized from UNICEF for the Decision-Making Tool for Family Planning Clients and Providers and to hold a national dissemination workshop and translate STI Management Guidelines.
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Myanmar 87. Negotiations and conclusions of seven donor agreements with UNOPS on the 3 Diseases Fund for HIV/AIDS, malaria and tuberculoses with the total amounting to US$ 7.3 million. 88. Developed project proposals and concluded agreements with USAID, ADB and AusAID, totalling US$ 1 540 000; developed proposals for the Japanese Grassroot funds amounting to US$ 360 000; and concluded an agreement with DFID-UK for US$ 2.38 million to support Integrated Vaccine Preventable Disease Surveillance for 2006–2007. 89. Development of the GAVI Health Systems Strengthening proposal during 2006–2007 for Myanmar totalling US$ 32 780 902 over four years. Of this, roughly US$ 6 500 000 will be channelled through WHO in the first two years. 90. Developed and negotiated, in close coordination with the UN system in Myanmar, with the UNOCHA and received approval of two TB and TB/HIV projects (US$ 550 000 and US$ 800 000) from the United Nations Central Emergency Revolving Fund (UNCERF). 91. Funds were obtained, in close coordination with the Regional Office and headquarters, from DFID (US$ 2.38 million), GAVI (about US$ 3 million) and UNFIP (US$ 1169 million) for immunization activities in Myanmar.
Nepal 92. US$ 1.7 million was mobilized from USAID for polio eradication activities for 2006–2007 in coordination with the Regional Office and headquarters. 93. About US$ 180 000 was mobilized through the USAID umbrella grant on AI and immunization activities in 2007 in close coordination with the Regional Office and headquarters. 94. Developed a project on emergency activities and arrived at an agreement with the Republic of Korea for the funding of US$ 100 000. 95. An agreement was signed between WHO/Nepal and AusAID for US$ 210 000 to support the National Immunization Day (NID) for polio in 2006.
Sri Lanka 96. Developed two project proposals on IDP in coordination with the UN system at country level, and two funding grants were approved by UNCERF, totalling nearly US$ 1.3 million. 97. A donor agreement for the funding of US$ 1.14 million was signed with the World Vision International for mental health in Sri Lanka. 98. A proposal for the support of emergency health care in most needy areas (US$ 197,147) was developed, negotiated and agreed to with Italy through Exchange of Letters.
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Thailand 99. For improvement of health conditions of migrants in Ranong and Samutsakorn provinces of Thailand, in partnership with IOM, RTG-MoPH, a three-year project was funded by the United Trust Funds for Human Security by the Government of Japan, with a total project cost of US$ 1 482 359. 100. Supported the development of two projects on tobacco control in collaboration with national institutions and centres, and grants were made from the Bloomberg Global Initiative to Reduce Tobacco Use Grants (some $0.7 million) and several projects are under negotiation with partners. 101. In collaboration with the Faculty of Nursing, Mahidol University, developed a project titled smoke-free youth in school settings with requested financial support of US$ 10 000.
Timor-Leste 102. Several heath-related project proposals developed as part of the UN flash appeal, negotiated and agreed with the Republic of Korea and Monaco for funding two projects with US$ 100 000 and US$ 31 807 respectively. 103. In close coordination with the Regional Office, a proposal for a position of an epidemiologist was negotiated and agreed with AusAID for a grant of US$ 82 816. 104. Activities for eliminating leprosy, filariasis and yaws were negotiated in close coordination with the Regional Office and headquarters, and supported by the Sasakawa Foundation. 105. Unspecified funds were mobilized for activities in child and women’s health areas in close coordination with the Regional Office. Overall, resource mobilization of the Timor-Leste Country Office made significant progress in 2006–2007 when compared to the previous biennium.
Section III. Funding status 106. Total Voluntary Contributions mobilized in the biennium of 2006–2007 were US$ 344 million. This represents a 33.3% increase over the planned budget of Voluntary Contributions of the biennium ($257.9 million). The status for funding in respect of various offices (regional and country offices) and major programme areas is provided in the Annexes 2 and 3. 107. Overall, all offices in the Region, except the country offices in Bhutan, Maldives and TimorLeste, have achieved funding targets of Voluntary Contributions (see Annex 2) 108. Major technical areas – 8 of 27 technical programme areas have reached their target for Voluntary Contribution in a range of 100% to 408.7% and 19 of 27 technical programme areas have not reached their funding target in a range of 8.43% to 92.22%. (see Annex 3).
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Section IV. Facilitation to Member States for resource mobilization 109. The emergence of large global funding mechanisms, e.g. the Global Fund and GAVI, opened up opportunities for SEA Member countries to secure substantial funds for some of their priority health needs and programmes. Both the Regional Office and the country offices stepped forward in a big way to assist Member countries in accessing funds from these mechanisms. The following are the highlights of the facilitation provided by WHO in this regard:
Support for accessing funds from the Global Fund 110. Technical support was provided during the entire cycle of the grant, from the stage of writing and scrutiny of proposals, during negotiations, and for implementation and reporting. 111. During Round 6 and Round 7 of the Global Fund, six proposals for HIV/AIDS, six for TB and two for malaria were submitted by various countries in the Region and have been approved at these two rounds. 112. Technical assistance has also been provided for capacity development in proposal writing. WHO co-hosted the Round 7 proposal development workshop in Kathmandu (20–23 March 2007) and facilitated a workshop on developing health system strengthening proposals in Bangkok (9–11 May 2007).
Support for accessing funds from GAVI for immunization and vaccines 113. Assistance including technical support to write applications and annual progress reports provided to GAVI-eligible countries in the Region to access GAVI funds for immunization and vaccines. 114. WHO support helped in securing over US$ 4.67 million for the introduction of new vaccines, strengthening immunization systems and procuring other immunization-related supplies such as syringes. Bangladesh, Bhutan, DPR Korea, India, Indonesia, Myanmar, Nepal and Sri Lanka were the beneficiaries.
Support for accessing funds from GAVI-Health System Strengthening (HSS) 115. Technical support was provided to GAVI-eligible countries in the Region in preparing proposals for HSS grants to address the critical health system constraints that impede scaling up of essential MCH-related interventions. In 2007, Bhutan, Nepal and Sri Lanka successfully secured GAVI HSS funding while the Governments of Bangladesh, Indonesia and Myanmar, with technical support from WHO, have completed and submitted HSS proposals to GAVI for funding.
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Section V. Opportunities, challenges and issues Opportunities 116. In recent years, the volume of the Official Development Assistance (ODA) – which is the main source of contribution for international development – is increasing as a result of increased commitment by donor countries to achieve internationally agreed goals. The health-sector contribution of ODA has also risen. 117. New health partnerships offer additional opportunity for raising resources, especially at the country level (Global Funds, International Health Partnerships, and GAVI-Health System Strengthening, etc.) 118. The low levels of development, lingering threat from polio and emerging diseases like avian influenza, and the slow rate of progress with the implementation of the Millennium Development Goals, in particular, high maternal and child mortality rates in some countries of the Region, validates the case of some Member countries for receiving aid. 119. Most countries have local donor offices making regular dialogue at the country level possible. Donors are increasingly decentralizing their operations and authority at the country level to make conclusive negotiations more possible and practicable.
Challenges 120. Alignment of resource mobilization with funding requirements for all programmes in the Programme Budget or workplan is a significant challenge for WHO. Most donors have their own interests/priority in terms of programme or geographical areas. Most funds, if not all, mobilized at the regional and country levels are fully specified for specific programmes and countries, and thus constrain WHO’s ability to align the funds mobilized with planned Programme Budgets. In coordination with headquarters, SEARO is allotted with some flexible funds from core Voluntary Contributions. The amount, however, is not significant when total Voluntary Contributions are taken into account. 121. The South-East Asia Region is the only one in WHO (except Africa) with no donors from among its Member States, since all Member States in the Region are either developing countries or ones with the greatest needs. Major global donors to the SEA Region are all from beyond the Region. No donor has its regional representation in the Region, except a few which are dealing in regional issues with limited scope. . 122. Resource mobilization is influenced by many factors. WHO’s ability to raise resources to support Member States is also constrained by the fact that certain donors have reservations about providing funds to certain countries due to some reasons. 123. Although the WHO Programme Budget, especially that of SEARO, has been increased constantly and significantly, the human resources capacity to mobilize resources and implement them in the regional and country offices remains constrained due to the nominal or zero increase of Assessed Contribution, which is the main source of staff funding; while donors focus more on activities rather than human resources support.
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Issues 124. Planning of the Programme Budget, especially resource planning, in WHO becomes difficult as the major part of the Budget has to be planned with the VC which is not provided but has to be mobilized. In the last few bienniums, several programme areas and country offices have not achieved their targets for VC. However, their targets have been increased with every biennium. While these countries and several programme areas need to improve resource mobilization, the workplan budget needs to be made in a more realistic way: budget costing as accurate as possible and considering the ability to mobilize and the capacity to implement the mobilized fund To improve programme budget planning, WHO applies these principles in Programme Budget Planning for 2010–2011 for its overall improvement. 125. All areas of the workplan are to be budgeted by the Voluntary Contributions, but there is a risk that many expected results in the workplans would not be achieved unless the planned amount of VC is mobilized. WHO’s approach for resource mobilization needs to be changed into a more pro-active and systematic one and with appropriate investment, including human resource strengthening. Therefore, it was decided that all WHO country offices prepare Country Office Plan for Resource Mobilization on the basis of funding need, donor analysis and strategy for raising resources. Several country offices have already prepared the plan and are implementing it.
Section VI. Key strategies and approaches for improved resource mobilization in 2008–2009 126. The target of VC to be mobilized under the approved program budget for 2008–2009 is US$ 387.6 million which is a US$ 129.7 million increase compared to the approved programme budget for 2006–2007 (US$ 257.9 million). The target of VC in the revised budget in workplans (planned budget) for 2008–2009 is US$ 458 million which is a US$ 167 million increase compared to the revised program budget in workplans for 2006–2007 (US$ 291 million). To achieve this considerably increased VC targets, Regional and country offices should implement the following key strategies and approaches: 127. Continued and improved follow-up to WHO’s decentralized and corporate resource mobilization approach, providing full mandate and responsibility to every office for resource mobilization and improved support and coordination by the Regional Office. 128. Enhanced initiatives at the regional and country levels of WHO to develop, maintain, and strengthen partnerships with development agencies, UN organizations, foundations and the private sector at the regional and country levels for health development and resource mobilization. 129. Improved budget/resource planning in WHO biennial workplans – accurate costing for each strategic objectives and organization-wide expected results, and incorporating the ability to mobilize VCs and the capacity to implement the funds mobilized.
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130. Development and implementation of Resource Mobilization Action Plans by all WHO offices (including SEARO departments and country offices) for strategic, coordinated and systematic work for resource mobilization at each level. 131. More focus on and intensification of efforts towards resource mobilization for the programme areas which have not reached the Voluntary Contribution targets in 2006–2007 and active involvement of the Regional Office in the resource mobilization activities at the corporate level by WHO headquarters. 132. Close coordination by the Regional Office with WHO/HQ to secure flexible funding from the Core Voluntary Contributions Fund. 133. Strengthening the capacity of resource mobilization, especially at country offices, through more investment in the strengthening of human resource capacity for resource mobilization and organization of more training activities for staff on resource mobilization. 134. Placing resource mobilization as the priority concern in the Region to meet the requirements of Voluntary Contribution of Programme Budget to provide technical support to Member States. 135. Providing continued support and facilitation to Member States for their access to global funding mechanisms such as Global Funds, GAVI, etc. 136. Ensuring the accountability to donors regarding their contributions and improving monitoring of the implementation and management of Voluntary Contributions.
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Annex 1
Funding sources of Voluntary Contributions to the WHO SEA Region in 2006–2007 (Figures in thousand US$)1 1) Government donors: USA2 UK 3
Allotted 71,136 31,606 17,976 13,426 10,241 6,750 5,513 3,629 2,216 1,129 831 782 702 697 625 412 254 200 160 120 100 50 6 168,561 Allotted
2) UN agencies…….(Contd…) UNCERF UNICEF UNDP UNAIDS GAVI CEC UNOCHA UNFPA Total 3) Foundations: Sasakawa Rotary International World Lung Foundation Gates Foundation National Foundation World Vision International World Diabetes Foundation Nippon Foundation Agfund Total 4) Private/Corporate sector Novartis PATH Johns Hopkins Bloomberg Initiative Mr J. Victorin, Sweden David & Lucile Packard Eli Lilly & Co. University of Washington Daewoo International Corpn. Pan American Health 6,060 354 275 225 145 110 100 85 72 58 6,819 2,872 1,422 1,400 459 384 179 22 17 13,574 4,172 3,644 3,262 2,758 2,111 1,773 1,013 964 92,198
Canada Republic of Korea Australia Japan Norway Sweden Italy Luxembourg France Denmark Ireland Finland Saudi Arabia Germany Portugal Iceland Monaco Singapore Thailand Poland Netherlands
Total 2) UN agencies, International financing and funding mechanisms: UNFIP UNFID World Bank GFATM UNOPS ADB
18,956 15,300 16,329 11,306 5,883 4,727
________________ 1 The figures in the table do not represent the total commitment made by a donor, but only the amount allocated (released) during 2006–2007. 2 Includes USAID and CDC 3 Includes DFID
SEA/RC61/5 Inf.Doc. Page 18 4) Private/Corporate sector (Contd...) JHPIEGO Corporation Federal International PSI Christoffel Blinde New York Community Others Total 5) Trust fund (by governments of SEA Member States) 6) Unspecified funds 7) Other funds Grand Total 57 54 50 29 29 28 7,731 11,691
32,155 19,525 344,000
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Annex 2
Voluntary Contributions mobilized for each WHO office in the Region in 2006–2007 (Targets and achievements) Office India Regional Office Indonesia Bangladesh DPR Korea Myanmar Nepal Sri Lanka Thailand Timor-Leste Maldives Bhutan Total Target of voluntary contribution 84.3 80.8 35.0 20.2 14.6 13.7 5.6 2.4 2.4 2.8 2.0 2.6 266.42 257.93 ___________________ 1 2 3
Achievements1 96.5 80.2 55.2 26.7 22.5 20.5 14 4.3 3.4 1.6 0.7 0.3 325.9 344.0
Percentage of VC achieved 114.6 99.4 158 132.6 154.8 149.6 250 179 141 57 35 11.5 122.5 126.3
Final data from WHO Activity Management System (AMS) The amount of voluntary contribution in workplans for 2006–2007
The amount of voluntary contribution in the Programme Budget 2006–2007 approved by WHA.
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Annex 3
Voluntary Contributions mobilized for major technical programme areas in 2006–2007 Programme areas 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Immunization and vaccine development Tuberculosis Emergency preparedness and response Epidemic alert and response HIV/AIDS Communicable disease prevention and control Malaria Child and adolescent health Tobacco Health system policies and service delivery Human resources for health Reproductive health Health and environment Mental health and substance abuse Health financing and social protection Making pregnancy safer Health promotion Essential medicines Health information, evidence and research policy Violence, injuries and disabilities Surveillance, prevention and management of chronic diseases Essential health technologies Policy making for health in development Communicable disease research Food safety Gender, women and health Nutrition IVD TUB EHA CSR HIV CPC MAL CAH TOB HSP HRH RHR PHE MNH HFS MPS HPR EDM IER INJ NCD BCT HSD CRD FOS WMH NUT Target in workplan1 100.4 28.9 9.2 21.3 25.7 23.7 6.8 6.4 1.2 4.0 2.7 2.6 3.3 1.6 1.2 3.7 1.0 3.1 8.3 1.5 3.2 0.9 0.7 1.2 1.2 0.3 0.8 Achievement2 135 42.9 37.6 34.6 23.7 15.6 10.8 3.3 3.1 1.9 1.7 1.6 1.4 1.3 1.3 1.2 0.9 0.7 0.7 0.7 0.6 0.5 0.4 0.3 0.3 0.3 0.3 Percentage of VC achieved 134.46 148.44 408.70 162.44 92.22 65.82 158.82 51.56 258.33 47.50 62.96 61.54 42.42 81.25 108.33 32.43 90.00 22.58 8.43 46.67 18.75 55.56 57.14 25.00 25.00 100.00 37.50
__________________ 1 2
WHO Financial Management Report for 2006–2007 at the end of December 2007
Financial data from WHO Activity Management System (AMS)