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Progress reports on selected Regional Committee resolutions

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REGIONAL COMMITTEE Seventieth Session Maldives 6–10 September 2017

Provisional Agenda item 9 SEA/RC70/13 20 July 2017

Progress reports on selected Regional Committee resolutions Progress reports on the following selected Regional Committee resolutions are covered in this document: 1. 2. 3. 4. 5. 6. 7. 8. Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6) Challenges in polio eradication (SEA/RC60/R8) Measles elimination and rubella/congenital rubella syndrome control (SEA/RC66/R5) Antimicrobial resistance (SEA/RC68/R3) Patient safety contributing to sustainable universal health coverage (SEA/RC68/R4) South-East Asia Regional Action Plan to Implement Global Strategy to Reduce Harmful Use of Alcohol (2014–2025) (SEA/RC67/R4) Capacity-building of Member States in global health (SEA/RC63/R6) Consultative Expert Working Group on Research and Development (CEWG): Financing and Coordination (SEA/RC65/R3)

CONTENTS Page No.

Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6)..................................................................................................... 1 Challenges in polio eradication (SEA/RC60/R8) ................................................................... 6 Measles elimination and rubella/congenital rubella syndrome control (SEA/RC66/R5) ......... 9 Antimicrobial resistance (SEA/RC68/R3) ............................................................................ 12 Patient safety contributing to sustainable universal health coverage (SEA/RC68/R4) .......... 15 South-East Asia Regional Action Plan to Implement Global Strategy to Reduce Harmful Use of Alcohol (2014–2025) (SEA/RC67/R4) ....................................................... 17 Capacity-building of Member States in global health (SEA/RC63/R6) ................................. 23 Consultative Expert Working Group on Research and Development (CEWG): Financing and Coordination (SEA/RC65/R3) ...................................................................... 26

2. 3. 4. 5. 6.

7. 8.

SEA/RC70/13

1. Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6) Background (a) SEA/RC60/R7 – South-East Asia Regional Health Emergency Fund (SEARHEF)

The South-East Asia Regional Health Emergency Fund (SEARHEF) is an operational fund of the SEA Region, and is earmarked for providing support for the health sector response of Member States during emergencies. The Fund was established in 2008 by Regional Committee resolution SEA/RC60/R7 by pooling a budget of US$ 1 million for each biennium from Assessed Contributions.

The Fund is designed to provide financial support for the first three months following a disaster in a Member State to meet immediate and urgent health needs, support emergency field operations and fill in critical gaps. It also has a window for receiving funds from donors. A total amount of US$ 350 000 can be released in two tranches. The funds can be released within 24 hours of receiving a request from a Member State. SEARHEF is known to be the fastest emergency fund to be released among those provided by UN agencies.

Since its inception, the Fund has allowed for an immediate and flexible response to 33 disasters in nine Member States of the Region. The first disaster supported by the Fund was Cyclone Nargis in Myanmar in 2008 and the last so far was Cyclone Mora in Bangladesh in June 2017. To date, SEARHEF has disbursed a total of US$ 5.1 million. Oversight is provided by the SEARHEF Working Group in which each Member State is represented. Six meetings of the Working Group have been held till date. (b) SEA/RC69/R6 – Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF)

The Sixty-ninth session of the Regional Committee endorsed resolution SEA/RC69/R6 on “Expanding the scope of SEARHEF” to include a preparedness stream that would strengthen key aspects such as disease surveillance, health emergency workforce and health emergency teams. There was also an expressed need for increasing the tranches for emergency funding from SEARHEF. It is anticipated that support for basic preparedness activities may cost US$ 200 000 per country per biennium. Thus, the minimum corpus per biennium may be set at US$ 2.2 million. The target date for implementation of the SEARHEF preparedness funding stream is 1 January 2018.

The purpose of the fund for preparedness is to complement, not replace, development programmes under the biennium workplans. Activities under SEARHEF funding aim to provide short-term, bridging funds to kick-start, add value to and/or support larger preparedness projects.

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Further, the SEARHEF Preparedness Stream does not affect functioning of the response fund. The criteria for allocation for preparedness from the fund is as follows: a. Address a priority gap as found in the International Health Regulations (IHR) capacity assessments and/or South-East Asia (SEA) Region benchmark assessments. b. Address gaps in core skills such as risk assessments or information management. c. Strengthen public health emergency operations centres (PHEOCs).

The types of activities for emergency health preparedness to be considered under the new Preparedness Stream of SEARHEF, as endorsed by the resolution of Regional Committee (SEA/RC69/R6), are as follows: i. ii. iii. iv. v. vi. vii. viii. developing and strengthening of policies and capacities; developing and implementing training courses; establishing systems for disease surveillance, information and knowledge exchange across countries for risk assessment and risk communication; strengthening PHEOCs; strengthening the health emergency supply chain management system; strengthening emergency medical teams and their coordination; assessing health facilities for disaster risk reduction; and strengthening the health emergency workforce through establishment of systems that include efficient recruitment and deployment.

Updates on SEARHEF and challenges (a) SEA/RC60/R7 – South-East Asia Regional Health Emergency Fund (SEARHEF) The following are the updates on SEARHEF: a. Timor-Leste made a voluntary contribution of US$ 100 000 to the Fund at the Sixtyeighth session of the Regional Committee, and this contribution is now available for this biennium in addition to US$ 1 million. b. In May 2017, Sri Lanka reported a series of floods and landslides, reportedly the worst floods triggered by the monsoons in that country since 2003. Support from SEARHEF for response efforts related to the floods/landslides was to the tune of US$ 175 000 in this biennium. c. The SEARHEF balance as of date is US$ 143 376 for the current biennium 2016 – 2017 (the Fund was fully utilized at the end of the last biennium 2014–2015).

d. The Regional Office organized a meeting of the SEARHEF Working Group on 6–7 June 2017 to develop the proposal for the preparedness stream of SEARHEF. On utilization of SEARHEF, Member States appreciated adherence by WHO to disbursement of funds within 24 hours. e. Timely reporting on utilization of SEARHEF needs further strengthening, as we expand to this new Preparedness Stream.

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The table below gives a list of the disasters supported by SEARHEF since its inception until June 2017, and the Member States in which they occurred. Period No Emergency Month Year SEARHEF allocation in US$

1. 2. 3. 4.

Cyclone Nargis in Myanmar Flash floods in Sri Lanka Kosi river floods (in two tranches), Nepal Emergency health interventions for internally displaced populations (IDPs) in conflict-affected areas in northern Sri Lanka (in two tranches) Earthquake in North Sumatra province, Indonesia (in two tranches) Emergency health interventions for relocated IDPs affected by conflict in Sri Lanka Fire in Dhaka, Bangladesh Mt Merapi volcanic eruption in East Java province, Indonesia Critical health-care services to the resettled population affected by conflict in Sri Lanka Floods in Thailand (in two tranches) Torrential rains in Democratic People’s Republic of Korea (in two tranches) Fire outbreak/explosion in Yangon, Myanmar Support for provision of emergency health care in Rakhine State, Myanmar Flash floods in Democratic People’s Republic of Korea Support to population affected by storm in Maldives Support to Myanmar for procuring emergency medical supplies (fire outbreak and earthquake) Support to Myanmar for establishing health-care services for communal conflict-affected townships in Rakhine State Support to the emergency caused due to flash floods in South Phyongan, North Phyongan, Kangwon and South Hamgyong provinces of the Democratic People’s Republic of Korea Support to emergency response activities for the crises situation created due to Mt Sinabung eruption in North Sumatera province, Indonesia To establish sustainable health-care services for communal conflict-affected townships in Rakhine State, Myanmar

May June Sept. Sept. Oct. Jan. June Nov. Feb. July Aug. Jan. June July Nov. Nov. April

2008 2008 2008 2008 2009 2010 2010 2010 2011 2011 2011 2012 2012 2012 2012 2012 2013

350 000 23 299 325 000 350 000 300 000 175 000 175 000 139 000 175 000 350 000 310 000 25 000 12 300 134 130 47 717 30 778 175 000

5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

18.

July

2013

175 000

19.

Feb.

2014

144 068

20.

May

2014

175 000

SEA/RC70/13 Page 4

Period No Emergency Month Year

SEARHEF allocation in US$

21.

To complement the response and recovery activities conducted by the Ministry of Health (MoH), Sri Lanka to support the short- to medium-term needs of the health sector To complement the response and recovery activities conducted by the MoH, Sri Lanka from heavy floods and landslides in 22 (out of 25) administrative districts in Sri Lanka Support to the Nepal earthquake To support strengthening the capacity of health institutions to meet the immediate needs of the population in drought-affected areas (88 counties and 20 cities in South and North Hwanghae, South and North Pyongang provinces) of the Democratic People’s Republic of Korea Support to MoH for operational costs of for postdisaster management w.r.t floods following heavy rain that affected health facilities in the Sagaing and Magwe Region, and Rakhine State of Myanmar Support to MoH for emergency medical interventions for flood-affected populations in Rakhine and Chin states, and Sagaing and Magway regions, Myanmar Support for emergency medical supplies and essential drugs for flood-affected populations in Rason City, North Hamgyong province, Democratic People’s Republic of Korea Support to MoH, Sri Lanka for response and recovery activities for flood victims Support to MoH Bhutan to provide health sector support to the flood-affected population Support to MoH Myanmar for provision of emergency health care to the flood-affected population Support for provision of emergency health care due to torrential rains and flood-affected population in the northern part of Democratic People’s Republic of Korea SEARHEF for Sri Lanka floods and landslides SEARHEF for Bangladesh Cyclone Mora Grand total

Nov.

2014

35 500

22.

Dec. April

2014 2015

30 000 175 000

23. 24.

July

2015

137 160

25.

Aug.

2015

26 000

26.

Aug.

2015

149 000

27.

Sept.

2015

161 887

28. 29. 30.

May July Aug.

2016 2016 2016

100 000 161 624 175 000

31.

Sept. May June

2016 2017 2017

175 000 175 000 170 000 5 087 463

32. 33.

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(b)

SEA/RC69/R6 – Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF)

The major challenges faced by SEARHEF are well articulated in the recommendations made by the Working Group during its sixth meeting held in June 2017. These include:   challenges in mobilizing domestic resources for preparedness activities; and non-conducive global and regional donor environment for funding.

The way forward (a) SEA/RC60/R7 – South-East Asia Regional Health Emergency Fund (SEARHEF)

10. During the sixth Working Group Meeting held on 6–7 June 2017, the following recommendations were made and will constitute next steps for the way forward:     The Secretariat would develop a webpage for SEARHEF. The Secretariat would set up an email for the SEARHEF Working Group to enable regular communication and updates on progress. As 10 years have passed since the inception of SEARHEF, it was recommended that the Secretariat undertake an evaluation of the impact of the Fund. Regular communication to Member States at each disbursement of SEARHEF would be considered.

(b)

SEA/RC69/R6 – Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF)  Member States would provide updates on the progress made with regard to contributions to the SEARHEF Preparedness Stream during the High-Level Preparatory Meeting in anticipation of some pledges to be made during the Seventieth Session of the Regional Committee in Maldives. This is critical to enable operationalization of SEARHEF Preparedness Stream by 1 January 2018. The Secretariat would also communicate with all Member States through the country offices on requesting contributions to the SEARHEF Preparedness Stream, based on the country-specific context, and on mechanisms for disbursement of external donations. The Secretariat would provide updates on discussions with key donors on using SEARHEF as the main channel to support preparedness work in the Region.



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2. Challenges in polio eradication (SEA/RC60/R8) Background 11. The Sixty-eighth session of the World Health Assembly in 2015 urged Member States to fully implement all the strategic approaches outlined in the “Polio Era dication and Endgame Strategic Plan: 2013–2018”. The strategic approaches outlined in the Plan include: a. detection and interruption of poliovirus transmission; b. phased removal of oral poliovirus vaccines (OPV), beginning with the type 2 component of OPV; c. containment of polioviruses; and d. transition planning.

Situational analysis and progress made 12. The South-East Asia Region of WHO reported the last polio case due to wild poliovirus on 13 January 2011 and was certified polio-free on 27 March 2014. Despite being polio-free for six years, all Member States in the South-East Asia Region continue to be at risk of importation of the wild poliovirus from countries currently infected and subsequent spread of the virus in the Region. At the same time, the risk of circulating vaccine-derived polioviruses (cVDPV) emerging in areas of low immunization coverage remains a concern.

13. Appropriate actions to mitigate the risk of spread of wild poliovirus following an importation are being taken by all Member States in the Region.

14. Environmental surveillance for poliovirus detection has been expanded to additional countries in the Region. Four countries in the Region – Bangladesh, India, Indonesia and Thailand – are currently conducting environmental surveillance, with plans to initiate surveillance in two more countries, Myanmar and Nepal, in 2017.

15. All Member States in the Region have withdrawn the type 2 component of OPV by switching from trivalent OPV (tOPV) to bivalent OPV (bOPV) in April 2016 and have introduced inactivated poliovirus vaccine (IPV).

16. A global shortfall of IPV is affecting countries in the Region. In view of the IPV shortage, the available IPV supplies are being prioritized towards Member States that are at a higher risk of poliovirus resurgence. Recent clinical studies have demonstrated that two fractional doses of IPV provide better protection than one full dose. Two Member States in the Region, India and Sri Lanka, have replaced the full-dose IPV schedule with two fractional (one fifth) doses in their routine immunization schedule due to the effectiveness of the fractional IPV doses and to stretch the available IPV supplies. Another two Member States, Bangladesh and Nepal, are in the process of shifting to the fractional IPV dose schedule instead of a full-dose schedule before end2017.

17. Activities to contain type 2 polioviruses are progressing in the Region. Poliovirus essential facilities have been identified to store/handle type 2 polioviruses in India and Indonesia. National authorities for containment have been established in these two countries, and

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processes to undertake certification of these facilities as per the global containment certification scheme have been established.

Challenges 18. Significant IPV supply constraints globally are affecting all Member States, including Member States of the South-East Asia Region. The supply of IPV is expected to remain constrained through 2018.

19. It is challenging to ensure appropriate containment of polioviruses and meet the timelines as per the requirements of the Global Action Plan III.

20. There are financial, human resource-related and programmatic risks associated with the winding down of the Global Polio Eradication Initiative (GPEI).

The way forward 21. All Member States of the Region must maintain and further strengthen actions required to maintain the polio-free status of the South-East Asia Region until global polio-free certification is achieved and beyond.

22. Complete containment of polioviruses as per the Global Action Plan III must be ensured to mitigate the risk of exposure of communities to any type 2 polioviruses, following the switch from tOPV to bOPV.

23. Transition planning in five Member States that have established significant polio-funded assets over more than two decades needs to be finalized.

Transition planning and post-certification strategy 24. Over more than two decades of operation, the GPEI has built significant infrastructure for disease surveillance, social mobilization and vaccine delivery. It has developed in-depth expertise, and learned valuable lessons about reaching the most vulnerable and hard-to-reach populations. As the world comes closer to achieving polio eradication, the GPEI will begin to wind down its operations, and will come to a close in the post-eradication era.

25. Five Member States in the Region – Bangladesh, India, Indonesia, Myanmar and Nepal – have established significant polio-funded assets over the past years, which have not only contributed to the achievement and maintenance of polio eradication and the implementation of polio endgame strategies, but have also supported other priority programmes in these Member States.

26. Winding down of GPEI over the next few years poses financial, human resource-related and programmatic risks in these five Member States of the Region.

27. The human resource-related risks in the South-East Asia Region are relatively small, as the Region has only 4% of the WHO staff positions funded globally through the GPEI. Nearly 97% of the polio-funded workforce in the Region is non-staff with nearly 80% of these being in India.

28. However, the programmatic risks and challenges associated with the ramp-down of polio are substantial. These include risks to the regional priority programme of measles elimination and rubella control by 2020, as well as the control of other vaccine-preventable diseases. Other

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areas at risk include the introduction of new vaccines and the elimination of neglected tropical diseases. Providing support during emergencies and disasters will be a challenge as well, since polio networks have contributed to this area of work in the past. An example of such support in the past includes the support during the Nepal earthquake and Ebola crisis.

29. Fully mindful of these risks and priorities, the transition planning process has been initiated in all five Member States of the Region. A country-by-country approach is being adopted due to a difference in the scope and type of support being provided by polio networks in different countries, as well as variability in the capacities of different countries to absorb and support functions that are currently supported by polio networks.

30. The transition planning process has progressed well in India and an incremental increase in funding support for the polio network from the domestic budget of the government is being worked out. Transition plans are also being developed in Bangladesh, Indonesia, Myanmar and Nepal, with alternative funding options being explored in these Member States.

31. Finalization of the transition plans and their implementation remains an organizational priority in the Region. The key principles being applied in the Region as part of the transition planning process include (1) close collaboration with national governments and partners to clearly articulate and realign the programmatic priorities; (2) outlining the mechanisms for transferring capacities to the government, to the extent possible; and (3) increased engagement in and ownership of the transition process by national governments to ensure increased funding by them, as well as identification of additional donors to fill future funding gaps.

32. While the transition planning process recommends maintaining and mainstreaming polioessential functions after eradication is certified, a post-certification strategy (PCS) for polio is being developed by the GPEI to outline the technical standards for these functions, as well as a policy framework for ensuring appropriate governance and financing to protect a polio-free world. With the purpose of sustaining a polio-free world, the PCS will have three strategic goals: (a) containing poliovirus sources by ensuring that potential sources of poliovirus are properly controlled or removed; (b) protecting populations by immunizing them against unanticipated polio events; and (c) detecting any poliovirus introduction and rapidly responding to prevent transmission.

33. Development of the PCS was initiated in early 2017, and will be completed when endorsed by the World Health Assembly in May 2018.

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3. Measles elimination and rubella/congenital rubella syndrome control (SEA/RC66/R5) Background 34. In September 2013, the Sixty-sixth session of the Regional Committee through resolution SEA/RC66/R5 adopted the goal of measles elimination and rubella/congenital rubella syndrome (CRS) control in the South-East Asia Region by 2020.

35. All Member States have developed national plans for measles elimination and rubella control by 2020, which are aligned to the South-East Asia Regional Strategic Plan for Measles Elimination and Rubella/CRS Control: 2014–2020.

Progress made in the South-East Asia Region 36. All Member States have accelerated activities to achieve the goal of measles elimination and rubella/CRS control. Two countries – Bhutan and Maldives – have been verified in April 2017 by the South-East Asia Regional Verification Commission as having eliminated endemic measles virus.

37. All Member States in the Region have introduced two doses of measles-containing vaccine, resulting in the aversion of nearly 640 000 deaths due to measles in 2016 in the Region.

38. Nine Member States have introduced rubella-containing vaccine in their routine immunization schedule. Of the two remaining Member States, Indonesia is expected to introduce the vaccine in August 2017 and the Democratic People’s Republic of Korea is also working on introducing the vaccine soon.

39. Nearly 105 million children have been reached with an additional dose of measlescontaining vaccine through mass vaccination campaigns between 2013 and 2016, and an additional 500 million children are planned to be reached through mass campaigns in 2017 and 2018. All Member States in the Region have initiated case-based surveillance for measles and rubella. The surveillance standards in the Region have been revised to meet elimination standards.

40. The Measles Rubella (MR) Laboratory Network in the Region has expanded from 23 laboratories in 2013 to 39 WHO-accredited laboratories in 2016, and it is proposed to include six additional laboratories in the network in 2017. Nearly 35 000 samples were tested by the MR Laboratory Network for serology in 2016.

41. A Regional Verification Commission was established to review progress on measles elimination and rubella control in the Region. All 11 Member States have a functional National Verification Committee for Measles Elimination and Rubella –CRS control.

42. The overarching goal of universal health coverage and the core theme of “leaving no one behind” in the Sustainable Development Goals provide a renewed opportunity to improve national immunization programmes, enhance access to new vaccines, and help strengthen health systems to sustain the gains made thus far.

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Challenges 43. Coverage with the first dose of measles-containing vaccine in routine immunization has stagnated at around 85% for the past five years in the Region. Nearly 4.7 million children remain unvaccinated with measles-containing vaccine annually in the Region. Of these, nearly 3 million are in India and 1 million in Indonesia.

44. Large-scale mass vaccination campaigns have been planned in these two large countries – India and Indonesia – in 2017 and 2018, to close the immunity gaps against measles and rubella. With more than 470 million children targeted for vaccination in these two Member States over the next 18 months, these campaigns have significant global implications. The vaccination campaigns will have an impact on the epidemiology of measles and rubella, not only in these Member States but also globally. Achieving high coverage during these large-scale mass vaccination campaigns remains a significant challenge for the Region, and the global Measles and Rubella Initiative.

45. The current sensitivity of surveillance in the Region remains below the globally recommended standard. Achieving and maintaining high-quality surveillance for measles and rubella in all Member States to meet the regional measles elimination target of 2020 remains a challenge.

46. Polio-funded human resources and systems have been established in five Member States of the Region over the past two decades to support polio eradication activities. This workforce has been increasingly supporting surveillance and immunization activities for measles elimination and rubella control over the past few years. The Global Polio Eradication Initiative has now indicated a ramp down of polio funding between 2017 and 2019, followed by an eventual cessation of this funding. This poses a huge risk to the goal of achieving measles elimination and rubella control in the Region.

The way forward 47. Almost 500 million children are planned to be vaccinated over the next two years in the Region. Nearly 470 million of these will be in just two countries – India and Indonesia. It is critical that all components of the campaign are well financed and mechanisms are in place to ensure a high quality of coverage during the campaigns. Active engagement of governments and partners will be essential to ensure high coverage.

48. A mid-term review of the “South-East Asia Regional Strategic Plan for Measles Elimination and Rubella/CRS Control: 2014–2020” is planned to be conducted in 2017 to review the progress made so far, refine the strategies to accelerate progress towards the 2020 goal, formulate the lessons learned and risks, and identify the financial, political and programmatic priorities over the next three years (2018–2020).

49. Strengthening surveillance for measles and rubella in all countries is critical for ensuring detection of all measles cases and outbreaks in the Region followed by prompt follow-up action.

50. As the Region comes closer to elimination, a cross-border notification system across countries in the Region needs to be established to ensure that the virus is tracked across borders. Responses to outbreaks should be synchronized across borders.

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51. The polio transition planning process will have to be managed well in the five Member States that have substantial assets funded through the GPEI to mitigate the risks to the regional goal of measles elimination and rubella control.

52. Additional efforts to mobilize resources will be required in the Region to achieve the goal of measles elimination and rubella control by 2020. This includes commitment by national governments to sufficiently fund measles elimination and rubella/CRS control activities, including the laboratories involved, based on technically sound plans developed by national immunization programmes.

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4. Antimicrobial resistance (SEA/RC68/R3) Background 53. In 2015, the Sixty-eighth World Health Assembly adopted a resolution, WHA68.7, on the Global Action Plan (GAP) on Antimicrobial Resistance. All Member States committed to have in place, by May 2017, a national action plan (NAP) on antimicrobial resistance (AMR) that is aligned with the GAP. WHO is required to report to the World Health Assembly on the development and implementation of the NAPs.

54. In May 2017, the Seventieth World Health Assembly adopted a resolution, WHA70.7 on “Improving the prevention, diagnosis and clinical management of sepsis”. In particular, the resolution requests the WHO Director-General to collaborate with partners “in enhancing access to quality, safe, efficacious and affordable types of treatments of sepsis”. The sepsi s resolution notes that sepsis causes approximately 6 million deaths worldwide every year, which are mostly preventable.

Progress made in the South-East Asia Region 55. Two high-level ministerial meetings on AMR involving the Region’s Member States were held in 2016. In February, there was a meeting “Combating AMR: public health challenge and priority” organized by the Government of India in New Delhi, where a roadmap for the creation of NAPs was developed, and where countries pledged to have these plans finalized by May 2017.

56. In April, a bi-regional meeting on AMR was held in Tokyo and organized by Japan, in collaboration with the WHO regions for South-East Asia and the Western Pacific. This meeting allowed Member States the opportunity to expedite the process of development of their NAPs, and reiterated the need to focus on reversing the rising trend of AMR.

57. In addition, a workshop was held in November 2016 in New Delhi with officials from WHO, Food and Agriculture Organization (FAO) and World Organisation for Animal Health (OIE). This workshop focused on the specific concerns of developing countries as they relate to AMR and the One Health approach. As these initiatives demonstrate, AMR has been considered a clear and present danger to health, development and prosperity across the Region.

58. Work in different departments of the Regional Office is mapped out and consolidated through a coordination group for AMR. To date, 10 South-East Asia (SEA) Region Member States have finalized their NAPs. Multisectoral endorsement is needed for cross-sectoral collaboration. The situation or baseline analysis conducted in 10 countries of the Region showed that most are at the initial stages of their national AMR prevention and containment programme and NAP implementation.

59. The Regional Office for South-East Asia has collaborated with its regional tripartite partners (OIE, FAO and other partners) to develop harmonized surveillance on AMR and antimicrobial use (AMU).

60. Studies have been conducted on a six-year retrospective analysis of antimicrobial consumption data in several Member States to determine the extent and pattern of use of antibiotics.

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61. Several projects have been carried out to review the situation of AMR in the Region. The findings made it clear that AMR is an issue of critical concern for the Region. A risk assessment conducted by the Regional Office shows the Region is at high risk for the development of antimicrobial-resistant bacteria – probably the highest among the WHO regions globally. Most factors driving this can be well understood.

62. The Regional Office has supported laboratory strengthening in Member States, as laboratory activities are an important part of the AMR control programme. The topic of AMR was also raised during the launch of the immunization campaign in India in May 2017, as prevention of infection by immunization is indeed important. The topic of Environment and AMR was also being analysed, based on the recent study undertaken by WHO (snapshot survey of AMR in the East Kolkata Wetlands) this year.

63. Other aspects of this multifaceted AMR issue in the Region have been also analysed and are being published in a special issue of the British Medical Journal (BMJ). Initiatives to advance the battle against AMR were presented from three of the Region’s count ries – India, Indonesia and Thailand. The Regional Office also surveyed the broader situation, including progress on NAPs, surveillance, infection prevention and control, and diffusion of antimicrobial resistance genes (ARG) in the environment. Apart from articles documenting the present situation, the BMJ issue would also include a focus on areas that will be key to making progress, including implementing the One Health approach successfully, and creating and implementing stronger surveillance.

64. During the HLP Meeting, Member States also raised key issues related to the implementation of their NAPs, including: a. over-the-counter sale of antibiotics; b. focusing on and the allocation of adequate resources for research and development of new antibiotics; c. robust monitoring and evaluation in order to closely track progress and provide corrective actions in the implementation of NAPs; d. comprehensive planning and engagement across sectors, including but not limited to animal health and agriculture; e. investing resources across sectors to implement NAPs; f. participating in the Global Antimicrobial Resistance Surveillance Systems (GLASS) to foster standardized AMR surveillance globally;

g. implementing NAPs in decentralized systems; and h. promoting affordable access to existing and new antimicrobials and diagnostic tools.

Challenges 65. Several challenges have been recognized, most of them during the in-country situation analysis process – a process that was recommended prior to the development of the NAP in Member States of the SEA Region. These include: (i) unregulated sale of cheap antibiotics for human health; (ii) widespread use of antibiotics in the animal industry; and (iii) poor awareness

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about AMR and its drivers – particularly its relationship with sanitation, hygiene and food handling among health professionals and consumers.

66. Member States of the SEA Region will need strong political commitment to develop effective country-dependent policies and the capacity for enforcing these to address these crosssectoral challenges.

The way forward 67. As a Flagship Priority for the SEA Region, the Regional Office will continue to support the implementation of the AMR NAP in Member States. WHO will collaborate to periodically review implementation and measure progress made using the Regional Office tool for situation analysis.

68. Another area where the Regional Office will provide technical support is to strengthen national regulatory authorities for AMR to implement the AMR NAP.

69. The Regional Office is committed to strengthen a “One Health” tripartite partnership with the regional offices of OIE and FAO to combat AMR. One major priority includes harmonized surveillance of AMR and AMU in the human and animal sectors and the environment. To support surveillance, WHO will advocate for Member States to participate in GLASS.

70. The research aspect will also be strengthened through various mechanisms. Preparations are on to observe the World Antibiotic Awareness Week in November 2017, as well as conduct other awareness-raising programmes on AMR in line with the GAP Strategic Objective 1.

71. Together with Member States, WHO continues to support the implementation of (a) the UN General Assembly High-level Political Declaration on AMR adopted in October 2016, World Health Assembly resolutions (WHA67.25 and WHA68.7) and Regional Committee resolution (SEA/RC68/R3) on AMR, and (b) the Seventieth World Health Assembly resolution (WHA70.7) on sepsis, which recommends that Member States improve the prevention, diagnosis and management of sepsis.

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5. Patient safety contributing to sustainable universal health coverage (SEA/RC68/R4) Background 72. Up to one in ten patients experiences an adverse event as a result of health care. Patient safety has been recognized as a public health problem for many years in the South-East Asia Region. In 2006, the Fifty-ninth session of the Regional Committee endorsed a resolution SEA/RC59/R3 on “Promoting patient safety in health care”. A regional survey by the Organisation for Economic Co-operation and Development (OECD) on patient safety and health-care quality in 2013 reinforced the view that a regional strategy on patient safety was needed. Member States endorsed the Regional Strategy on Patient Safety (2016 –2025) in the WHO South-East Asia Region at the Sixty-eighth session of the Regional Committee (Resolution SEA/RC68/R4). The Resolution recognized that patient safety and quality of care are integral elements in progress towards universal health coverage, and noted compelling health and economic arguments for improving patient safety. It stated that improving safety requires action by multiple stakeholders, including patients and health professionals, and needs system-wide solutions. It urged Member States to take action on the six strategic objectives of the Strategy, and requested the Regional Director to report on progress every two years, starting from 2017.

Progress and challenges in the South-East Asia Region 73. As a first step, a patient safety self-assessment tool was developed by the Regional Office for use by Member States. It is organized around the six objectives of the Strategy, and designed to collect baseline information on the national policies, systems and procedures in place for promoting patient safety, and help identify priorities for action. It does not collect data on actual adverse events. The tool was pilot-tested in late 2015, and revised and shared with all Member States. Five countries have now completed national self-assessments: India, Maldives, Sri Lanka, Thailand and Timor-Leste. Self-assessments are ongoing in three more countries–Democratic People’s Republic of Korea, Indonesia and Nepal. Preliminary discussions are under way in Bangladesh. The findings have been presented in summary dashboards, with each dimension scored and rated weak to excellent by the self-assessment team, and discussed in national workshops. Key findings:      No country in the Region routinely reports errors in health-care settings, except for adverse events following immunization and maternal deaths. Many countries do not have hospital quality assurance mechanisms, nor routinely conduct patient safety assessments. Policy frameworks and legislation are not always adequate. Compliance with patient safety standards by health-care workers is often poor. Hard data for preparing estimates of errors in patient safety and the cost implications of these are not available.

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Follow-up: Five countries with completed assessments have prioritized interventions and developed five-year patient safety implementation plans.    India has adopted a new policy for patient safety and a patient safety strategic framework. Thailand has adopted the “2P” policy (patient and personal safety). Maldives, Sri Lanka, Thailand and Timor-Leste have already developed routing error reporting and learning systems after the self-assessment exercise. These four countries will publish reports in early 2018, which will capture the burden of unsafe care. The Democratic People’s Republic of Korea, Maldives, Sri Lanka and Timor -Leste have conducted national training of trainers’ work shops on patient safety, supported by the Regional Office.

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74. In addition, most Member States have appointed high-level officers responsible for national patient safety programmes. Several have developed quality and safety indicators to be used in hospitals. These best practices are being shared with other countries. Many countries are implementing national action plans for prevention of antimicrobial resistance, and blood, laboratory and medication safety.

75. The Regional Office has promoted the WHO Multi-professional patient safety curriculum guide for use in all medical, nursing and other health professional pre-service and in-service programmes. This guide was adopted by the South-East Asia Medical Council Network in 2015, to be used in future medical education curricula. The Regional Office also promotes the use of WHO checklists and guidelines on safe childbirth, safe surgery, infection prevention and control, and prevention of surgical site infection. An Asia Pacific Healthcare Quality Improvement Network has been established, supported by OECD and WHO.

The way forward 76. Well-functioning error reporting systems are needed to enhance patient safety in all Member States. Policy-makers and managers in hospitals and health centres need to move away from blaming individual health workers, and focus on encouraging error reporting and how to prevent them in future. Policy frameworks and legislation may need review and revision.

77. Member States also need to increase all health workers’ awareness of patient safety, build their capacity to practise the measures needed to minimize errors, and improve infection prevention and control, for which hand hygiene remains one of the most effective interventions. Hospital management must provide adequate logistics and materials required for good hand hygiene practices within facilities.

78. Member States may consider establishing a national mechanism for certification of health facilities that provide good quality and safe health-care services.

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6. South-East Asia Regional Action Plan to Implement Global Strategy to Reduce Harmful Use of Alcohol (2014–2025) (SEA/RC67/R4) Background 79. Alcohol consumption has a negative impact on all dimensions of health – physical, mental and social – and is related to over 60 groups of diseases. It was the cause of 3.3 million global deaths in 2012 (5.9% of all global deaths), including 634 539 deaths in the South-East Asia (SEA) Region. Alcohol use contributed to 5.1% of the global burden of diseases, in terms of total disability-adjusted life-years (DALYs) lost in 2012, and 4.0% of the burden of diseases in the SEA Region. Alcohol consumption also leads to many noncommunicable diseases (NCDs), including cardiovascular diseases and cancers, and increases the risk of developing communicable diseases such as HIV/AIDS, tuberculosis (TB) and lower respiratory tract infections.

80. Compared to other regions, the SEA Region has a relatively low drinker prevalence (13.5%), with a high gender discrepancy (males more than females). While drinker prevalence among teenagers is of concern, over 85% are abstainers, a positive aspect that needs to be maintained. However, heavy episodic or binge drinking is common among a large percentage of those who drink. The adult per capita consumption rose continuously from 2.2 L in 2005 to 3.4 L of ethanol in 2010, and is projected to further increase to close to 4 L of ethanol in 2025. It is estimated that unrecorded alcohol consumption still accounts for almost 50% of regional consumption. The majority of alcohol consumed in the Region is in the form of spirits (77.3%).

81. The Sixty-seventh session of the WHO South-East Asia Regional Committee endorsed the South-East Asia Regional Action Plan to implement the Global Strategy to Reduce the Harmful Use of Alcohol (2014–2025). The vision of the Action Plan is to reduce the health and societal burden from alcohol consumption, and the goal is to strengthen Member States with tools and build their capacity to address alcohol-related problems. The target is a 10% relative reduction in total adult per capita consumption within a calendar year in litres of pure alcohol, as appropriate, within the national context, to be achieved by 2025 in comparison to the 2010 baseline.

82. This Action Plan also fulfils the mandate given by the Political Declaration of the General Assembly (resolution WHA66.10) on the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. To further action in this area, the Sustainable Development Goals included a target that calls for strengthening the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol (Target 3.5).

83. This report cites the progress in implementing the Action Plan on reducing the harmful use of alcohol at the regional and country levels.

Progress in the WHO South-East Asia Region in implementing the Global Strategy to Reduce the Harmful Use of Alcohol 84. Since the endorsement of resolution SEA/RC67/R4 entitled “South -East Asia Regional Action Plan to implement the Global Strategy to Reduce the Harmful Use of Alcohol (2014– 2025)”, Member States of the Region have achieved several milestones, despite challenges in enforcement of policies and resource mobilization.

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85. The WHO Regional Office, in conjunction with WHO headquarters and WHO collaborating centres, plays a leading role in coordinating a response to the challenges of alcohol-related harm in the SEA Region. Technical support has been provided to build the capacity of Member States to advance implementation of the Regional Action Plan to implement the Global Strategy to Reduce the Harmful Use of Alcohol, which is in accordance with the Action Plan to implement the Global Strategy to Reduce the Harmful Use of Alcohol, as well as meet the targets for the prevention and control of NCDs.

86. Technical tools and guidance materials have been developed in consultation with experts in the Region. Community programmes have also been initiated in Member States (Bhutan and Sri Lanka) and good practices documented. Modules have been developed for the online portal for management of problematic alcohol use, which is a template for programme planners and implementers, describing the necessary components of a comprehensive policy framework to minimize the harm from alcohol use.

87. The regional network of national counterparts has been strengthened and the Regional Office has supported Member States to participate in capacity-building workshops on prevention and management of the harmful use of alcohol. Global initiatives such as the Global Survey on Alcohol and Health strengthen country capacity and culminate in the publication of the Global status report on alcohol and health. Similarly, the NCD STEPS survey provides evidence-based data and the process contributes to country capacity-building. A Technical Advisory Group on Alcohol and Health for the SEA Region is under development.

88. National policies and legislation: Till recently, only Thailand had a written alcohol policy. Two more countries, Bhutan and Sri Lanka, have adopted national alcohol policies since the Sixty-seventh Regional Committee Meeting. Bangladesh has taken initiatives to develop a draft national alcohol policy. India and Indonesia have begun developing national alcohol policies; Nepal has endorsed a National Alcohol Control and Regulatory Act in 2017. The progress made by individual countries is described in the Annexure.

Challenges 89. Overall, policy interventions to address the harms from alcohol use in the SEA Region need concerted attention from all stakeholders. The existing policies and legislation lack effective implementation and enforcement. Most Member States do not have effective infrastructure to support alcohol control policies and strategies, as well as laws and regulations for policy enforcement. Coordination across sectors and capacity need to be further strengthened.

90. The alcohol industry has been progressively investing in the Region. Globalization and bilateral, regional and multilateral trade agreements facilitate free flow of alcohol-related trade and investment, which might limit the ability of Member States to prevent and control alcoholrelated harms.

91. Issues such as pay-day drinking, violence and domestic violence, exposure of younger age groups to alcohol promotion, informal and illegal production, and the possible impact of trade agreements are challenges faced by the Region.

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The way forward 92. The Regional Office will continue to assist Member States in the development, implementation, evaluation and monitoring of alcohol control policies and plans, according to their needs, culture and socioeconomic situation. Seamless coordination within programmes, including those for NCDs, health promotion and mental health, should be ensured.

93. The alcohol policy situation in the Region has been reviewed by the Regional Office and recommendations made for country-specific actions. The following ten specific areas will be given priority:  Multisectoral mechanisms at national and subnational levels, and aligning national and subnational policies. Many issues related to alcohol control are beyond the purview of the health sector, and fall under subnational policies and legislations. Therefore, priority requirements for Member States are to establish multisectoral mechanisms to align national and subnational policies and measures on alcohol control. Capacity-building. The human, technical, institutional and financial capacity for developing and implementing alcohol control policies needs to be strengthened. Member States will be encouraged to identify human, technical, institutional and financial capacity development needs. Priority will be given to strengthening the health services for screening and early identification of, and brief interventions for, alcohol use. Preventing new drinkers and protecting high abstinence rates. In most Member States, the rate of abstinence from alcohol use is over 80%, including in countries with large populations such as Bangladesh, India and Indonesia, and is almost 80% in countries such as Sri Lanka. National and subnational strategies for alcohol control in the Region need to draw attention to sustaining this high level of abstinence. Surveillance and information. Establishment of surveillance that goes beyond the collection of prevalence, morbidity and mortality data will be established to ensure a comprehensive response to the harms caused by alcohol. Addressing unrecorded and illegal alcohol products. Unrecorded alcohol products escape policy measures in most countries. Hence, in addition to law enforcement, emphasis is needed to address the social and cultural norms that promote home production and consumption of unrecorded alcohol. Marketing regulation. Advocacy for a total ban on advertising and sponsorships is supported by evidence that shows that comprehensive bans are more effective than partial ones. Member States will be encouraged to move towards a comprehensive ban on alcohol. Alcohol taxation. Member States will be encouraged to use taxation as a means of reducing alcohol-related harm. The Regional Office will provide technical support to countries to initiate studies that can guide optimum taxation approaches. Addressing the effects of trade agreements. The effects of trade agreements on present and future alcohol control policies in Member States should be taken into account in trade agreement policies.

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Counteracting the influence of the alcohol industry. Systems should be put in place to prevent conflicts of interest, and steps taken to ensure that alcohol industry-funded research and projects are excluded from the policy development process. Community actions. National-level policies and programmes have to be implemented at the community level to address harms and promote changes in behaviour. In addition, countries will be encouraged to implement and support community action that addresses issues specific to alcohol use in the community. Success stories and good practices will be documented and disseminated.

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Annexure Progress by individual countries on the implementation of the Global Strategy to Reduce the Harmful Use of Alcohol  Bangladesh: Bangladesh has taken the initiative to develop a draft National Policy on Alcohol. Comprehensive measures are being taken to train primary health- care workers on mental health, substance abuse and alcohol. Prevention and management of the harmful use of alcohol is included in the postgraduate psychiatry curriculum. Bhutan: The Bhutan National Policy and Strategic Framework to Reduce Harmful Use of Alcohol (2015–2020) were endorsed on 2 December 2015. In August 2016, the Executive Order was signed by the Chairman of the National-level Committee and sent to all stakeholders in Bhutan. District-level and Gewog-level committees were formed in all dzongkhags to implement actions under their purview. The implementation status will be submitted every year to the secretariat, to be submitted to the Nationallevel Committee. India: The Ministry of Social Justice and Empowerment, which is the nodal ministry in India for alcohol control, has constituted a committee to formulate the National Alcohol Prevention and Control Policy. The process of drafting this policy is under way. The Multisectoral Action Plan on NCDs by the Ministry of Health and Family Welfare has provisions for the prevention and control of alcohol as a risk factor for NCDs. The newly endorsed National Health Policy 2017 also focuses on alcohol, linking it to other NCDs and road traffic accidents. Indonesia: The Indonesia draft law for a ban of consumption of alcoholic drinks is under discussion in Parliament. The draft law will include regulation of production and distribution, implementation of a tax on sale of alcohol for health promotion and rehabilitation, community involvement, criminal provisions, monitoring and surveillance, roles of stakeholders, and addressing illicit and traditional alcoholic drinks. Maldives: Maldives observes total prohibition. Myanmar: Alcohol is addressed as a part of the National Mental Health Plan and has levied excise tax on alcohol. It has laid down a minimum age for on-premises sales, and legally binding regulations on alcohol advertising. Nepal: the Alcohol Control and Regulatory Act 2017 and Alcohol Control and Regulatory Policy 2017 have been recently endorsed by the government. These are aligned with the Global Strategy to Reduce the Harmful Use of Alcohol. There is a differential taxation policy for alcoholic beverages based on alcohol concentration. Enforcement of marketing restrictions with a total ban on alcohol advertising, promotion and sponsorship are in place. Restriction on availability has been enforced by prohibiting the sale of alcohol in the vicinity of public places; alcohol use is prohibited in Government-sponsored programmes and events.

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Sri Lanka: A comprehensive National Policy on Alcohol, covering all technical areas identified in the WHO Global Strategy to Reduce the Harmful Use of Alcohol has been developed. This was approved by the Cabinet of Ministers in 2015. This complements the stringent alcohol laws contained in the National Authority on Tobacco and Alcohol Act of Sri Lanka. This law totally prohibits all forms of alcohol promotion and sponsorship, sales to those below 21 years of age, sale by vending machines, free distribution of alcohol, etc. The Ministry of Health, along with the National Authority on Tobacco and Alcohol, is working to further strengthen the related laws, for which amendments have been proposed to the Cabinet of Ministers for approval. A National Action Plan to implement the National Policy on Alcohol was developed during 2016 – 2017, with support from the Regional Office. Thailand: Thailand has a well-established alcohol policy in place and implementation is progressing. Thailand has set a target for reducing harmful use of alcohol by 10% by 2025. Alcohol is included as one of the risk factors in the NCD National Strategic Action Plan, which is soon going to be endorsed by the Cabinet. Thailand takes initiatives and collaborates with WHO to advance alcohol-related activities in the Region. The WHO-ThaiHealth Workshop on Technical Support for Alcohol Policy Development in Low- and Middle-Income Countries has been instrumental in increasing the capacity of countries with a high burden, such as Bhutan, Myanmar and Sri Lanka. Timor-Leste: The National Mental Health Strategy 2017 –2021 provides a framework for priority mental health conditions and gives strategic directions for the implementation of the Global Strategy to Reduce the Harmful Use of Alcohol in the national context.

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7. Capacity-building of Member States in global health (SEA/RC63/R6) Background 94. The term “global health” has emerged as part of the larger political and historical process replacing the term “international health” to imply a shared global responsibility for health. It is also associated with the growing number and increased roles in health of other actors beyond governments, namely intergovernmental organizations and agencies, nongovernmental agencies, international and domestic stakeholders, civil society and academia.

95. The United Nations General Assembly (UNGA) in New York had adopted the resolutions A/RES/63/33 in November 2008 and A/RES/64/108 in February 2010, which recognized the close relationship between foreign policy and global health and their interdependence. The UN Secretary-General, in collaboration with the Director-General of WHO, and in consultation with Member States as well as pursuant to UNGA resolution A/RES/63/33, submitted a progress report to the Sixty-fourth session of UN General Assembly in September 2009, titled “Global health and foreign policy: strategic opportunities and challenges”.

96. The World Health Assembly resolution WHA59.26 on International trade and health urged Member States to create constructive and interactive relationships across the public and private sectors to promote coherence in national trade and health policies, and also requested WHO to support Member States to build capacity to understand the implications of international trade and trade agreements for health.

97. The Sixty-third session of the WHO Regional Committee for South-East Asia adopted resolution SEA/RC63/R6, urging Member States to establish policies and programmes for capacity-building in global health of staff concerned, who would be representing their respective governments at high-level policy and programme meetings.

98. The Sixty-ninth session of the WHO Regional Committee for South-East Asia requested the Regional Director to conduct an assessment of the five-year experience (2011–2015) in capacity-building in global health in the Region in response to resolution RC63/R6. The report would be provided to the Seventieth Session of the Regional Committee in order to obtain a more systematic understanding of the strengths, weaknesses and impact of activities, and to provide recommendations on effective management of capacity-building on global health.

Progress made in the Region 99. WHO embarked on a global initiative in 2010 to support Member States in developing their national health policies and strategies, and planning. The initiative provides evidence-based technical and policy advice, and support to Member States in enhancing understanding of the relationship between foreign policy and global health by commissioning research, sponsoring symposiums and developing an international network of governments and institutions – the

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Network on Global Health Diplomacy – with the support of the Rockefeller Foundation and the Global Health and Foreign Policy Initiative.1

100. Prior to the Sixty-third World Health Assembly and the 127th session of the Executive Board, the First Regional Training Course on Global Health was organized by the Ministry of Public Health, Thailand, on 1–5 May 2010, in collaboration with the WHO Regional Office for South-East Asia and the Thai Health Global Link Initiative Programme (TGLIP). The training was conducted in Nakhon Pathom, Thailand, followed by the second module on practical experience and learning through attendance at the Sixty-third World Health Assembly from 17 to 21 May 2010 in Geneva. A wrap-up session − the third module − was conducted on 22 May 2010 in Geneva.

101. Between 2011 and 2013, the Regional Office for South-East Asia annually organized three workshops on global health in collaboration with Thai Health and the Rockefeller Foundation. These workshops were attended by almost all Member States of the Region. The objectives of the workshop were to build up and strengthen the capacity of health and related professionals on global health, which could lead to the setting up of a global health agenda and policy formulation, and to ensure that participants realize the evolution and importance of global health diplomacy. In addition, related activities and courses were also undertaken in a few of the Member States at national level.

102. Besides the efforts made by the Regional Office in holding regular technical briefings, coordination and preparatory meetings before important regional and global engagements, such as Executive Board, World Health Assembly, High-Level Preparatory Meeting for the Regional Committee, intergovernmental meetings, global technical consultations on strategies and plans of action, etc., increase exposure to global health issues and strengthen global health capacities of Member States. There is recognition in the international health arena of the Region’s expertise, be it in collaborating centres, professional training and research institutions of excellence, pharmaceuticals or academia. The vision of the Regional Director is envisaged in the “One by Four” plan – where “One” refers to a more responsive WHO in the Region and “Four” to the four strategic directions; the fourth being articulation of a strong regional voice in the global health agenda. The combined efforts of Member States have made a difference in protecting and promoting regional and global public health through the health strategies, plans of action and frameworks being adopted at the global level.

103. Following requests by Member States to conduct an assessment of five years’ experience (2011–2015) in capacity-building in global health and report it to the Seventieth Session of the Regional Committee, WHO decided to assign the assessment to a public health agency that is familiar with Member States and international health processes, and is best placed to carry out the assessment in consultation with official focal points as well as the organizers of the exercise. The Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand – a semi-autonomous research unit under Thailand’s Ministry of Public Health – was finally identified to conduct the assessment.

104. The HITAP, under an agreement with the WHO Regional Office, has drafted a preliminary report on the assessment, including the draft survey questionnaire and interview questions. WHO is working closely with the centre to facilitate the assessment. HITAP will soon be 1

The Global Health and Foreign Policy Initiative was launched in September 2006 as an immediate outcome of the Oslo Ministerial Declaration (by the foreign ministers of Brazil, France, Norway, Senegal, South Africa and Thailand).

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contacting the focal persons in the ministries of health in Member States for interviewing selected high-level policy-makers who have participated in or witnessed the global health forums to assess the global health capacities and contributions thereof. The final report of the assessment will be submitted to the Seventieth Session of the Regional Committee for South-East Asia in Maldives in September 2017.

The way forward 105. WHO would continue to support Member States to organize national, regional and global seminars and training workshops on global health that could act as an effective tool to strengthen national capacity in global health. These would enable them to participate and play active roles in international/global health forums with improved negotiation skills. At the same time, national strategies and plans have to be developed to address the increasing demand for well-trained public health professionals who could address the changing context of global health challenges, including complex and persistent health issues, increasing health inequities, new and emerging diseases, the necessity for greater collaboration, and incorporation of social models and determinants.

106. The final report of the assessment, including details of the activities conducted on global health capacity development at country and regional levels; contribution of the capacity-building action to improved global health diplomacy/negotiation capacity in individual Member States; strengths, weaknesses and impacts of the activities undertaken and recommendations for effective management of capacity-building on global health, including (a) building/strengthening, and (b) sustaining; will be submitted to the Seventieth Session of the Regional Committee for South-East Asia.

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8. Consultative Expert Working Group on Research and Development (CEWG): Financing and Coordination (SEA/RC65/R3) Background 107. The Regional Committee resolution on the Consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG) (SEA/RC65/R3) has contributed in great measure to the outcomes of resolution WHA70.22 on CEWG. The SEA Region resolution was the outcome of national and regional consultations on the CEWG report and provided the basis for the development and adoption of resolution WHA66.22 at the Sixtysixth World Health Assembly in May 2013. Resolution WHA70.22 encompasses and builds on regional resolution SEA-RC65-R3; hence they are considered together for outcomes and progress.

108. The follow-up of the report of the Consultative Expert Working Group on Research and Development: Financing and Coordination, addresses, in effect,

a. b.

terms of reference and a costed workplan for the Global Observatory on Health Research and Development; a proposal with goals and an operational plan for a voluntary pooled fund to support research and development (R&D) for Type III and Type II diseases and specific R&D needs of developing countries for Type I diseases; and progress on demonstration projects.

Progress made in the South-East Asia Region 109. The Global Observatory on Health Research and Development: The terms of reference are, inter alia, to produce comprehensive analysis of existing data and information on health R&D, to monitor and report on global trends, to benchmark and compare health R&D activities across countries and health conditions, to contribute to improving data collection and make it available in a web portal, to conduct comprehensive analysis and syntheses of data based on the advice of the Expert Committee on Health R&D.

110. Voluntary pooled fund: A proposal with goals and an operational plan for a voluntary pooled fund to support R&D. The success of a voluntary pooled fund will depend on its ability to attract sufficient amounts of funding, with a minimum size of US$ 100 million per year with a diverse portfolio of 35–40 R&D projects. Various options for sustainable funding are proposed.

111. Health R&D demonstration projects: Six demonstration projects were finally selected. On 17 March 2017, the “Multiplexed Point -of-Care test for acute febrile illness” demonstration project by the Translational Health Science and Technology Institute, India, and developed in coordination with the Regional Office and the Country Office for India received Indian rupees 59.9 million from WHO. The project was selected to take resolutions SEA/RC65/R3 and WHA66.22 forward and identified at the Regional Consultation for developing a strategic workplan as a follow-up of the CEWG held on 25–26 July 2013 in Bangkok, Thailand. The scope for the demonstration project is significant as it goes beyond Type III neglected diseases and

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emphasizes engaging the CEWG mechanism for all Type I, II and III diseases for providing access to affordable medical products.

112. The estimated total financial requirement over the period 2014 –2017 for the implementation of the demonstration projects and establishment of the Global Observatory is US$ 85 million. A total of US$ 10.49 million had been contributed by Brazil, Germany, India, Norway, South Africa and Switzerland to the voluntary fund designated for demonstration projects till May 2017.

Challenges being faced 113. The progress on CEWG needs to gain momentum. This has been recognized in discussions on other resolutions at the World Health Assembly. The CEWG came up for discussion also in resolution WHA70.20 on “Addressing the global shortage of, and access to, medicines and vaccines”. The United Nations Secretary-General’s High-level Panel on Access to Med icines “to review and assess proposals and recommend solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies” echoes the conclusions of previous reports, in particular the reports of the Commission on Intellectual Property Rights, Innovation and Public Health and the CEWG. National regulatory capacity and local production has been discussed in line with the parent CEWG resolution WHA61.21 of 2008 on the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property. Member States reiterated the importance of the Strategic Workplan of CEWG for the 2030 Agenda for Sustainable Development.

The way forward 114. The implementation of the Regional Committee resolution SEA/RC65/R3 and World Health Assembly resolutions WHA69.23 and WHA70.22 on CEWG reiterate a focus on R&D for health products related to needs of developing countries and those of Member States of the Region. Concerted efforts are necessary to take the CEWG forward, including through adequate and sustainable funding, to fully implement the CEWG Strategic Workplan agreed in resolution WHA66.22.

115. These aspects need to be reflected in the overall evaluation of the Global Strategy and Plan of Action (GSPA) that is currently under progress at WHO headquarters and in which select experts from Member countries of the region are participating.

116. It may be noted that previous deliberations on GSPA and CEWG such as the regional Member State assessment exercise and national GSPA assessment in Sri Lanka have recommended establishing a regional network to speed up regulatory approvals within the countries for access to medical products. Member States of the WHO South-East Asia Region launched the South-East Asia Regulatory Network (SEARN) to enhance information sharing, collaboration and convergence of medical product regulatory practices across the Region that aims to guarantee access to high-quality medical products. SEARN will be instrumental in encouraging convergence, effective use of resources and rapid exchange of information on regulation of medical products across the countries of the South-East Asia Region.

SEA/RC70/13 Add.1

REGIONAL COMMITTEE Seventieth Session Maldives 6–10 September 2017

Provisional Agenda item 9 SEA/RC70/13 Add. 1 20 July 2017

Progress reports on selected Regional Committee resolutions The High-Level Preparatory Meeting held in the WHO Regional Office in New Delhi from 10 to 13 July 2017 reviewed the progress reports on the following selected Regional Committee resolutions: 1. 2. 3. 4. 5. 6. 7. 8. Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6) Challenges in polio eradication (SEA/RC60/R8) Measles elimination (SEA/RC66/R5) Patient safety (SEA/RC68/R4) and rubella/congenital rubella syndrome control

Antimicrobial resistance (SEA/RC68/R3) contributing to sustainable universal health coverage

South-East Asia Regional Action Plan to Implement the Global Strategy to Reduce the Harmful Use of Alcohol (2014–2025) (SEA/RC67/R4) Capacity-building of Member States in global health (SEA/RC63/R6) Consultative Expert Working Group on Research and Development (CEWG): Financing and Coordination (SEA/RC65/R3)

The recommendations made by the High-Level Preparatory Meeting on each of the above-mentioned progress reports are submitted to the Seventieth Session of the WHO Regional Committee for its consideration.

SEA/RC70/13 Add.1

Introduction 1. The High-Level Preparatory Meeting held in the WHO Regional Office in New Delhi from 10 to 13 July 2017 reviewed the progress reports on the following selected Regional Committee resolutions: 1. Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6) 2. 3. 4. 5. 6. 7. 8. Challenges in polio eradication (SEA/RC60/R8) Measles elimination and rubella/congenital rubella syndrome control (SEA/RC66/R5) Antimicrobial resistance (SEA/RC68/R3) Patient safety contributing to sustainable universal health coverage (SEA/RC68/R4) South-East Asia Regional Action Plan to Implement Global Strategy to Reduce Harmful Use of Alcohol (2014–2025) (SEA/RC67/R4) Capacity-building of Member States in global health (SEA/RC63/R6) Consultative Expert Working Group on Research and Development (CEWG): Financing and Coordination (SEA/RC65/R3)

2. The recommendations made by the High-Level Preparatory Meeting on each of the above-mentioned progress reports are submitted to the Seventieth Session of the WHO Regional Committee for its consideration.

1. Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6) Recommendations Actions by Member States (1) (2) Continue discussions with the ministries of finance and ministries of foreign affairs of Member States for contributions to SEARHEF. Support implementation of SEARHEF business rules, especially in reporting.

Actions by WHO (1) (2) Continue to provide support to Member States in their discussions on the SEARHEF preparedness stream. Continue to discuss with donors about contributions to SEARHEF.

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2. Challenges in polio eradication (SEA/RC60/R8) Recommendations Actions by Member States (1) Continue efforts to maintain certification standard surveillance and outbreak response preparedness to ensure timely detection of and response to any wild or vaccinederived poliovirus. Complete the containment of type 2 polioviruses as per Global Action Plan (GAP) III to mitigate the risk of exposure of communities to any type 2 poliovirus. Finalize the polio transition plans by ensuring adequate resources for polio-funded networks to mitigate the programmatic risks associated with the ramp-down of polio funding.

(2) (3)

Actions by WHO (1) (2) Support Member States in fully implementing the activities outlined under the Polio Eradication and Endgame Strategic Plan 2013–2018. Ensure collaboration among Member States for knowledge exchange on the use of fractional inactivated poliovirus (IPV) in India and Sri Lanka to facilitate the introduction of fractional IPV in other Member States. Support the finalization and implementation of polio transition plans in five Member States of the Region with the full engagement of national governments, donors and partners to mitigate the risks associated with the ramp-down of polio funding. Develop practical guidelines for implementing the containment requirements outlined in GAP III.

(3)

(4)

3. Measles elimination and rubella/congenital rubella syndrome control (SEA/RC66/R5) Recommendations Actions by Member States (1) Ensure the full engagement of governments at the national and subnational levels, as well as partners and donors, for mobilization of resources and implementation of strategies to achieve the goal of measles elimination and rubella/congenital rubella syndrome (CRS) control, including achievement of high coverage during the upcoming mass vaccination campaigns with measles–rubella vaccine in Member States.

SEA/RC70/13 Add.1 Page 3

(2)

Accelerate efforts to strengthen laboratory-supported case-based surveillance and routine immunization performance at national and subnational levels, required to achieve measles elimination and rubella/CRS control by 2020. Ensure country capacity to adequately investigate and respond to large measles and rubella outbreaks.

(3)

Actions by WHO (1) Support Member States with the full implementation of the approaches outlined under the Regional Strategic Plan for Measles Elimination and Rubella/CRS Control: 2014– 2020. Support Member States with the polio transition planning process to mitigate the programmatic risks to the measles elimination and rubella/CRS control efforts associated with the ramp-down of polio funding.

(2)

4. Antimicrobial resistance (SEA/RC68/R3) Recommendations Actions by Member States (1) Ensure high-level endorsement of the national action plans on antimicrobial resistance through appropriate mechanisms in the national contexts that will facilitate high-level engagement across all sectors. Continue with the comprehensive implementation of national action plans.

(2)

Actions by WHO (1) (2) Provide support for the implementation of national action plans on antimicrobial resistance by Member States. Support intercountry exchanges of good practices for implementing national action plans on antimicrobial resistance.

SEA/RC70/13 Add.1 Page 4

5. Patient safety contributing to sustainable universal health coverage (SEA/RC68/R4) Recommendations Actions by Member States (1) (2) Continue to implement interventions to improve patient safety based on priorities identified during the patient safety self-assessment exercises. Share experiences with other countries on actions to improve patient safety.

Actions by WHO (1) Support the documenting and sharing of national experiences with interventions for improving patient safety and quality of care as an integral part of advancing universal health coverage (UHC). Continue to provide support to countries on interventions to improve patient safety, including adverse event-reporting systems. Report to the Regional Committee in 2019.

(2) (3)

6. South-East Asia Regional Action Plan to Implement the Global Strategy to Reduce the Harmful Use of Alcohol (2014–2025) (SEA/RC67/R4) Recommendations Actions by Member States (1) Develop and/or strengthen systems and mechanisms to facilitate the implementation of the WHO Global Strategy to Reduce the Harmful Use of Alcohol (2014–2025) in the light of the Regional Action Plan and according to national priorities. Promote multisectoral mechanisms at national and subnational levels to reduce the harmful use of alcohol. Address unrecorded and illegal alcohol products by enforcement of laws, and address social and cultural norms that promote home production and consumption of unrecorded alcohol.

(2) (3)

SEA/RC70/13 Add.1 Page 5

Actions by WHO (1) Provide support to build the capacity of Member States (technical and institutional) to advance the implementation of the Regional Action Plan to Reduce the Harmful Use of Alcohol in the national context, including providing technical support in meeting the evidence needs related to international trade agreements. Support and strengthen ongoing collaboration of the regional networks of national counterparts. Document and disseminate information on “best buys” and good practices to reduce the harmful use of alcohol.

(2) (3)

7. Capacity-building of Member States in global health (SEA/RC63/R6) Recommendations Actions by Member States (1) Ensure full support to the conduct of the assessment of WHO’s five years’ experience (2011–2015) in capacity-building in global health by the Health Intervention and Technology Assessment Program (HITAP). Engage actively in capacity-building in global health, including through strengthening national institutional processes to build global health capacities. Encourage and support greater participation at the Governing Body meetings and intergovernmental processes.

(2) (3)

Actions by WHO (1) (2) (3) Continue supporting Member States in organizing national, regional and global workshops on global health issues. Continue to hold technical briefings and coordination meetings before important regional and global governing bodies and related meetings. Explore various mechanisms to facilitate, support and coordinate global health capacity-building efforts in the Region.

SEA/RC70/13 Add.1 Page 6

8. Consultative Expert Working Group on Research and Development (CEWG): Financing and Coordination (SEA/RC65/R3) Recommendations Actions by Member States (1) Promote further unified engagement on the CEWG, Global Strategy and Plan of Action (GSPA) and demonstration projects at the regional and global levels, including negotiating the global research and development (R&D) agreement and the unfinished discussions on the CEWG follow up. Develop a roadmap for promoting access to medical products through regulators’ engagement in the South-East Asia Regulatory Network (SEARN) in the Region.

(2)

Actions by WHO (1) (2) Support Member States on the CEWG, GSPA and demonstration projects. Support Member States on SEARN to promote access to medical products.

SEA/RC60/R7

SOUTH-EAST ASIA REGIONAL HEALTH EMERGENCY FUND The Regional Committee, Recalling World Health Assembly resolutions WHA58.1 and WHA59.22, and its own resolutions SEA/RC57/3 and SEA/RC58/3, all of which called for improved investments of resources, systems and expertise for emergency preparedness and response, Further recalling the recommendations made at the Regional Consultation for Emergency Preparedness and Response (June 2006), at which the Bali Declaration called for setting up a Regional Emergency Fund, and the Twenty-fourth Health Ministers’ Meeting, at which it was recommended that the Regional Office take steps to set up a Regional Emergency Fund, Confirming that emergencies are a priority in the Region, with 58% of the total number of people killed in natural disasters during the decade 1996–2005 from countries of the South-East Asia Region; that the Organization has prioritized emergency preparedness and response, and that a dedicated Strategic Objective has been developed and Health Action in Crises has become a full-fledged cluster in WHO headquarters, Noting that steps have been taken to create the Fund with a Working Group based in the Regional Office and a series of consultations conducted with WHO Representatives and representatives of Member countries, Acknowledging the establishment of the South-East Asia Regional Health Emergency Fund (SEARHEF) as contained in the “Thimphu Declaration on International Health Security in the South-East Asia Region”, Appreciating the contribution of US$ 100 000 of the Royal Thai Government to the Fund, and

Having considered the recommendations made by the Joint Meeting of Health Secretaries of countries of the WHO South-East Asia Region and the Consultative Committee for Programme Development and Management, held during 2-6 July 2007, 1. URGES Member States: (a) to contribute 1% of their WHO Regular Budget allocation to the SEARHEF; (b) to support proper use and management of the Fund to address immediate needs in any emergency, and (c) to actively participate in the management and utilization of SEARHEF through its Working Group, and 2. REQUESTS the Regional Director: (a) to lead in the efficient implementation of the Fund so that financial support is provided for immediate needs in countries affected by events; (b) to support further resource mobilization for the Fund; (c) to have a transparent mechanism for the distribution of the Fund; (d) to facilitate linking the SEARHEF with planning and activities for Strategic Objective 5, and (e) to report annually to Member States at the Regional Committee on the status of the Fund usage.

SEA/RC69/R6

EXPANDING THE SCOPE OF THE SOUTH-EAST ASIA REGIONAL HEALTH EMERGENCY FUND (SEARHEF) The Regional Committee, Recognizing the Sendai Framework for Disaster Risk Reduction and Sustainable Development Goals adopted by the UN General Assembly, Recalling World Health Assembly resolutions WHA54.14, WHA58.1, WHA59.22, WHA64.10, WHA65.20, WHA68.5, Executive Board Special Session on Ebola EBS53.R1 and its own resolutions SEA/RC57/R3, SEA/RC60/R7, SEA/RC62/R5 and SEA/RC68/R2 which call for strengthening the resilience of national health systems in response to all hazards that may lead to emergencies and for improved investments of resources, systems and expertise for emergency preparedness and response, Further recalling the recommendations made at the Regional Consultation for Emergency Preparedness and Response (June 2006), at which the Bali Declaration called for setting up a Regional Emergency Fund, and the Twenty-fourth Health Ministers’ Meeting, at which it was recommended that the Regional Office take steps to set up a Regional Emergency Fund, Acknowledging the establishment of the South-East Asia Regional Health Emergency Fund (SEARHEF) as established through Regional Committee resolution SEA/RC60/R7, Reaffirming that emergencies remain a concern in the Region and recognizing SEARHEF as an important component for regional solidarity for support in times of acute emergencies and that Member States have commended the speed and flexibility provided by the funds,

Appreciating the contribution of Member States to continuously support SEARHEF with AC and VC funds, Endorsing the report and the recommendations of the High-Level Preparatory Meeting of Member States in July 2016 to expand the scope of SEARHEF to include a preparedness stream that would strengthen key aspects such as disease surveillance, health emergency workforce and health emergency teams, IHR core capacities and SEARO Benchmarks for emergencies, 1. URGES Member States: (a) to endorse the expansion of the mandate of SEARHEF to include an additional stream covering preparedness; (b) to endorse the recommendations of and the proposed policy and guidelines for the preparedness stream of SEARHEF developed during the Fifth Meeting of the Working Group for Governance of SEARHEF (Annex 1); (c) to use the preparedness stream of SEARHEF to support critical capacities in preparedness that include but will not be limited to : i. strengthening capacities defined by IHR and SEAR benchmarks in order to enable a full and effective response to emergencies with health consequences; ensuring that preparedness and risk reduction efforts across all hazards contribute to resilient health systems; strengthening disease surveillance capacity and data and information flows and sharing between local and national levels and with WHO at country, regional and global levels in order to ensure early reporting and detection; continue supporting the regional and sub-regional collaboration among disease surveillance networks within and across WHO regions; building up local and national surge capacity by strengthening the health emergency workforce through establishment of systematic systems that include training, efficient recruitment and deployment; establish or strengthen multidisciplinary health emergency teams that can be deployed in a timely manner;

ii. iii.

iv. v.

vi.

(d) to discuss within the internal government processes so as to mobilize resources to fund the preparedness stream of SEARHEF, and (e) to continuously participate in the management and utilization of SEARHEF through its Working Group, and

REQUESTS the Regional Director: (a) to facilitate discussion among Member States to determine the feasible options to fund the preparedness stream of SEARHEF; (b) to support the implementation of the policy, guidelines and procedures drafted by the Working Group for the governance of SEARHEF (c) to mobilize technical and operational assistance to the initiatives that the preparedness stream of SEARHEF will support (d) to support resource mobilization efforts as guided by Member States, and (e) to report annually to the Regional Committee on the progress of the preparedness stream of SEARHEF in conjunction with reporting on the response stream of SEARHEF .

Seventh session, 9 September 2016

SEA/RC60/R8

CHALLENGES IN POLIO ERADICATION The Regional Committee, Recalling its resolution SEA/RC58/R6, Reaffirming WHO’s commitment to the goal of eradication of poliomyelitis, Recognizing that substantial progress has been made in the Region towards the achievement of the goal of polio eradication in 2006, despite minor setbacks, Encouraged by the high commitment of the Director-General of WHO to finish the job of polio eradication, coupled also with the strong commitment by Member States still endemic to polio to achieve the goal of eradication of poliomyelitis at any cost, Further bolstered by the effectiveness of new tools such as the use of monovalent OPV (mOPV) and new strategies such as those outlined in the 2006 World Health Assembly resolution WHA59.1, to combat outbreaks of wild polioviruses or appearance of vaccine-derived polioviruses (VDPV), Re-affirming that poliomyelitis eradication will result in far-reaching humanitarian and economic benefits to all countries, and Realizing that sustainable polio eradication is only possible with a strong routine immunization programme that reaches all children with all routine antigens, 1. URGES Member States to strengthen the Expanded Programme on Immunization in order to maintain the highest surveillance levels and high routine immunization coverage as the best means to control the spread of polio virus and the outbreaks in the Region, and

REQUESTS the Regional Director: (a) to support/facilitate a thorough review of the status of routine immunization in Member countries to strengthen polio eradication efforts and to maintain polio-free status in those countries where polio is eradicated; (b) to convene a technical working group to evaluate the various options to prevent the spread of polio in the Region; (c) to seek and facilitate mobilization of financial resources for supporting the polio and routine immunization programme of Member States; (d) to support and facilitate Member States to maintain the highest surveillance levels and high routine immunization coverage as the best means to control the spread of polio virus and outbreaks in the Region; (e) to work with international agencies and the private sector so that newly developed polio vaccines are available at an affordable price, and

(f)

to report on the progress made in polio eradication to the Regional Committee on an annual basis until polio-free status is achieved in the Region.

SEA/RC66/R5

MEASLES ELIMINATION AND RUBELLA/CONGENITAL RUBELLA SYNDROME CONTROL The Regional Committee, Noting a significant reduction in global measles mortality by 71% between 2000 and 2011, from an estimated 542 000 deaths in 2000 to 158 000 in 2011, and an increase in the global routine measles immunization coverage from 72% in 2000 to 84% in 2011; Concerned that measles mortality is one of the barriers to achieving Millennium Development Goal 4, and that the South-East Asia Region accounted for approximately half of global measles deaths (158 000) in 2011; Recognizing that the South-East Asia Region hosts major vaccines manufacturing capacity, and that one Member State is the largest manufacturer of measles vaccines in the world; Noting progress in the South-East Asia Region of an increase in first-dose measles vaccine coverage from 61% to 79% between 2000 and 2012; Recalling resolution WHA65.17, urging Member States to apply the vision and strategies of the Global Vaccine Action Plan to develop the vaccines and immunization components of their national health strategy and plans; Cognizant that in order to achieve elimination, the vaccine coverage target of two doses of measles-containing vaccine needs to be greater than 95% in all country districts, and that this can be achieved through a combination of routine services and periodic mass campaigns;

Concerned that the South-East Asia Region is the only WHO region without a measles elimination goal and that circulating viruses pose a threat to countries and regions which have already eliminated measles or are close to doing so; Recognizing that various health systems challenges need to be addressed in the efforts towards measles elimination and rubella/congenital rubella syndrome (CRS) control, in particular sustaining a high level of routine immunization coverage, other public health priorities that compete for limited resources, and maintenance of high-quality surveillance systems; Noting concern about the social and political implications from adverse events following immunization (AEFI) and stressing that utmost efforts need to be made to ensure vaccines and injections are safe and that effective information, education and communication strategies and responses to AEFI are in place; Noting with concern the inadequately addressed burden of rubella and CRS in the SouthEast Asia Region; Acknowledging the early stage of rubella/CRS control in the Region and the challenges that remain, and recognizing that measles elimination is an opportunity for rubella/CRS elimination and that with use of combined measles-rubella vaccine, when measles is eliminated, rubella/CRS will also likely be eliminated; Citing the results of the February 2013 regional consultation of technical and policy officials in Kathmandu on feasibility of measles elimination and rubella/CRS control, and the recommendation by the South-East Asia Region Immunization Technical Advisory Group; 1. DECIDES to adopt the goal of measles elimination and rubella/CRS control in the South-East Asia Region by 2020; 2. URGES Member States: (1) to strengthen immunization and surveillance systems in the context of health systems, including laboratory capacity, for increasing and sustaining high levels of immunization coverage, high-quality case-based surveillance and well-functioning AEFI monitoring systems; (2) to conduct epidemiological assessments of population susceptibility to measles and rubella/CRS as a way of informing policy and planning preventive strategies to increase immunity levels uniformly;

(3)

to develop measles elimination and rubella/CRS control policy strategies using evidence-based data;

(4)

to mobilize political, societal and financial support to eliminate measles and control rubella/CRS in the South-East Asia Region by 2020;

3. REQUESTS the Regional Director: (1) to provide technical support to Member States in their efforts to develop elimination policy and strategies, while strengthening their immunization and surveillance systems and improving their programme performance; (2) to mobilize the required resources, build on existing partnerships and foster the development of new ones in support of measles elimination and rubella/CRS control efforts; (3) to report to the Regional Committee every two years on the status of global measles elimination and rubella/CRS control targets, milestones and progress of ongoing activities in countries towards achieving the goal by 2020 in the South-East Asia Region.

Sixth session, 13 September 2013

SEA/RC68/R3

ANTIMICROBIAL RESISTANCE The Regional Committee, Having considered World Health Assembly resolution WHA68.7 on antimicrobial resistance and having reviewed the Global Action Plan on Antimicrobial Resistance adopted by the Sixtyeighth World Health Assembly, Recalling World Health Assembly resolutions WHA51.17 on emerging and other communicable diseases: antimicrobial resistance, WHA54.14 on global health security: epidemic alert and response, WHA58.27 on improving the containment of antimicrobial resistance, WHA67.25 on antimicrobial resistance, and the Regional Committee resolution SEA/RC63/R4 on prevention and containment of antimicrobial resistance, Aware that the health and economic consequences of antimicrobial resistance shall be immense for the Member States of the WHO South-East Asia Region, Recognizing that combating antimicrobial resistance shall require political commitments, multisectoral coordination, sustained investment and technical assistance, Underlining the pressing need for availability of new affordable antimicrobial medicines, vaccines and diagnostics, and monitoring the potency of available antibiotics, Underscoring the need for strengthened cooperation among health professionals in antibiotic stewardship including infection prevention and control, appropriate use of antimicrobials and regular monitoring of the magnitude and profile of antimicrobial resistance; as well as engagement by the communities in responsible use of antibiotics through effective public

communication programmes, education and training in the human health, veterinary and agricultural sectors, Appreciating the political commitment at the national and regional levels via the ministerial Jaipur Declaration of 2011 and subsequent inclusion of antimicrobial resistance in the Regional Director’s flagship priorities in 2014, 1. URGES Member States: (a) to include antimicrobial resistance as one of the top priorities on their national health agendas; (b) to develop and implement a multisectoral national action plan on antimicrobial resistance in alignment with the Global Action Plan on Antimicrobial Resistance in the country context; and 2. REQUESTS the Regional Director: (a) to provide technical support to Member States in the development and implementation of national action plans in line with the Global Action Plan on Antimicrobial Resistance; (b) to assist Member States in mobilizing resources for sustainable implementation of national action plans on antimicrobial resistance; (c) to support the establishment of a regional surveillance network and provide technical support for the development and strengthening of national reference laboratories in human and animal sectors that contributes to the magnitude and profile of antimicrobial resistance in both sectors at the country and regional levels; (d) to build or strengthen capacity of Member States on the monitoring systems on the use of antimicrobials in human and animal sectors that contribute to national profiles and develop regional profiles; (e) to strengthen regional tripartite collaboration among WHO, FAO and OIE to support national collaboration to combat antimicrobial resistance; and (f) to submit to the WHO Regional Committee for South-East Asia reports on progress achieved in implementing this resolution in 2017 and in 2019; and conduct an assessment of regional achievements and challenges and present to the Seventy-fourth session of the Regional Committee in 2021.

Eighth session, 11 September 2015

SEA/RC68/R4

PATIENT SAFETY CONTRIBUTING TO SUSTAINABLE UNIVERSAL HEALTH COVERAGE The Regional Committee, Recalling Resolution RC59/R3 on promoting patient safety in healthcare, Acknowledging that health services are still not as safe as they should be; that up to one in ten patients experience adverse events in health facilities, safety among health personnel is still a major concern, and that there are compelling health and economic arguments for improving patient safety, Realizing that improved patient safety and quality of care are essential in gaining trust by the population, and an integral element in progressing towards universal health coverage, and further recognizing that improved quality and safety requires the engagement of stakeholders in particular patients and health professionals, and beyond health sector, Recognizing barriers for improving patient safety, including reporting errors and adverse events, safety culture, effective communication and coordinated care among health professionals, and the need for a whole systems solution, 1. ENDORSES the Regional Strategy on Patient Safety (2016–2025)1;

Regional strategy for patient safety in the WHO South-East Asia Region, SEA-HSD-378 http://apps.searo.who.int/PDS_DOCS/B5187.pdf?ua=1

URGES Member States: (a) to translate the six strategic objectives of the Regional Strategy for Patient Safety in the WHO South-East Asia Region into actions, implementation, monitoring and evaluations in line with country context; (b) to engage all relevant stakeholders in building safer health-care facilities, creating and sustaining a culture of safety at all levels of health care; (c) to create awareness and engage patients and communities in the process of improved patient safety, in strengthening health systems and supporting UHC; (d) to consider allocating adequate resources to implement the country action plan; and

REQUESTS the Regional Director: (a) to provide technical support to Member States in implementing the Regional Strategy and country action plans; (b) to facilitate collaboration and the exchange of information and best practices between Member States, regional and global networks; and (c) to report progress, achievements and challenges in implementing this Resolution to the Regional Committee in 2017, 2019, and facilitate assessment of the patient safety in Member States in the Region, upon request, and report to the Regional Committee in 2021.

Eighth session, 11 September 2015

SEA/RC67/R4

SOUTH-EAST ASIA REGIONAL ACTION PLAN TO IMPLEMENT GLOBAL STRATEGY TO REDUCE HARMFUL USE OF ALCOHOL (2014–2025) The Regional Committee, Noting the report on Strengthening the Implementation of the Global strategy to reduce harmful use of alcohol to support the achievement of the regional targets on noncommunicable diseases (NCDs) prevention and control in the South-East Asia Region, Recalling the World Health Assembly resolution WHA63.13 on the Global strategy to reduce the harmful use of alcohol, the follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases, particularly in regard to the adoption of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 and the global target on the reduction of harmful use of alcohol as one of the nine voluntary targets, Also recalling Regional Committee resolution SEA/RC66/R6 on the Regional Action Plan and Targets for Prevention and Control of NCDs (2013–2020), that endorsed a regional voluntary target of 10% reduction in the harmful use of alcohol and recommended to Member States to use total adult per capita consumption as the basic indicator, Further recalling Regional Committee resolutions SEA/RC54/R2 on Mental Health and Substance Abuse, including Alcohol, and SEA/RC59/R8 on Alcohol Consumption Control: Policy Options which endorsed the Regional Policy Framework, and document SEA/RC59/15 on providing strategic guidance to Member States,

Concerned that there is a gradual increase in consumption of alcohol among the general population – particularly among adolescents, youth and also women in some Member States – and quite a high prevalence of heavy episodic drinking or binge drinking and unrecorded alcohol consumption in the Region, Deeply concerned that the South-East Asia Region is an emerging market for the alcohol industry which is progressively investing and marketing in the Region, and that there is a shift in consumption of beverage types from indigenous/traditional to modern beverages such as wines and beers, as well as from ritual use to lifestyle-related drinking, Recognizing the consequences of trade agreements that facilitate the free flow of and investment in alcohol, which may increase the consumption and negative impact of alcohol in the Region, and may limit the ability of Member States to prevent and control alcohol-related harms, Concerned that consumption of illicit or informally produced alcohol has additional negative consequences, partly due to a higher ethanol content and potential contamination with toxic substances, such as methanol, Noting that alcohol consumption leads to many health problems including NCDs such as cardiovascular diseases and cancers, which contribute to a great proportion of the global and regional burden of disease, Mindful of the concern that alcohol consumption also has a negative impact on people other than those who drink, and also social and economic consequences on the population, in particular the poor, Reiterating that the basis for prevention of alcohol-related harm in the context of the SouthEast Asia Region may also include negative social and economic consequences related to productivity loss, poverty, social safety and quality of life, and also take into account social structure and sociocultural norms, Further noting the progress of work of the WHO Global Network of National Counterparts to implement the Global Strategy, formed in 2011, and their task forces and working groups, as well as the establishment of the South-East Asia Region Network of National Counterparts and other regional initiatives,

Recognizing the commitment to address the harmful use of alcohol as a risk factor for NCDs, in particular the outcomes of the 2012 Bi-Regional Workshop in Bangkok on building capacity for reducing the harmful use of alcohol at the country level in coordination with NCD prevention and control programmes of the South-East Asia and Western Pacific regions, Acknowledging the need for further strengthening of national and regional capacities, including institutional capacity, and further accelerating the implementation of the Global strategy to reduce harmful use of alcohol at the national level, and Noting the draft regional action plan that was developed through consultations among SEA Network of National Counterparts on Implementing the Global Strategy to Reduce Harmful Use of Alcohol, 1. ENDORSES the Regional Action Plan to Implement the Global Strategy to Reduce Harmful

Use of Alcohol for the South-East Asia Region (2014–2025); 2. URGES Member States: (a) to consider setting targets, as appropriate, on the reduction of the harmful use of alcohol; (b) to develop and/or strengthen, as appropriate, a comprehensive alcohol policy framework to reduce the harmful use of alcohol, taking into consideration the Regional Action Plan to Implement the Global strategy to reduce harmful use of alcohol for the South-East Asia Region (2014–2025); (c) to develop and/or strengthen, as appropriate, systems and mechanisms to facilitate the implementation of the WHO Global strategy to reduce harmful use of alcohol, which may include responsible institutional, human and financial resources, multisectoral collaborating mechanisms, and technical knowledge and information systems; (d) to promote the linkages between the implementation of the Global strategy to reduce the harmful use of alcohol and efforts on NCD prevention and control; (e) to strengthen surveillance for alcohol consumption and related harm including integrated surveillance for NCDs, and (f) to consider observing a regional/national non-alcohol day and advocate for global non-alcohol day.

REQUESTS the Regional Director: (a) to provide technical support and build capacity of Member States to advance the implementation of the Regional action plan for reducing the harmful use of alcohol, in accordance with the implementation of the Regional action plan and targets for prevention and control of NCDs; and (b) to support capacity strengthening and international collaboration mechanisms, including setting up the Regional Technical Advisory Group on Alcohol and Health, to support the WHO Global and Regional Networks of National Counterparts for Implementation of the Global strategy to reduce harmful use of alcohol and their subsidiary groups, and to continue the biennial regional forum of key partners from Member States and international partners. (c) to report progress on this resolution to the Seventieth, Seventy-third, Seventy-sixth and Seventy-ninth sessions of the Regional Committee for South-East Asia in 2017, 2020, 2023 and 2026. Sixth session, 12 September 2014

SEA/RC63/R6

CAPACITY BUILDING OF MEMBER STATES IN GLOBAL HEALTH The Regional Committee, Recalling World Health Assembly resolution WHA59.26 on international trade and health, which urged Member States to create constructive and interactive relationships across the public and private sectors to promote coherence in national trade and health policies, and also requested WHO to support Member States to build capacity to understand the implications of international trade and trade agreements for health, Recognizing that mainstreaming health into public policies is vital and that health interventions should move beyond national policies and boundaries, and also that the active collaboration and sharing of experience among partners in global health development has become essential for the development of healthy public policies, Noting United Nations General Assembly resolutions A/RES/63/33 and A/RES/64/108 that highlighted the close relationship between foreign policy and global health and encouraged Member States to consider health issues in the formulation of foreign policy and to increase their capacity for training of diplomats and health officials on global health and foreign policy by developing best practices and guidelines, open-source information, and educational and training resources, Acknowledging the importance of building and strengthening the capacity of health and health-related professionals of Member States in global health, which can lead to better collaboration and more active participation among them in preparing common regional statements and regional policy and strategy, taking into account the interests and concerns of all Member States in the Region, 1

Further acknowledging the successful innovation of the South-East Asia regional “One Voice” at the World Health Assembly in the last few years, reflecting regional solidarity and perspectives as a result of full engagement by Member States of the Region and support from the Regional Office; and Considering the report on capacity building of Member States in global health (Document SEA/RC63/25), 1. URGES Member States: (1) to establish policies and programmes for capacity building in global health of concerned staff who would be representing their respective governments at high-level policy and programme meetings, by strengthening their skills to actively contribute and participate in global health issues; (2) to organize, with the support of the Regional Office, regional training courses and capacity-building on global health on a rotational basis; (3) to support and facilitate, as far as possible, an adequate number of competent members of a delegation, preferrably those who attended regional training courses and related capacity-building programmes on global health, to represent the national and regional views at all sessions of the World Health Assembly and at similar global policy meetings and forums; and 2. REQUESTS the Regional Director: (1) to provide support to Member States in organizing regional training courses and

related capacity-building programmes on global health on a continuous basis; (2) to report to the Sixty-fifth Session of the Regional Committee in 2012 on the progress made in implementing this resolution; and (3) to conduct assessment of five-year experiences (2011-2015) on capacity building in global health in the Region in 2015, and report to the Sixty-ninth Session of the Regional Committee in 2016. Fifth meeting, 10 September 2010

SEA/RC65/R3

CONSULTATIVE EXPERT WORKING GROUP ON RESEARCH AND DEVELOPMENT: FINANCING AND COORDINATION The Regional Committee, Recalling resolutions WHA59.24 on Public Health, Innovation, Essential Health Research and Intellectual Property Rights: Towards a Global Strategy and Plan of Action, and its subsequent resolutions WHA61.21 and WHA62.16 on Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property; Further recalling resolution WHA63.28 on the establishment of a Consultative Expert Working Group (CEWG) on Research and Development: Financing and Coordination; requesting the Director-General, inter alia, to establish the CEWG to take forward the work of the Expert Working Group earlier established under resolution WHA61.21; Noting the resolution WHA65.22 which requests Regional Committees to discuss at their 2012 meetings the report of the CEWG in the context of the implementation of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property in order to contribute to concrete proposals and actions; Recognising the need for enhancing investments in health research and development (R&D) related to Type II and Type III diseases and the specific R&D needs of developing countries in relation to Type I diseases;

Recognising that improved access to medical products such as medicines, vaccines and diagnostics in relation to Type II and Type III diseases and specific R&D needs of diseases of Type I in developing countries are the paramount goals; Acknowledging the importance of innovation, technology transfer and access to medical products for essential health R&D relevant to diseases which disproportionately affect developing countries, proposing clear objectives and priorities for R&D, estimating funding needs in this area, and coordinating, facilitating and promoting health R&D; Recognising the importance of securing sustainable financing mechanisms for R&D to develop and deliver health products to address the health needs of developing countries and develop mechanisms to monitor and evaluate the implementation of the Global Strategy and Plan of Action, including reporting systems; Realizing the need for improving priority-setting and transparent decision-making processes based on the public health needs of developing countries; Appreciating the Regional Director for convening a regional technical discussion on the report of the CEWG where Member States take an active role in the discussions; and Welcoming the recommendations made by the CEWG and the need of Member States of the Region to implement the same in phases starting with coordination mechanisms, including the setting up of a global health R&D observatory, inter alia, to determine the existing capacities, requirements and the absorptive capacities of developing countries in essential health R&D relevant to diseases which disproportionately affect developing countries which would enable the individual countries to decide the level of commitment of resources; URGES Member States: (1) To strengthen health R&D capacities on diseases of Type II, III and specific R&D needs of developing countries on diseases of Type I, through increased financial resources from the existing government budgets and private sources through different incentive schemes, and explore potential new or innovative sources specifically for health R&D; To build, strengthen and sustain human resources and infrastructure for health research and development; To promote coordination of health R&D among public and private partners in the country, and support regional and global coordination for health R&D in order to maximize synergies and avoid duplications;

(2) (3)

(4)

To establish or strengthen national health R&D observatories for tracking and monitoring human and financial resources spent on health R&D and contribute to the work of a global health R&D observatory; To promote the establishment of Advisory Mechanisms and the Global Health R&D Observatory as suggested by the CEWG to enable WHO to play a central and stronger role in improving coordination of R&D directed at the health needs of developing countries; To support the formation of a working group with equal representation from each Region to undertake future preparatory work for the convention as suggested by the CEWG; To explore the potential role of pooled funding at the global level, from different sources of finance, in supporting health R&D, and that the promising medical products, technologies and innovations generated from the pooled fund are global public goods and made available free of R&D cost; and To engage actively in the negotiations in an open-ended meeting of Member States in November 2012, inter alia, by supporting the development of the Global Health R&D Observatory, effective global R&D coordination, adequate and sustainable funding for R&D on diseases of Type II and III and specific R&D needs of diseases of Type I in developing countries; and

(5)

(6)

(7)

(8)

REQUESTS the Regional Director: (1) To support Member States in their endeavour to establish or strengthen health R&D capacities and national health R&D observatories, which inter alia also contribute to the Regional and Global Health R&D observatory; To facilitate the establishment of Regional and Global Health R&D Observatories and related Advisory Mechanisms as suggested by the CEWG through technical and financial support; To strengthen the capacity of Member States to access and benefit from mechanisms as suggested by the CEWG, including the Global Health R&D Observatory and the pooled fund mechanism; To promote partnerships and coordination at the country, regional and global levels in order to maximize synergies in health R&D; To convey to the Director-General the wish of the Member States for consideration that the Chair of the open-ended meeting of Member States be from the SEA Region; and To report to the Sixty-seventh Session of the WHO Regional Committee for SouthEast Asia in 2014 on the progress made in implementing this resolution. Fifth meeting, 7 September 2012

(2)

(3)

(4) (5)

(6)

REGIONAL COMMITTEE Seventieth Session Maldives 6–10 September 2017

Provisional Agenda item 9 SEA/RC70/13 Rev.1 24 August 2017

The High-Level Preparatory Meeting held in New Delhi from 10 to 13 July 2017 reviewed each progress report and made recommendations, which have been consolidated as an addendum (SEA/RC70/13 Add. 1) to this Working Paper for consideration by the Seventieth Session of the WHO Regional Committee for South- East Asia. The related Regional Committee resolutions covered in this Agenda item are appended to this Working Paper as Addendum 2 (SEA/RC70/13 Add. 2). Following requests by Member States to conduct an assessment of five years’ experience (2011–2015) in capacity-building in global health and report it to the Seventieth Session of the Regional Committee, WHO assigned the assessment to the Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand – a semiautonomous research unit under Thailand’s Ministry of Publi c Health. The assessment report submitted by HITAP is appended as Addendum 3 (SEA/RC70/13 Add.3).

CONTENTS Page No.

2. 3. 4. 5. 6.

7. 8.

SEA/RC70/13 Rev. 1

1. Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF) (SEA/R69/R6) Background (a) SEA/RC60/R7 – South-East Asia Regional Health Emergency Fund (SEARHEF)

SEA/RC70/13 Rev.1 Page 2

Updates on SEARHEF and challenges (a) SEA/RC60/R7 – South-East Asia Regional Health Emergency Fund (SEARHEF) The following are the updates on SEARHEF: a. Timor-Leste made a voluntary contribution of US$ 100 000 to the Fund at the Sixtyeighth session of the Regional Committee, and this contribution is now available for this biennium in addition to US$ 1 million. b. In May 2017, Sri Lanka reported a series of floods and landslides, reportedly the worst floods triggered by the monsoons in that country since 2003. Support from SEARHEF for response efforts related to the floods/landslides was to the tune of US$ 175 000 in this biennium. c. The SEARHEF balance as of date is US$ 143 376 for the current biennium 2016– 2017 (the Fund was fully utilized at the end of the last biennium 2014–2015).

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1. 2. 3. 4.

May June Sept. Sept. Oct. Jan. June Nov. Feb. July Aug. Jan. June July Nov. Nov. April

2008 2008 2008 2008 2009 2010 2010 2010 2011 2011 2011 2012 2012 2012 2012 2012 2013

350 000 23 299 325 000 350 000 300 000 175 000 175 000 139 000 175 000 350 000 310 000 25 000 12 300 134 130 47 717 30 778 175 000

5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17.

18.

July

2013

175 000

19.

Feb.

2014

144 068

20.

May

2014

175 000

SEA/RC70/13 Rev.1 Page 4

Period No Emergency Month Year

SEARHEF allocation in US$

21.

Nov.

2014

35 500

22.

Dec. April

2014 2015

30 000 175 000

23. 24.

July

2015

137 160

25.

Aug.

2015

26 000

26.

Aug.

2015

149 000

27.

Sept.

2015

161 887

28. 29. 30.

May July Aug.

2016 2016 2016

100 000 161 624 175 000

31.

Sept. May June

2016 2017 2017

175 000 175 000 170 000 5 087 463

32. 33.

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(b)

SEA/RC69/R6 – Expanding the scope of the South-East Asia Regional Health Emergency Fund (SEARHEF)

The way forward (a) SEA/RC60/R7 – South-East Asia Regional Health Emergency Fund (SEARHEF)

(b)



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2. Challenges in polio eradication (SEA/RC60/R8) Background 11. The Sixty-eighth session of the World Health Assembly in 2015 urged Member States to fully implement all the strategic approaches outlined in the “Polio Eradication and En dgame Strategic Plan: 2013–2018”. The strategic approaches outlined in the Plan include: a. detection and interruption of poliovirus transmission; b. phased removal of oral poliovirus vaccines (OPV), beginning with the type 2 component of OPV; c. containment of polioviruses; and d. transition planning.

13. Appropriate actions to mitigate the risk of spread of wild poliovirus following an importation are being taken by all Member States in the Region.

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processes to undertake certification of these facilities as per the global containment certification scheme have been established.

19. It is challenging to ensure appropriate containment of polioviruses and meet the timelines as per the requirements of the Global Action Plan III.

20. There are financial, human resource-related and programmatic risks associated with the winding down of the Global Polio Eradication Initiative (GPEI).

23. Transition planning in five Member States that have established significant polio-funded assets over more than two decades needs to be finalized.

26. Winding down of GPEI over the next few years poses financial, human resource-related and programmatic risks in these five Member States of the Region.

SEA/RC70/13 Rev.1 Page 8

33. Development of the PCS was initiated in early 2017, and will be completed when endorsed by the World Health Assembly in May 2018.

SEA/RC70/13 Rev.1 Page 9

37. All Member States in the Region have introduced two doses of measles-containing vaccine, resulting in the aversion of nearly 640 000 deaths due to measles in 2016 in the Region.

SEA/RC70/13 Rev.1 Page 10

49. Strengthening surveillance for measles and rubella in all countries is critical for ensuring detection of all measles cases and outbreaks in the Region followed by prompt follow-up action.

SEA/RC70/13 Rev.1 Page 11

SEA/RC70/13 Rev.1 Page 12

54. In May 2017, the Seventieth World Health Assembly adopted a resolution, WHA70.7 on “Improving the prevention, diagnosis and clinical management of sepsis”. In particular, the resolution requests the WHO Director-General to collaborate with partners “in enhancing access to quality, safe, efficacious and affordable types of treatments of sepsis”. The sepsis resolution notes that sepsis causes approximately 6 million deaths worldwide every year, which are mostly preventable.

59. The Regional Office for South-East Asia has collaborated with its regional tripartite partners (OIE, FAO and other partners) to develop harmonized surveillance on AMR and antimicrobial use (AMU).

60. Studies have been conducted on a six-year retrospective analysis of antimicrobial consumption data in several Member States to determine the extent and pattern of use of antibiotics.

SEA/RC70/13 Rev.1 Page 13

63. Other aspects of this multifaceted AMR issue in the Region have been also analysed and are being published in a special issue of the British Medical Journal (BMJ). Initiatives to advance the battle against AMR were presented from three of the Region’s countries – India, Indonesia and Thailand. The Regional Office also surveyed the broader situation, including progress on NAPs, surveillance, infection prevention and control, and diffusion of antimicrobial resistance genes (ARG) in the environment. Apart from articles documenting the present situation, the BMJ issue would also include a focus on areas that will be key to making progress, including implementing the One Health approach successfully, and creating and implementing stronger surveillance.

g. implementing NAPs in decentralized systems; and h. promoting affordable access to existing and new antimicrobials and diagnostic tools.

SEA/RC70/13 Rev.1 Page 14

about AMR and its drivers – particularly its relationship with sanitation, hygiene and food handling among health professionals and consumers.

68. Another area where the Regional Office will provide technical support is to strengthen national regulatory authorities for AMR to implement the AMR NAP.

SEA/RC70/13 Rev.1 Page 15

SEA/RC70/13 Rev.1 Page 16

Follow-up: Five countries with completed assessments have prioritized interventions and developed five-year patient safety implementation plans.    India has adopted a new policy for patient safety and a patient safety strategic framework. Thailand has adopted the “2P” policy (patient and personal safety). Maldives, Sri Lanka, Thailand and Timor-Leste have already developed routing error reporting and learning systems after the self-assessment exercise. These four countries will publish reports in early 2018, which will capture the burden of unsafe care. The Democratic People’s Republic of Korea, Maldives, Sri Lanka and Timor -Leste have conducted national training of trainers’ workshops on patien t safety, supported by the Regional Office.



78. Member States may consider establishing a national mechanism for certification of health facilities that provide good quality and safe health-care services.

SEA/RC70/13 Rev.1 Page 17

83. This report cites the progress in implementing the Action Plan on reducing the harmful use of alcohol at the regional and country levels.

SEA/RC70/13 Rev.1 Page 18

SEA/RC70/13 Rev.1 Page 19



SEA/RC70/13 Rev.1 Page 20



SEA/RC70/13 Rev.1 Page 21



 



SEA/RC70/13 Rev.1 Page 22



SEA/RC70/13 Rev.1 Page 23

SEA/RC70/13 Rev.1 Page 24

Network on Global Health Diplomacy – with the support of the Rockefeller Foundation and the Global Health and Foreign Policy Initiative.1

104. The HITAP, under an agreement with the WHO Regional Office, conducted the assessment from April to mid-August 2017. During the assessment exercise, (i) the chronological development of in-country and regional programmes and activities for capacity-building and the 1

SEA/RC70/13 Rev.1 Page 25

number of staff trained in global health were explored to identify the enabling and impeding factors; (ii) strengths, weaknesses and impact of the capacity-building activities conducted were assessed; (iii) in-depth interviews of the country senior officials in charge of global health policy and WHO Senior Management were conducted to explore their perspectives on the development of regional collective capacity on global health; and (iv) recommendations on effective management and improvement of capacity-building on global health and possible future actions were also provided. The final report of the assessment, appended to this Working Paper as Addendum 3 (SEA/RC70/13 Add. 3), is submitted to the Seventieth Session of the WHO Regional Committee for South-East Asia.

106. The final report of the assessment, including (i) methodology of the assessment; (ii) details on development of global health capacity-building activities; (iii) awareness and need of capacity-building in global health and priority global health issues of the Member States in the Region; (iv) strengths, weaknesses and impact of these activities in the Region; (v) details of enabling and impeding factors affecting capacity development in the Region; (vi) regional collective capacity on global health in safeguarding regional interest; (vii) plans for future development of the capacity-building activities in each Member State; and (viii) conclusions and recommendations for further strengthening of capacity-building in global health in the Region, is submitted to the Seventieth Session of the WHO Regional Committee for South-East Asia.

SEA/RC70/13 Rev.1 Page 26

108. The follow-up of the report of the Consultative Expert Working Group on Research and Development: Financing and Coordination, addresses, in effect,

a. b.

SEA/RC70/13 Rev.1 Page 27

emphasizes engaging the CEWG mechanism for all Type I, II and III diseases for providing access to affordable medical products.

Challenges being faced 113. The progress on CEWG needs to gain momentum. This has been recognized in discussions on other resolutions at the World Health Assembly. The CEWG came up for discussion also in resolution WHA70.20 on “Addressing the global shortag e of, and access to, medicines and vaccines”. The United Nations Secretary-General’s High-level Panel on Access to Medicines “to review and assess proposals and recommend solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies” echoes the conclusions of previous reports, in particular the reports of the Commission on Intellectual Property Rights, Innovation and Public Health and the CEWG. National regulatory capacity and local production has been discussed in line with the parent CEWG resolution WHA61.21 of 2008 on the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property. Member States reiterated the importance of the Strategic Workplan of CEWG for the 2030 Agenda for Sustainable Development.

REGIONAL COMMITTEE Seventieth Session Maldives 6–10 September 2017

Provisional Agenda item 9 SEA/RC70/13 Add.3 24 August 2017

Progress reports on selected Regional Committee resolutions Following requests by Member States to conduct an assessment of five years’ experience (2011–2015) in capacity-building in global health and report it to the Seventieth Session of the Regional Committee, WHO assigned the assessment to the Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand – a semi-autonomous research unit under Thailand’s Ministry of Public Health. The HITAP, under an agreement with the WHO Regional Office, conducted the assessment from April to mid-August 2017. The final report of the assessment exercise is submitted to the Seventieth Session of the WHO Regional Committee for South-East Asia for its noting.

Final Report

Assessment of Capacity Building of Member States of WHO South-East Asia Region in Global Health

August 2017

By Health Intervention and Technology Assessment Program Faculty of Social Sciences and Humanities, Mahidol University THAILAND

Submitted to The World Health Organization Regional Officer for South-East Asia

Research team Health Intervention and Technology Assessment Program, Thailand 1. Mr. Songyot Pilasant 2. Dr. Sripen Tantivess 3. Ms. Akanittha Poonchai Faculty of Social Sciences and Humanities, Mahidol University, Thailand 4. Dr. Natthani Meemon 5. Dr. Thammarat Marohabutr 6. Dr. Seung Chun Paek

Acknowledgement The research team owes a great deal of gratitude to Dr. Suwit Wibulpolprasert, Vice Chair of the International Health Policy Program Foundation (IHPF) and Health Intervention and Technology Assessment Foundation (HITAF), and Dr. Viroj Tangcharoensathien, Senior Advisor at International Health Policy Program (IHPP), who have greatly supported the research team in accessing the key informants. We have benefitted greatly from Dr. Attaya Limwattanayingyong (Deputy Director, Bureau of International Health, Ministry of Public Health, Thailand), Dr. Walaiporn Patcharanarumol (Senior Researcher at IHPP), Dr.Warisa Panichkriangkrai (Researcher at IHPP) and Mahidol University Global Health (MUGH) for providing the important and necessary information to this study. Our great thanks also goes to SEARO and all SEAR countries for their kind cooperation. The Health Intervention and Technology Assessment Program (HITAP) is funded by the Thailand Research Fund (TRF) under a grant for Senior Research Scholar (RTA5980011).

August 2017

Executive Summary The term “global health” has emerged as part of the larger political and historical process, replacing the term “international health” to imply a shared global responsibility for health. The General Assembly of the United Nations highlighted the relations of “Global health and foreign policy and indicated the need to increase capacity of and raise levels of training of diplomats and health officials in global health diplomacy. In South-East Asia Region (SEAR), Member States were urged by the Regional Committee in 2010 to establish policies and programs for capacity building in global health of concerned staff who would be representing their respective governments at high-level policy and program meetings. This study aims to provide an insight on the introduction of resolution (RC63/R6) on capacity building in global health of Member States during 2011 to 2015, in response to resolution RC63/R6 for reporting to the Seventieth session of the Regional Committee of the WHO South-East Asia Region, to be held in September 2017. The study used quantitative and qualitative approaches to explore the development and practice of global health capacity building in the region. It provides strengths, weaknesses and impact of capacity building activities in the region, and also enabling and impeding factors that affect capacity building in global health development. It was found that SEAR Member States are aware of the need for strengthening their capacity in different policy areas concerning global health. Activities for building capacity in global health that have been conducted at national and regional levels have been successful, resulted in a significant number of actively countries’ delegations contributed to international policy forums. Clearly, collaborations between country representatives at the WHA have become closer as equal partnerships in the region are enhanced. Moreover, individual officers have benefited not only from the training programmes but also by learning at the site of global health policy making when they attend briefing sessions facilitated by SEARO staff. Key impediments in the introduction of the regional resolution on capacity development in global health in the region include an inadequate financial support for the training programmes and lack of explicit policy framework for global health, which has resulted in the discontinuity of such activities, especially in SEARO. There are several proposed recommendations for SEARO and Member States can adopt to practice for sustainable of capacity building in global health in the region: (1) Strategic frameworks for global health at the country and regional levels, both short- and longer-term, should be developed. A human resource plan should be integrated as a key component of a country’s long-term global health strategy.

(2)

iii

(3)

SEARO should be a leader in mobilizing resources inside and outside the region to address the shortage of experts and budget for capacity building of Member States in global health. SEARO should continue to build and maintain a platform for countries to create and expand their networks in the region. Standard courses for capacity building in global health still need to be developed, with a flexibility for future adjustment to shape the course according to the country’s situation and needs. Monitoring and evaluation of the introduction of the regional resolution and country’s strategy for global health should be established.

(4)

(5)

(6)

Abbreviation and acronyms Abbreviation ASEAN BD BIH BT DGHS DPM EB FPGH GH GHD GIZ HITAP HIV HSS & GH Cell ICCDR ID IHPP IN INNE IRB JICA KP Lao PDR LK MFA MHFW MM MOPH /MOH MUGH MU-SSIRB MV NAM CSSTC NP RC ROV SDGs SEAR SEARO TB TGLIP Definition Association of Southeast Asian Nations Bangladesh Bureau of International Health Bhutan Directorate General of Health Services Director of Program Management Executive Board Foreign Policy and Global Health Initiative Global Health Global Health Diplomacy Deutsche Gesellschaft für Internationale Zusammenarbeit Health Intervention and Technology Assessment Program Human Immunodeficiency Virus Health System Strengthening & Global Health Cell International Centre for Diarrhoeal Disease Research, Bangladesh Indonesia The International Health Policy Program India Individual-Node-Network-Environment Institutional Review Board Japan International Cooperation Agency Democratic People's Republic of Korea Lao People's Democratic Republic Sri Lanka Ministry of Foreign Affairs Ministry of Health and Family Welfare Myanmar Ministry of Public Health/ Ministry of Health Mahidol Univesity Global Health Faculty of Social Sciences and Humanities’ Ethical Review Board from Mahidol University Maldives the Non-Aligned Movement Centre for South-South Technical Cooperation Nepal Regional Committee Regional One Voice The Sustainable Development Goals South-East Asia Region Regional Office for South East Asia Tuberculosis Thai Health Global Link Initiative Project

Abbreviation TH TL UNAIDS UNICEF USAID WHA WHO WPRO

Definition Thailand Timor-Leste The Joint United Nations Programme on HIV/AIDS the United Nations Children's Fund The United States Agency for International Development World Health Assembly World Health Organization The World Health Organization Regional Office for the Western Pacific

Table of Contents

RESEARCH TEAM ACKNOWLEDGEMENT EXECUTIVE SUMMARY ABBREVIATION AND ACRONYMS TABLE OF CONTENTS CHAPTER 1 INTRODUCTION 1.1 INTRODUCTION 1.2 OBJECTIVES CHAPTER 2 METHODOLOGY 2.1 2.2 2.3 2.4 QUESTIONNAIRE SURVEYS IN-DEPTH INTERVIEWS DOCUMENT REVIEW ETHICAL APPROVAL

I II III V VII 1 1 3 4 4 5 8 9 10

CHAPTER 3 RESULTS

3.1 DEVELOPMENT OF GLOBAL HEALTH CAPACITY BUILDING ACTIVITIES IN SOUTH-EAST ASIA REGION (SEAR) 10 3.2 PRIORITY GLOBAL HEALTH ISSUES OF MEMBER STATES IN SEAR 30 3.3 AWARENESS AND NEEDS OF CAPACITY BUILDING IN GLOBAL HEALTH IN SEAR 31 3.4 STRENGTHS, WEAKNESSES, AND IMPACT OF CAPACITY BUILDING ACTIVITIES IN SEAR 34 3.5 REGIONAL COLLECTIVE CAPACITY ON GLOBAL HEALTH IN SAFEGUARDING REGIONAL INTERESTS 43 3.6 ENABLING AND IMPEDING FACTORS THAT AFFECT CAPACITY DEVELOPMENT IN GLOBAL HEALTH 46 3.7 PLAN FOR FUTURE DEVELOPMENT AND SUPPORT REQUIRED FROM SEARO FOR EACH COUNTRY 48 CHAPTER 4 CONCLUSION AND RECOMMENDATIONS 50

vii

REFERENCES APPENDIX 1 SURVEY QUESTIONNAIRE: SITUATION AND AWARENESS OF CAPACITY BUILDING ACTIVITIES QUESTIONNAIRE FOR COUNTRY FOCAL PERSONS QUESTIONNAIRE FOR RESOURCE PERSONS IN CAPACITY BUILDING ACTIVITIES QUESTIONS FOR PARTICIPANTS IN CAPACITY BUILDING ACTIVITIES APPENDIX 2 SURVEY QUESTIONNAIRE: IN-COUNTRY CAPACITY BUILDING ACTIVITIES ON GLOBAL HEALTH OF SEAR

56 56 57 59

APPENDIX 3 THE INTERVIEW GUIDELINES FOR COUNTRY’S SENIOR OFFICERS AND DELEGATES 67 APPENDIX 4: INTERVIEW QUESTIONS FORMATTED FOR E-MAIL INTERVIEW APPENDIX 5 ETHICAL APPROVAL 69 79

APPENDIX 6 FULL RESPONSES OF GLOBAL HEALTH CAPACITY BUILDING SURVEY FOR COUNTRY FOCAL POINT IN 5‐POINT SCALE 84

viii

Chapter 1 Introduction 1.1 Introduction Global health is a term derived from public health and international health. While there is some overlap in certain areas with the other two more established disciplines – particularly on health issues – global health also extends to cross-country elements which have implications on population health [1]. In 2010, Beaglehole and Bonita [2] proposed a definition for global health: ‘a collaborative trans-national research and action for promoting health for all’. Essentially, this can be explained as the involvement of more than two countries in addressing all health-related issues by developing evidence-based information to improve health and health equity; this may include those directed at the underlying social, economic, environmental, and political determinants of health in all countries. Global health is a long-term objective which is national, regional, and international in scope and requires sustained attention, commitment, and closer international cooperation [3]. The term ‘global’ in global health refers to the scope of problems, and as such may focus on domestic health disparities as well as cross-border issues and not on their location [1]. Therefore, issues in global health can range from epidemics, universal health coverage, and health workers to climate change and natural disasters [4]. Health is profoundly interconnected with many issues, especially social and economic development, national security, human rights, and foreign policy [5]. In 2009, a close relation between health and foreign policy was recognized by the United Nations where a resolution adopted by the General Assembly of the United Nations (UN) urged Member States to consider health issues in the formulation of foreign policy [3]. One of the important tools for implementing such policy to ensure peaceful relations with other states while safeguarding each country’s own interests is diplomacy [6, 7]. Diplomacy is defined as the art and practice of conducting negotiations and maintaining relations between nations [8, 9]. The term “health diplomacy” encompasses not only international agreements on health but also efforts to promote the role of global health in foreign policy as well as the use of health interventions to support foreign policy objectives [10]. Global health diplomacy (GHD) – as defined by the World Health Organization (WHO) – ‘brings together the disciplines of public health, international affairs, management, law, and economics and focuses on negotiations that shape and manage the global policy environment for health’ [11]. Global health and GHD are multidisciplinary areas involving broad political, social, and economic implications of health issues. Consequently, this has resulted in the transfer of more diplomats into the health arena and more public health experts into the world of diplomacy. At the

same time, the importance of GHD continues to grow and its negotiators should be well-prepared [9]. In 2010, the General Assembly of the UN highlighted the importance of capacity building in global health and foreign policy. It encouraged Member States, the UN system, academic institutions, and networks to increase their capacity training on global health and foreign policy for diplomats and health officials, particularly those from developing countries. Best practices and guidelines for training and open source information should be developed in addition to educational and training resources [12, 13]. A similar concept was initiated in the South-East Asia Region (SEAR) where the Sixtythird session of the WHO Regional Committee (RC) adopted a resolution on building capacity in global health [14]. This resolution urges Member States to establish policies and programs for capacity building in global health of concerned staff who would be representing their respective governments at high-level policy and program meetings by: 1) strengthening their skills to actively contribute and participate in global health issues; 2) organizing regional training courses and capacity building on global health on a rotational basis with the support of the regional office; and 3) supporting and facilitating, as far as possible, an adequate number of competent members of a delegation, preferably those who attended regional training courses and related capacity building programs on global health, to represent the national and regional views at all sessions of the World Health Assembly (WHA) and at similar global policy meetings and forums. The Regional Committee for South-East Asia requested the WHO to develop standards for national and international training courses on global health and to conduct comprehensive evaluations with the purpose of further improving training quality [15]. The Committee also noted the importance of developing strategy and planning on global health to address the increasing demand for well-trained public health professionals able to address the changing context of global health challenges including complex and persistent health issues, increasing inequities, new and emerging diseases, necessity for greater collaboration, and incorporation of social models and determinants [16]. The importance of the institutionalization of capacity and the need for sustaining capacity on global health in the long term were also expressed. Regional experiences have clearly shown that hands-on, in-service training at global health forums not only sustain capacity but also foster a regional ‘one voice’ [15]. Therefore, Member States should be encouraged and supported to engage in global health capacity building for greater participation in governing body meetings. The Regional Director was requested to conduct an assessment of experiences in global health capacity building in the region over a five-year period (2011–2015) in response to resolution RC63/R6 and to report the results to the Seventieth session of the RC in order to obtain a more systematic understanding of the strengths, weaknesses, and impact of activities, as well as to provide recommendations on how to effectively manage global health capacity building.

This report reviews the development of capacity building activities in global health in the region in response to resolution RC63/R6 for reporting to the Seventieth session of the RC of the WHO South-East Asia Region, to be held in September 2017.

1.2 Objectives This study aims to provide an insight on the introduction of resolution RC63/R6 for capacity building of Member States during 2011 to 2015. The specific objectives are as follows: 1. To explore the chronological development of in-country and regional programs and activities for capacity building in global health. Enabling and impeding factors of such development will also be identified. Moreover, if the activity involved training of respective personnel, the number of participants (by ministry), objectives, support from SEARO and other partners, training duration, main contents, training program review, and feedback/outcomes will also be explored. 2. To assess the strengths, weaknesses, and impact of these capacity building activities. These include reviewing the following issues in each Member State: a. Number of professional staff trained in global health and GHD b. Improved capacity and skills in global health and GHD of that country c. Contributions of the trained personnel to global health policy agenda setting and formulation at the RC, Executive Board (EB), and WHA sessions and other policy forums d. Strategies used by the country to sustain its GHD capacity e. Plans for future development and support required from SEARO 3. To explore the perspectives of SEARO executives/senior managers and country senior officers about the development of regional collective capacity on global health in safeguarding regional interests such as a regional one voice at the WHA 4. To provide recommendations on effective management and improvement of capacity building on global health and possible future actions on a. In-country capacity building, b. Regional capacity building

Chapter 2 Methodology Quantitative and qualitative approaches were employed in this study. These include Internet- and email-based questionnaire surveys, in-depth interviews, and a document review.

2.1 Questionnaire surveys 2.1.1 Questionnaire development The research team developed two sets of questionnaires. The first set (questionnaire set 1) (Appendix 1) aimed to gather information about the situation and awareness of capacity building activities on global health and other related issues at the country and regional levels. After the contents and questions in the questionnaire were developed, they were reviewed by an expert in global health who is also a resource person in capacity building services in Thailand. The questions consist of four main aspects of capacity building in global health as follows: 1. The importance of capacity building in global health; 2. Awareness and understanding on global health after the RC resolution (capacity building of Member States in global health: SEA/RC63/R6) was adopted in 2010; 3. The need for support in building capacity in global health; 4. Recommendations to improve global health capacity in the respondent’s country and/or in SEAR. Another questionnaire set (questionnaire set 2) (Appendix 2) was developed in fillable forms in Microsoft Word. This aimed to gather detailed information about capacity building activities in global health conducted in particular SEAR countries during 2011-2015. In the questionnaires, participants were asked to indicate their level of agreement to the given statements using a five‐point scale ranging from “Strongly Disagree” on one end to “Strongly Agree” on the other with “Neutral” in the middle. 2.1.2 Key informants Three sets of Internet-based questionnaires were designed for different groups of key informants comprising focal persons of countries in the South-East Asia Region (SEAR), resource persons in capacity building activities, and participants in capacity building activities. The names of focal persons in each country were identified by the SEARO coordinating officer, while the names of resource persons and participants of capacity building activities were provided to the

research team via the questionnaires answered by country focal persons. The questionnaires were sent to all identified key informants. Descriptions of key informant groups and number of respondents are presented in Table 1. Table 1 Key features of expected respondents of the questionnaire survey Approach Questionnaire set 1 (situation and awareness of capacity building activities) Respondents Country focal persons Description Government officer or person who is authorized by the government to be responsible for global health issues Member of faculties of capacity building activities on global health at both country and regional levels Participants of capacity building activities on global health at both country and regional levels Government officer or person who is authorized by the government to be responsible for global health issues Expected number of respondents At least 11 respondents (one person per country) At least 5 respondents Exact number of respondents 15 respondents

Resource persons in capacity building activities Participants in capacity building activities

None

At least 20 respondents

21 respondents

Questionnaire set 2 (information about capacity building activities in global health)

Country focal points

At least 11 respondents

3 respondents

2.1.3 Questionnaire distribution and duration of the survey The first questionnaire set was conducted by means of the “SurveyMonkey” online survey website. The questionnaire was distributed by sending a survey URL along with invitation emails to all identified study participants. The survey was conducted during June 20 to July 5, 2017, with two follow-ups on June 27 and July 4. The second questionnaire set was distributed to country focal points via email in the same period as questionnaire set 1. 2.1.4 Analysis Descriptive statistics were used to analysed this part.

2.2 In-depth interviews

The interviews were conducted in July 2017 and involved representatives of SEAR countries who participated in global health capacity building activities supported by SEARO as well as SEARO executives. The qualitative data covered the following assessment issues:    Enabling and impeding factors in the development of in-country and regional programs and activities; Strengths, weaknesses, and impacts of these capacity building activities as well as plans for future development and support required from SEARO; and Perspectives on the development of regional collective capacity on global health in safeguarding regional interests.

2.2.1 Key Informants There were two groups of informants representing country and regional levels including (1) SEAR countries’ senior officers in charge of global health policy and/or chief delegates to the WHA1, and (2) SEARO executives and senior managers. The list of country senior officers and WHA delegates for 2015 were obtained from SEARO and summary records of the WHA [17]. Some of the potential informants were identified by the International Health Policy Program (IHPP), Thailand, which serves as the main partner and facilitator of SEAR global health capacity building. The assessment team contacted everyone on the list via e-mail and telephone, and a total of five country representatives (from Bangladesh, Nepal, Bhutan, Maldives, and Indonesia) and three WHO-SEARO representatives eventually agreed to be interviewed. 2.2.2 Interview instruments Semi-structured interview guidelines were developed to meet the assessment objectives. There were two sets of interview questions to acquire country-level and regional-level information:  At the country level, country representatives were requested to provide information on the implementation and participation in capacity building activities on global health at the country and regional levels and to identify the enabling and impeding factors that affected the development of global health capacity building; strengths and weaknesses of the global health capacity building programs; future development for global health capacity building; and support required from SEARO. At the regional level, SEARO representatives were requested to describe the development of capacity building programs and their perspectives on the development of regional collective capacity on global health in safeguarding regional interests in addition to the extent that they were aligned with global health agenda of



Initially, the country’s representatives included two separated groups of country senior officers and delegates to the WHA. However, most of the country-level informants with the exception of Bhutan indicated that they had participated in the WHA, and hence could represent both groups. 1

each individual country. Moreover, they were also asked to identify factors that contributed to the success (or failure) of the global health capacity building in each country and among the region. The interview guidelines are provided in Appendix 3. In addition, there was a form developed for collecting information from those who preferred to give information in written from instead of giving an interview (Appendix 4).

2.2.3 Data collection A formal invitation letter to participate in the interview was sent via e-mail to each potential informant from 11 countries and WHO-SEARO along with an information sheet, a consent form, and interview guidelines. The potential informants were asked to provide their preferred mode of interview (by phone, video call, or e-mail) and their available dates and times for interview. On the first attempt, there were no responses from any potential informants at the country level. The assessment team then tried to reach the informants by phone and used a snowball approach by asking the WHO officer located in each country to identify a person who could participate in the interview. In addition, the IHPP provided assistance in communicating with some country senior officers. If no response was received within 2 weeks, a follow-up to the potential informant was conducted by either e-mail or telephone call. The length of the telephone interviews ranged from 40 – 60 minutes. For any key informant who requested to answer the email in written form, the fillable form would be sent so they could provide their answers. Table 2 shows the information about the interviewees, their country of representation and organization, and the interview method.

Table 2 : Key features of interviewees No. 1 2 3 Level of representation Country level Country of representation Bangladesh Bhutan Indonesia Organization Ministry of Health and Family Welfare Policy and Planning Division, Ministry of Health Department of Public Health, Ministry of Health of Republic of Indonesia Policy Planning and International Health, Ministry of Health Policy Planning and International Cooperation Division, Ministry of Health International Health Policy Program, Ministry of Public Health Bureau of Internal Health Ministry of Public Health Department of Health System Development Director Programme Management Partnerships, Interagency Coordination, Resource Mobilization and Governing Bodies (PIR) Current position of the informant Technical Specialist Senior Planning Officer Director General of Public Health Deputy Director Chief, PPIDC Mode of interview Telephone E-mail E-mail

4 5

Maldives Nepal

Telephone E-mail

6 7 8 9 10 Regional level

Thailand Thailand WHO-SEARO

Senior Advisor Director Director Director Technical Officer

Face-to-face interview Face-to-face interview Telephone E-mail E-mail

2.3 Document review The document review aimed to assess in-country and regional collective capacity on global health in safeguarding both in-country and regional interests as well as to evaluate the contributions of the trained personnel to global health policy agenda setting and formulation at these policy forums. This review included the summary records of meetings of committees and reports of committees at the WHA, summary records of the EB, and reports of the RC for South-East Asia from 2005-2015. This review aimed to quantitatively illustrate the contribution of the translation of the resolution (SEA/RC63/R6) into action in SEAR Member States. Outcomes were measured at both national and regional levels. At the national level, the outcome was measured by reviewing the difference in the number of interventions made in each SEAR country against the agenda set in each respective year between WHA58 (2005) and WHA68 (2015), with the purpose of trying to determine whether there were any noticeable changes before and after 2010 – the year in which the resolution was adopted. The number of interventions was then calculated per total agenda in each respective year of the WHA and converted into a percentage. At the regional level, the

outcome was similarly determined by counting the number of agendas in which SEAR delivered in unison (‘one voice’) at the WHA before and after the resolution was adopted in 2010.

2.4 Ethical approval Since in-depth interviews are a major approach for data collection in this study, approval from a respective institutional review board (IRB) must be obtained. This study was approved by the Faculty of Social Sciences and Humanities’ Ethical Review Board from Mahidol University (MU-SSIRB) on May 19, 2017. The approval letter can be found in Appendix 5

Chapter 3 Results 3.1 Development of global health capacity building activities in South-East Asia Region (SEAR) Global health has been taught as a study programme in higher education institutes in developed countries for decades. In the past, this area of study was known as international health and introduced as an individual course, especially as a master’s course, or inserted as one module in public health or other related courses. Students in global health learn and build their capacity in different disciplines, e.g. public health, health economics and financing, health and foreign policy, and human rights and conflicts. Therefore, when discussing about capacity building in global health, it should cover all areas related to health in terms of a country’s needs and common problems among nations. For SEAR, it is stated in the resolution of the WHO RC on Capacity Building of Member States in Global Health (SEA/RC63/R6) [18] that the capacity in global health needs to be built for their concerned staff, especially those who would be representing state governments in order to actively contribute and represent national and regional views at the WHA or other international forums. This means that apart from technical knowledge on specific health topics, another required capacity is the skill of negotiation, which is necessary for a country’s delegation at international forums, especially the WHA [19]. 3.1.1 Development at the regional level After the adoption of resolution in 2010, the WHO office for SEARO made significant efforts to provide technical and policy support to Member States in order to achieve the ultimate goal of this resolution. There were 2 significant activities organized by the WHO in order to support countries in the region to build the capacity of their staff in global health: workshops on global health diplomacy capacity building and briefing sessions for Member States at international forums. The very first global health capacity building activity in South-East Asia was a training workshop held in May 2010 – before the RC resolution was issued in September. The programme was a collaboration between SEARO, the Ministry of Public Health, Thailand, and the Thai Health Global Link Initiative Programme (TGLIP)2. It aimed to build and strengthen the capacity of health

Thai Health Global Link Initiative Program or TGLIP is a programme that operated between 2004-2006 with support from the Thai Health Promotion Foundation. The main objective of the TGLIP was to strengthen the capacity of Thai scholars and people working related to health promotion to play key roles in international health forums and other mechanisms. This programme was organized by the Institute for Population and Social Research, Mahidol University.

and related professionals in different areas of global health. Such capacity would be beneficial when the trainees are assigned to advocate for global health agenda setting or participate in global policy formulation while taking into account the interests and concerns of their countries [20]. The course consisted of 3 sequential modules: (1) introduction to global health; (2) handson experience; and (3) debriefing and reflection on lessons learned. In the first module, general knowledge about global health and GHD was discussed and shared by resource persons with participants. The second module involved hands-on experience where participants who attended the first module would be able to understand the practical aspect of global health by being delegates for their countries in the Sixty-third WHA in 2010. The last module required those participants who passed the first and the second modules to provide their opinions about course activities and lessons learned to faculty. Feedback from participants in the 2010 workshop suggested that this programme yielded good results. Participants remarked that learning about global health negotiation theory and experience sharing, role-plays as well as exercises on making interventions and negotiation were all very useful and practical for their preparation for and participation in the WHA. Success from the workshop together with a request from the RC as part of the resolution endorsed in September 2010 convinced SEARO to continue organizing similar workshops in the following three consecutive years, i.e. 2011, 2012 and 2013 [20-24]. However, this training programme was subsequently discontinued even though one of the requests from the RC to the Regional Director of SEARO was to provide support to Member States in organising regional training courses on global health on a continuous basis; this may possibly be due to financial constraints. Since the adoption of the resolution in 2010, the RC assessed the outcomes of the resolutions in 2012 and 2016. In the Sixty-fifth session of the RC [15], the results of regional workshops in 2010-2012 could be seen through the vast improvement in the quality of interventions made by representatives of Member States at governing body meetings. According to the report of the Sixty-ninth session of the RC for South-East Asia, these capacity building activities helped to resolve global health problems. Moreover, it was also a long-lasting investment in human capital in terms of substantial payoffs and returns, particularly by investing in the young generation of public health leaders [25], for which they may be able to contribute greatly on global health issues. However, in order to claim this as a success, a systematic and comprehensive long-term monitoring and evaluation system needs to be developed. The RC also requested the WHO to develop standard models for national and international training courses on global health [15]. However, there is currently no such standard course. Table 3 summarizes the key features of regional capacity building workshops held by SEARO during 2011-2013. It can be seen that the number of countries that participated continually increased from 7 in 2011 to 10 in 2013. Furthermore, delegates from countries outside

SEAR – namely China and Vietnam – were involved as observers in the last workshop. During this period, the main content and training approaches were not changed, and it was expected that trainees would be able to develop their capacity including the essential skills for protecting their countries’ health interest when taking part in policy agenda setting and formulation in international forums, especially the WHA sessions. These skills include developing evidence-based arguments for use as a country’s interventions, as well as diplomatic negotiations and networking with delegations from like-minded countries. Although this training programme targeted government officials in health and non-health organizations, all of the participants represented health ministries of Member States. Apart from the workshops mentioned above, the interviews in this study revealed that SEARO also provides a series of global health capacity building activities to Member States through several briefing sessions. During these sessions, technical departments prepare briefs and make presentations on important topical issues which are being considered. The briefings include highlights of the WHO programme priorities, both global and regional, for aiding the Member States’ delegates in effectively participating in discussions or negotiations. Countries in SEAR have been utilizing the EB and WHA briefing platforms to arrive at a consensus on important items and develop Regional One Voice (ROV) statements which reflect a common regional position and priorities. These briefings include: 1. A briefing for representatives of all Member States that is held in SEARO, New Delhi, every January prior to the EB meeting. All important technical and other agenda items are discussed. An opportunity is provided to Member States to forge a consensus on important items so that Member States representing SEAR in the EB can make an ROV statement on the relevant items. 2. A similar briefing is held every May in SEARO for all Member States prior to the WHA. All technical and other agenda items on the WHA agenda are discussed. An opportunity is provided to Member States to identify items that would require intervention because of importance to the region or to multiple countries. The Member States then allocate among themselves items for intervention together with designating a lead country and a support country, and jointly develop a ROV statement. 3. At the WHA in Geneva, a special briefing session is organized every morning for all Member States. The purpose of the session is to provide an opportunity for Member States to discuss important issues that may come and to fine-tune the ROVs. The capacity building element involves identifying the right issues to discuss and make interventions, the content and language of the ROVs, and procedures in governing bodies meetings. 4. SEARO also organizes a high level preparatory meeting for the RC every July. All Member States are invited with discussions of the RC’s agenda items. By

participating in the meeting and the resolution drafting group, Member State delegates have the opportunity to learn about global issues of relevance to their context and then work on the resolutions to address important issues. In order to introduce the above-mentioned programmes, financial support was required from various sources. The regional workshops were funded by SEARO through the Director of Program Management (DPM) work plan. The workshops also received partial financial support from the Rockefeller Foundation. However, the cost of participation of the invited participants and resource persons was mainly supported by SEARO or the WHO country office budget and at times by the WHO headquarters at the global level. Finally, funding for participation in the WHO governing bodies meeting, namely the EB and WHA, comes from the national budget of each country. 3.1.2 Development at the country level SEAR Member States prioritize different facets of global health depending on many factors such as public health urgency, domestic political situation, and economic situation. For instance, many of them inserted global health issues into their national health policy or other specific policies, e.g. communicable diseases, emergency medicine, health information system, or climate change [26, 27]. In some countries, taking Thailand as an example, global health is separately established as an explicit individual policy – the Thailand Global Health Strategic Framework 2016 - 2010 [28]. This framework aims to promote national policy coherence on global health between health and non-health agencies. It can be applied to the implementation of global health projects at the national level as well as in international cooperation related to socioeconomic collaboration, trade negotiations, and Thailand’s commitment to international agreement concerning health. Capacity building of officials and institutions is set as one of its strategic actions in order to support global health work in a continuous manner. However, not only is global health important on the Ministry of Public Health’s side, it is also an important foreign policy issue. Evidence showing that Thailand was actively involved in global health issues can be seen in 2006 when the country became a part of the Foreign Policy and Global Health Initiative (FPGH), which was formed in 2006 during the UN General Assembly. In 2011, the Global Health Policy Advisory Committee was established to be a policy body at the ministerial level [29]. For capacity building in global health, since health-related trade issues and trade negotiation were of concern to the Ministry of Public Health (MoPH) for many years [30, 31], the country paid more attention to global health diplomacy and how to build capacity for its staff. In the past, Thailand used an informal approach – learning by doing – to build capacity of its staff and network in

negotiating health-related trade issues. As such, the first national workshop on GHD was conducted in 2010. The first workshop on global health diplomacy for Thai officials was jointly conducted in 2011 by the International Health Policy Program (IHPP), MoPH, and MUGH. Thus, since it was hosted by the same organizations that hosted the regional workshop in GHD in 2010, it shared the same structure as the regional workshop that was conducted in Thailand in 2010; the minor differences were in terms of content and approaches as the organizers had to revise it to make it suitable for the situation. The workshop aimed to build and strengthen capacity of health and health-related professionals on global health agenda setting and policy formulation. The workshop focused on training Thai delegates who would attend the WHA to be ready for making interventions actively and effectively at the WHA, especially in negotiating and revising interventions. As such, the programme was designed to be practice-based rather than lecturebased. Similar to the regional training course introduced by SEARO, it consisted of 3 modules: (1) introduction to global health; (2) hands-on experience; and (3) debriefing and reflection on lessons learned. The workshop has continually been conducted every year since. The principle of building capacity in global health diplomacy in Thailand is based on the INNE model. This model comprises capacity building at four different levels: individual, node or organization, network, and enabling environment. With this model, the organizers tried to gather individual participants from diverse organizations – including those from non-health sectors – in order to enhance capacity in global health of those organization themselves and to link them together as a network. This networking is not limited only within country but is also connected with other countries bearing the same interests; thus, in later years, participants in the national workshop on global health also came from other Asian countries [32-34]. Essentially, Thailand has built its network by helping other countries arrange global health diplomacy workshops. Besides Thailand, Indonesia is a country that has placed global health as a priority on national agenda. Although global health is not documented explicitly as a strategy or policy, the actions taken by high-level executives in the Indonesian government implied that Indonesia has given priority to global health issues, especially GHD [35]. The Indonesian role in global health diplomacy was clearly seen in 2008 when the government negotiated with developed countries and drug companies about refusing to share bird flu virus-containing specimens and reporting incidence of the disease unless they were granted access to affordable vaccines derived from their samples [35]. The role of Indonesia on GHD became larger when the country was the Chair of the Association of South-East Asia Nations (ASEAN) in 2011 [36]. For capacity building activities, Indonesia was the first country in the region that conducted a workshop on global health diplomacy with technical support from the Graduate Institute, Geneva, the Non-Aligned Movement

Centre for South-South Technical Cooperation (NAM CSSTC), and its Ministry of Foreign Affairs and Ministry of Health, and financial support from the Rockefeller Foundation [37]. An Indonesian Executive course in global health diplomacy did not target only its own officials but was also extended to health professionals and diplomats from other countries in ASEAN. The content of this course ranged from key concepts in global health and linkages between global health and foreign policy to case studies in health negotiations. This course also required participants to learn and understand the importance of the regional role at international forums. As such, participants also had to work towards the development of an action plan for strengthened regional cooperation on global health issues. This course was conducted again two more times in Indonesia in 2011 and 2013 [38, 39]. In addition, Indonesia held one more workshop on global health diplomacy in 2013, which was hosted by Mahidol University Global Health (MUGH)3 with financial support from the WHO [40]. This course was different from the one that was held by the Graduate Institute, Geneva, in which the former was a practice-based workshop while the latter was lecture-based. The course organized by the MUGH had a similar structure to the ones held at the regional level as well as in Thailand. Apart from Thailand, the Thai MoPH, MUGH, and IHPP conducted a workshop in Bangladesh, Maldives, and Sri Lanka. The workshops that were conducted in Maldives and Sri Lanka in 2014 had the same structure and objectives as the Thai and Bangladesh workshops. Details of the national workshop can be found in Table 4. The information from the surveys reported that the regional resolution on capacity building in global health urged Bangladesh to place high priority in capacity building for young professionals in the area of global health. The country established a Health System Strengthening & Global Health Cell (HSS & GH Cell) - which is affiliated with the Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MHFW) - to be responsible for global health capacity building in the country. The DGHS initiated a project on “improving country capacity in global health diplomacy” where it received support from the Rockefeller foundation with the aim of building capacity in GHD for Bangladesh through different activities. This project also had a plan to organize a GHD training to build up an effective team of GHD experts in Bangladesh; therefore, a technical committee of the project decided to arrange a GHD training programme in 2012. The DGHS, in collaboration with the MUGH and IHPP, conducted a GHD workshop in July 2012. The format of the workshop and resource persons in the workshop was similar to the workshops arranged in Thailand. Like the first national workshop in Thailand, this

Mahidol University Global Health or MUGH was a university-based Global Health initiative committed to bringing collaboration among our network of global health partners to move forward actions on global health to achieve health equity for better health for all. MUGH had operated from 2012 to 2017.

workshop aimed to support young staff who passed to participate in the WHA or other international forums. Table 4 and 5 summarizes the key features of a country’s activities for capacity building in global health. All of the activities were GHD workshops supported technically by Thailand. The main objectives were to build up and strengthen the capacity of health and health-related professionals in global health diplomacy. For some countries such as Maldives, objectives were more specified to prepare delegates for participating in international forums. In addition, networking among participants and between participants and resource persons were also part of the main objective. Most of the workshops arranged in SEAR countries received financial support from organizations outside their countries; most of the support came from the WHO and some were from the Rockefeller Foundation. All of the workshops targeted health or health-related professionals in the Ministry of Public Health. However, for Indonesia, the target participants were specifically youth health professionals. The number of participants ranged from 17 to 32. All the participants in Indonesia and Sri Lanka were from the Ministry of Health, while the participants from Bangladesh and Maldives were from various departments. Most resource persons were from the Ministry of Health and from IHPP, Thailand. All workshops also had the same main contents. Regarding programme evaluation, the workshops in Bangladesh, Maldives, and Sri Lanka did not have evaluation processes. Thailand, however, utilized 2 approaches: (1) qualitative, where resource persons observed and interviewed participants, focus group discussions were held among participants; and (2) quantitative, where questionnaires were used to evaluate the usefulness and logistics arrangement of the workshop. In general, at the country level, capacity building activities were managed by multiple affiliations. National and international agencies, academic institutions, and government assumed the responsibility of managing global health issues. The national organizations provided local level training to different members at the domestic level, while other international agencies such as Japan International Cooperation Agency (JICA), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) of Germany, and International Centre for Diarrhoeal Disease Research, Bangladesh (ICCDR, B), took lead roles in training. In addition, one thing that can be noticed is that most of the activities at both the national and regional levels received financial support from organizations outside the host countries. Taking into consideration the suggestions in the regional resolution on capacity building in global health, two additional concerns were raised. The first one is conducting capacity building activities on a continuous basis. So far, only Thailand has conducted a national workshop regularly since the introduction of the resolution in 2010. Some key informants in this study argued that the lack of continuity has been a crucial barrier to strengthening the GHD skills of SEAR countries because only a short discontinuity in capacity building can create a large developmental

gap as well as lead to the recession of skills that require practice to be effective. A lack of continuity in capacity building also occurred at the regional level. The workshops that were held between 2011 and 2013 opened opportunities to countries in the region to not only strengthen capacity in global health but also provided an important venue for countries to meet and discuss about the collective interest in regional global health topics. The lack of activities at the regional level may be a disadvantage, especially for young staff, to learn from the valuable experiences of other countries in the region. The other concern involves a statement in the preamble paragraph of the resolution: “…to increase their capacity for training of diplomats and health officials on global health and foreign policy…”. While more than 10 GHD workshops have been conducted in the region, only a few participants were from non-health sectors. There was a diplomat that participated in the workshop in Thailand as a resource person and not a participant. Kickbusch et al. highlighted that capacity for global health diplomacy needs to be balanced on both health professional and diplomat sides [9]. One key informant said that even if health professionals were trained to be fluent in negotiation and other diplomatic skills, they would not be able to use their skills in a timely manner if a global health situation occurred because most of them are working in the country and would not be on the global field. Consequently, this is why building capacity in global health for diplomats – who work regularly in missions to other countries – is just as important as health professionals. 3.1.3 Developments in the other countries outside the region Apart from the workshops conducted in SEAR Member States, there were also activities outside the region that participants from the SEAR Member States attended, e.g. the Global Health Diplomacy Executive Education Training Course that was held in China in 2012 or the Canadian Conference on Global Health which was arranged in 2015. The conference in Canada convened under the theme ‘Capacity building for global health: research and practice’ and consisted of 660 participants from 43 countries, some of which were from SEAR countries, namely Bangladesh, India, Indonesia, and Nepal. There were 4 participants from 2 countries in SEAR, namely Thailand and Indonesia, who attended the Global Health Diplomacy Executive Education Training Course, conducted by the Graduate Institute, Geneva. This course has been provided in many countries around the world for a decade [37], and the 5-day courses were developed in response to the increasing interdependence between health and foreign policy issues and the need for training in this field. The course aims to increase participants’ understanding of the dynamics of global health governance and to improve their negotiation skills.

Table 3 Summary of the key features of regional workshops for capacity building in global health, 2011 to 2013 Detail/year Title 2011 South-East Asia Regional Workshop on Global Health Date Venue General objectives 25-29 April 2011 New Delhi, India To further strengthen the capacity of health and health-related professionals of SEAR Member States on global health, leading to better participation and significant contributions from them in the global health agenda setting and policy formulation that should effectively reflect the collective interest and concern of WHO/SEAR Member States. Specific objectives (1) To strengthen the capacity of health and health-related professionals of SEAR Member States to actively participate in international health forums (2) To update on global health diplomacy and strengthen global health negotiations (3) To share experiences on participation in the international health forums and lessons learned thereon Target group(s) of participants (1) Health or international relations professionals in the Department of International Health or related departments cooperating with others responsible for (1) Health or international relations professionals in the Department of International Health or related departments cooperating with others responsible for health matters (1) Participants are expected, but not only limited, to be from every country in the WHO SEAR, specifically for those who serve as country delegates at the WHA N/A N/A 2012 South-East Asia Regional Workshop on Global Health 7-11 May 2012 New Delhi, India To build up and strengthen the capacity of health and related professionals on global health which could lead to global health agenda setting and policy formulation. 2013 South-East Asia Regional Workshop on Global Health 6-10 May 2013 New Delhi, India To build up and strengthen the capacity of health and related professionals of SEAR Member States on global health which could lead to the global health agenda setting and policy formulation while taking into account the interest and concerns of countries from the South-East Asian Region

Detail/year

2011 health matters; including those whose jobs are related to health-related issues

2012 (2) Health focal point at the Ministry of Foreign Affairs of countries in ASEAN, SEAR, and WEPR, specifically for those who serve as country delegates at the WHA Rockefeller Foundation (Financial: sponsor additional participants from each country to the training course and from countries outside SEAR)

2013

Support from other institutes

Rockefeller Foundation

Participants

Total 19, all from Ministry of Health: Bangladesh (3) Indonesia (5) Maldives (2) Nepal (1) Sri Lanka (2) Thailand (3) Timor-Leste (3)

Total 19, all from Ministry of Health: Bangladesh (2) Bhutan (1) Indonesia (5) Maldives (1) Myanmar (2) Nepal (2) Sri Lanka (2) Thailand (2) Vietnam (2)

Total 20, all from Ministry of Health: Bangladesh (2) Bhutan (2) DPR Korea (2) India (2) Indonesia (3) Maldives (2) Myanmar (2) Nepal (1) Sri Lanka (2) Thailand (2)

Facilitators

Total 17 Thailand: MoPH (1), IHPP (2), Mahidol University (1), National Health Commission Office (1) India: All India Institute of Medical Sciences (1) WHO SEARO (11)

Total 7 Thailand: MoPH (1), IHPP (2), Queen Sirikit National Institute of Child Health (1) Bangladesh: Ministry of Health and Welfare (1) WHO: (2) N/A

Total 10 Thailand: MoPH (1), IHPP (3), Mahidol University (1), Ministry of Foreign Affairs (1) Nepal: Ministry of Health and Population (1)

Observers

N/A

China: Peking University Health Science Center (1)

Detail/year

2011

2012

2013 India: Indian Institute of Public Health (1) Nepal: Ministry of Health and Population (1) Vietnam: Ministry of Health (1)

Main content

(1) Evolution of global health landscape (2) Current global health issues (3) Getting ready for WHA (4) Making interventions in the WHA (5) Global health negotiation (6) SEAR One Voice

(1) Evolution of global health landscape (2) Current global health issues (3) Getting ready for WHA (4) WHO/SEARO briefing (5) Making interventions in the WHA (6) Global health negotiation (7) SEAR One Voice

(1) Landscape and evolution of global health, different perspectives (2) Group discussion on Global Health issues (3) Attend WHA/SEARO briefing (4) Making interventions in the WHA (5) Global health negotiation and theory (6) Negotiation practice (7) SEAR One Voice

Main activities

(1) Lectures (2) Global health negotiation: practice (3) Making interventions

(1) Lectures (2) Group discussions (3) Lessons learned and experience

(1) Lectures (2) Group discussions (3) Role-plays (4) Case studies

Expected outcomes

Participants were expected to (1) gain and widen their knowledge and experience on global health (2) have a chance to meet with renowned experts and diplomats as well as experienced participants from other countries regionally and globally (3) be involved in formulating policies which take into account the interests and concerns of SEAR countries (4) develop a network among themselves for future cooperation on important health

Participants were expected to (1) gain and widen their knowledge and experience on global health (2) be involved in formulating policies which take into account the interests and concerns of SEAR countries (3) develop a network among themselves for future cooperation on important health issues and policies that impact developing countries

Detail/year

2011 issues and policies that impact SEAR countries

2012 (4) protect the interests of developing countries and would not allow developed countries to totally dominate (5) Global health center would be set up in at least 3 countries in the region

2013 issues and policies that impact SEAR countries

Programme evaluation approaches

(1) Focus group discussions from participants (2) Observation/assessment of participants

Table 4 Summary of the key features of country’s activities for capacity building in global health Detail/year Title Bangladesh Global Health Diplomacy Training Course Date Venue Objectives July 2013 (4 days) Dhaka, Bangladesh To build up and strengthen the capacity of health and related professionals on global health diplomacy which may lead to global health agenda setting and policy formulation. Indonesia Workshop on Global Health Diplomacy 14-16 August 2013 Jakarta, Indonesia To share knowledge and experience among members of the network for building up and strengthening capacity of health and related professionals on global health diplomacy and policy advocacy. Maldives Global Health Diplomacy Training 11-13 August 2014 Male, Maldives (1) To ensure effective preparation of delegation for representing Maldives in international meetings, workshops and official visits (2) To develop and strengthen skills for global health diplomacy and international relations among the staff (3) To acquiring the skills to engage other sectors of the government in fulfilling state obligations related to health (4) To facilitate follow up of country actions and state obligations with international partners Target group(s) of participants Health or international relations professionals from the Department of Public Health or related departments cooperating with responsibility for health matters; including those whose Young health professionals (1) Technical staff working on different progarmmes (2) Staff of Policy Planning and International Health Division (3) Senior Staff of Health Protection Agency, Maldives Health or health related professionals with responsibility for health matters in Ministry of Health (MOH) of Sri Lanka Sri Lanka Global Health Diplomacy Workshop 22-24 September 2014 Colombo, Sri Lanka (1) To improve country capacity to be able to play active roles in the global health forums, focusing on World Health Assembly (WHA), World Health Organization – Executive Board (WHO-EB) & WHO Regional Committee (RC). (2) To build & expand networks among the participants and resource persons.

Detail/year

Bangladesh jobs are related to the healthrelated issues

Indonesia

Maldives Food and Drug Authority and other divisions of Ministry of Health

Sri Lanka

Support from international organizations Participants,

Rockefeller Foundation

World Health Organization

World Health Organization and Ministry of Health

World Health Organization

Total 21 Medical University (1) National Institute of Prevention and Social Medicine (3) Institute of Public Health (2) Directorate General of Health Services (8) Institute of Public Health Nutrition (1) Institute of Epidemiology Disease Control and Research (1) International Centre for Diarrhoeal Disease Research, Bangladesh (1) School of Public Health (2) Health Economics Unit (1) World Health Organization (1)

Total 21 Ministry of Health (21)

Total 32 Health Protection Agency (10) Food and Drug Authority (3) Policy Planning and International Health Division (9) National Drug Agency (2) Maldivian Blood Service (3) National Social Protection Agency (1) Other divisions of Ministry of Health (4)

Total 26 Ministry of Health (26)

Facilitators

Thailand: MoPH (2), IHPP (1)

Thailand: MoPH (2), IHPP (1), MoFA (1) Indonesia: MoH (3),

N/A

Thailand: IHPP (3)

Detail/year

Bangladesh

Indonesia National Institute of Health (1), Center for Education & Training of Apparatus (1) WHO (1) N/A N/A

Maldives

Sri Lanka

Observers Main content

N/A (1) Landscape and evolution of global health (2) Capacity building and sharing experiences (3) Getting ready for WHO/EB

N/A N/A

N/A (1) Landscape and evolution of global health (2) Current important issues on global health (3) Global health and its relation with other global issues, including why Global Health is important (4) About WHO and WHA (5) Good and bad intervention (6) What is in the agenda? (7) Tips on negotiation

Main activities

(1) Lectures (2) Global health negotiation: practice (3) Making interventions

(1) Lectures (2) Group discussions (3) Lessons learned and experience The young health professional participants got opportunities to practice in formulating policies, learning negotiation skill, accumulating technical expertise which take into account the interests and concerns of

(1) Lectures (2) Group discussions (3) Lessons learned and experience N/A

(1) Lectures (2) Group discussions (3) Lessons learned and experience Capacity Building – The participants understood the core component of global health, and were exposed to the vision, impact and viewpoint of ‘health’ in a larger scale at regional and global levels.

Expected outcomes

(1) Health and related professionals will significantly widen the scope of their knowledge and experience on global health and provide opportunities to be involved in formulating policies which take

Detail/year

Bangladesh into account the interests and concerns of Bangladesh. (2) Through effective negotiations in the Global Health, the WHO resolutions in relation to health systems strengthening would protect the interests of Bangladesh, and would not be totally dominated by developed countries. (3) The network of Bangladesh will be developed for future cooperation on important health issues and policies that impact our health outcomes.

Indonesia developing countries. Moreover, through effective negotiations in the Global Health, the trainees were to acquire skills in making decisions in relation to health systems strengthening which would protect the interests of developing countries, and would not be totally dominated by developed countriesใ

Maldives

Sri Lanka Networking – The workshop provided participants an opportunity to know and learn from each other, to build up a network among them, and to discuss various issues, including sharing perspectives on reports and draft resolution of World Health Assembly on Ageing, Health Technology Assessment, Malaria, Social Determinant of Health, and Antimicrobial drug resistance, WHO Global Code of practice on international recruitment of health personnel through drafting and making interventions exercises

Sustaining development in Global Health – The workshop was not only a great opportunity for capacity building and networking on global health of Sri Lanka health professionals and resource persons but also continuity of global health development in the region of WHO-SEAR.

Detail/year Programme evaluation approaches N/A

Bangladesh

Indonesia Questionnaire N/A

Maldives N/A

Sri Lanka

Table 5 Summary of the key features of activities for capacity building in global health of Thailand Detail/year Title Date Venue General objectives 2013 Global Health Diplomacy Training Course 29 April – 3 May Nakhon Pathom Province, Thailand 2014 National Workshop on Global Health Diplomacy (GHD) 28 April - 2 May Nakhon Pathom Province, Thailand 2015 National Global Health Diplomacy (GHD) workshop 20 – 24 April Nakhon Pathom Province, Thailand

(1) To build up and strengthen the capacity of health and related professionals on global health which could lead to global health agenda setting and policy formulation (2) To provide knowledge and skills related to global health diplomacy to strengthen training capacity on global health diplomacy to produce more potential trainers on GHD (3) The capacities will be in three areas including individual, institutional (node), and network. The capacities focus in policy advocacy, research or knowledge management and networking whereby each capacity will reinforce one another. (4) To prepare participants as a country’s delegate to the World Health Assembly.

Target group(s) of participants Support from other institutes

Health or international relations professionals from the Department of Public Health or related departments cooperating with responsibility for health matters; including those whose jobs are related to the health-related issues (1) Rockefeller Foundation - financial support (2) International Health Policy Program, Thailand (IHPP) (3) Mahidol University Global Health (MUGH) (1) ThaiHealth Promotion Foundation and ThaiHealth Global Link Initiative Project (TGLIP) - financial support (2) International Health Policy Program, Thailand (IHPP) - technical support (3) Mahidol University Global Health (MUGH) - logistic support (1) ThaiHealth Promotion Foundation and ThaiHealth Global Link Initiative Project (TGLIP) - financial support (2) International Health Policy Program, Thailand (IHPP) (3) Mahidol University Global Health (MUGH) (4) ThaiHealth Promotion Foundation (5) MOPH

Participants

Total 17 Thailand: MOPH (4), IHPP (4), Human Services Research Institute (1).

Total 24 Thailand: MOPH (8), Mahidol University (3) National Health Security Office (2), HITAP (2), National Health Commission Office (1),

Total 20 Thailand: MOPH (8), IHPP (3), National Health Security Office (1), Mahidol University (1), Thailand Nursing Council (1), MUGH (1), National Health Commission Office (1),

Indonesia: MOPH (3)

ThaiHealth Promotion Foundation (1),

Detail/year

2013 Vietnam: Pasteur Institute (1), Health Strategy and Policy Institute (1) Department of International Cooperation (1) MOPH (1) Vietnam MOPH (5)

2014 The Office of Disease Prevention and Control (1), IHPP (1).

2015 Thai Health Promotion Foundation (1), Somdet Chaopraya Institute of Psychiatry (1) Malaysia MOPH (1) Total 23 Thailand: MOPH (9), MUGH (4) IHPP (3), IHPP (1), MOFA (1), WHO Thailand (1), Siriraj Hospital (1), UNAIDS (1) Other country: World Bank (1)

Facilitators

Total 20 Thailand: IHPP (6), MOPH (5), MUGH (4), WHO Thailand (1), UNICEF Thailand (1), National Health Commission Office (1). Other country: World Bank (1), Rockefeller Foundation (1)

Total 22 Thailand: MOPH (6), IHPP (5), Mahidol University (1), MOFA (1), HITAP (1), Child and Adolescent Mental Health Rajanagarindra Institute (1), WHO Thailand (1), Thai Health Promotion Foundation (1), UNAIDS (1) Inspector General Region 5 Bureau of Inspection and Evaluation (1), Mahidol University (1), MUGH (1) Other country: World Bank (1)

Main content

(1) Landscape and evolution of global health (2) Current important issues on global health (3) About WHO (4) Emerging global health architecture, their inter-relationship, functions, strengths and weaknesses (5) About WHA (6) Models in Global Health Capacity Building: investment or burden (7) Making interventions in World Health Assembly

(1) Landscape and evolution of Global Health (2) Global Health and its relation with other global issues (3) current important issues on Global Health (4) Model in GH Capacity building (5) Emerging global health architecture, their inter-relationship, functions, strengths and weaknesses (6) Get ready for WHA (7) Drafting intervention

(1) GH policy direction in Thailand (2) Landscape and evolution of global health (3) Global health and its relation with other global issues (4) Current important issues on global health (5) Models in Global Health Capacity Building: investment and burden (6) Emerging global health architecture, their inter-relationship, functions, strengths and weaknesses (7) About WHA (8) Drafting intervention

Detail/year

2013 (8) Get ready for WHA & Practical survival tips

2014 (8) Negotiation in Global Health

2015 (9) Negotiation in Global Health (10) Get ready for WHA

Main activities

(1) Lectures (2) Global health negotiation: practice (3) Making interventions

Outcomes

(1) Capacity building: Knowledge and skill related to global health of participants were improved individually. Participants were inspired to build up their own capacity building on global health by applying a similar workshop in their own country. This will lead to build up the institutional capacity. (2) Training Guideline on Global Health Diplomacy (GHD Training Manual) was developed. (3) Networking and cooperation across countries and regions has been strengthened and created GHD network among alumni, participants, resource persons, and their respective networks.

(1) Participants as a country’s delegate will significantly widen the scope of their knowledge and experience on global health and provide opportunities to be involved in formulating policies which take into account the interests and concerns of Asian countries. (2) Through effective negotiations in Global Health, the resolutions in relation to health systems strengthening would protect the interests of developing countries, and would not be totally dominated by developed countries. Also, the national health system of developing countries in Asia will be strengthened by the capacity building of their health and health related professionals on policy advocacy, research and knowledge management, and networking through the global health workshops.

Programme evaluation approaches

1) Qualitative approach: observation by resource persons and interviews (to evaluate qualification, active involvement, skills/experiences gained of participants), focus group discussion among participants (to evaluate opinion’s participants on usefulness and areas that need to be improved) 2) Quantitative approach: questionnaire (to evaluate the usefulness and logistics arrangement of the workshop)

3.2 Priority global health issues of Member States in SEAR The current situation of Member States in terms of global health issues ranges from communicable to non-communicable diseases; neurodevelopmental issues; autism; climate change; epidemics; emerging and re-emerging diseases; and nutrition and access to medication. Since Member States have diverse backgrounds and contexts, they have different priorities accordingly. For example, Bangladesh claims to be the leading country with priority in autism and cholera and expresses interest in the issue of electronic health services and physical health issues. Maldives, however, is more concerned about the issue of climate change and lack of human resources. Meanwhile, Nepal puts more focus on the pandemic of communicable diseases such as swine flu, HIV, TB, malaria, and ebola while non-communicable diseases such as diabetes, hypertension, and obesity are still a concern. As such, there is a need for global health capacity building activities that are more specific to country-level health concerns. The global health capacity of countries in the region is seen as a work-in-progress and needs to continue. Global health issues of current interests, as reported by SEARO, were migration and access to medicine in Sri Lanka; drug manufacturing in India; and cross-border health issues that would need to be carefully addressed including health security, surveillance, and disease outbreaks in other SEAR Member States, especially in the context of the global health security agenda. The Sustainable Development Goals (SDGs) serves as an umbrella for identifying international public health issues, and these global health issues have been emphasized and included into universities’ international public health courses. However, global health issues considered by each country vary in their complexity. Most countries prefer to intervene in less complex issues such as snakebites or vaccines while a lesser number of countries prefer to intervene in more complex issues that are related to politics such as health workforce issues or access to medicines – depending on the country’s experience. In fact, the previous agenda in the WHA already provided global health issues of concern. They included four dimensions: communicable diseases, non-communicable diseases, health systems, and emergency preparedness. Within these dimensions, the decision to address which global health issue is based on aligning their importance during a specific time. It is believed that global health capacity building courses organized domestically might help the country’s global health officers grow their confidence in diplomacy at the international level in terms of building awareness in global health issues.

3.3 Awareness and needs of capacity building in global health in SEAR An Internet-based questionnaire survey was conducted to explore the current situation and importance of global health issues in each Member State in the region. The survey was launched to 37 country focal persons who were identified by WHO-SEARO as a focal person in global health in the International Health Section/International Cooperation Section in the Ministry of Health of each Member State. Twenty-one respondents answered the questionnaire but 6 were excluded for further analysis due to incomplete answers. Hence, the response rate of this survey was 41% (n = 15). The responses were obtained from 9 out of 11 Member States in SEAR including Bangladesh, Bhutan, India, Indonesia, Maldives, Nepal, Sri Lanka, Thailand, and TimorLeste. Sixty percent (n = 9) of the survey responses were from focal persons who have a direct role in global health in their respective Ministry of Health, and 40% (n = 6) came from WHO representatives. The key findings are presented in Table 6. The full responses based on the 5‐ point scale are presented in Appendix 6. Finally, the results of the survey are presented in three major aspects as shown below: 3.3.1 The importance of capacity building in global health The importance of capacity building from a focal person’s perspective was measured. Based on 4 issues: 1) the necessity of capacity building in global health; 2) priority-setting of global health in the agenda; 3) availability of a clear policy/strategy; and 4) whether the current capacity of government agencies is sufficient. The results showed the majority of respondents (93%) from all the countries agreed that capacity building in global health in their country is necessary. Among these respondents, 80% strongly agreed towards such statement. In terms of the priority of this agenda in the country, the majority of respondents (67%) agreed that capacity building in global health is of high-priority while 20% of respondents did not place capacity building in global health as a high-priority agenda in their respective countries (all of which happened to be from Bhutan, India, and Nepal). Again, the majority of respondents (67%) agreed that their countries have clear policy/strategy for capacity building in global health. Regarding the capacity in global health of government agencies, the number of responses for the levels of neutral and disagreement were the same at 33%. Additionally, it was seen that Bangladesh, Bhutan, and Thailand believe that their government agencies have sufficient capacity in global health. 3.3.2 Awareness and understanding on global health after the Regional Committee resolution (capacity building of SEA/RC63/R6) was adopted in 2010 Member States in global health:

The awareness and understanding on global health of health officers, foreign affairs officers, and trade/commerce officers were assessed under this category. From the responses, it can be seen that the majority of respondents (66%) believed that the awareness and understanding of health officers improved after the resolution was adopted. However, for foreign affairs officers, almost a half of the respondents (47%) – mostly from Bangladesh, Bhutan, India, Indonesia, and Sri-Lanka – indicated that the awareness and understanding of these officers improved. However, only 20% among all respondents (from Bangladesh and India) answered that trade/commerce officers in their respective countries had improved awareness and understanding in global health. Therefore, it may be concluded that health officers considerably improved awareness and understanding in global health after the resolution was adopted compared to the foreign affairs officers and trade/commerce officers. Only 2 out of 9 countries – Bangladesh and India – considered that awareness and understanding in global health of all three target participants (health, foreign affairs, and trade/commerce officers) improved. 3.3.3 The need for support in building capacity in global health Regarding activities of capacity building in global health, 6 out of 9 countries – Bangladesh, India, Maldives, Indonesia, Sri Lanka, and Thailand – considered that the activities in building capacity in global health in their country were effective. However, the result clearly indicated that all countries still required support from SEARO (79%) and other institutes (73%) in building capacity in their country.

Table 6: Key finding of Global Health Capacity Building Survey for Country Focal Point Question No. 1 2 3 4 5 Question Text Capacity building in Global Health is necessary Global Health capacity building is high priority on your country’s agenda Your country has clear policy/strategy for capacity building in Global Health Global Health capacity in most government agencies in your country is inadequate Health officers’ awareness and understanding on Global Health have been improved after the Regional Committee resolution was adopted in 2010 Foreign Affairs officers’ awareness and understanding on Global Health have been improved after the Regional Committee resolution was adopted in 2010 Trade/Commerce officers’ awareness and understanding on Global Health have been improved after the Regional Committee resolution was adopted in 2010 Activities conducted in your country were effective in building capacity in global health Capacity building in Global Health in your country requires support from SEARO Capacity building in Global Health in your country requires support from other institutes in your countries Capacity building in Global Health in your country requires support from respective institutes in other countries % Negative4 7% 13% 7% 33% 0% % Neutral 0% 20% 27% 33% 33% % Positive5 93% 67% 67% 33% 67% Most Frequent Answer Strongly agree Agree Agree Neutral Agree % Most Frequent Answer 80 40 46 33 53

13%

40%

47%

Agree

27%

53%

20%

Neutral

8 9 10

13% 7% 0%

20% 14% 27%

67% 79% 73%

Agree Strongly agree Agree

53 43 47

13%

73%

Agree

4 5

includes “Strongly agree” and “Agree” includes “Strongly disagree” and “Disagree”

3.4 Strengths, weaknesses, and impact of capacity building activities in SEAR Numerous strategies have been applied by the member countries in order to sustain global health diplomacy such as the formation of GH units, collaboration with different agencies, and providing training to different personnel beyond the health department. These countries have started to realize the importance of each Member State in the global agenda and national strategies have been aligned on a regional basis; each country has more time to determine how they can facilitate capacity building in such a scenario. Countries claim to have the programme for the global health by preparing the human resources, training the personals beyond the health and collaboration with the different agency. They align the national strategy along the regional basis. They have space and time to think for the regional agenda and how can country facilitate in such scenario. They have started realizing the importance of each Member State on the global agenda. In the preparation of human resources, some countries have initiated trainings and workshops on the GH agenda for the nonhealth experts as well. 3.4.1 Strengths The strengths of capacity building activities in SEAR mostly belong to the input and process of the programme. From Member States’ perspectives, the strengths of GH capacity building lie in the proficiency of the resource persons who facilitate training and briefings/meetings. In addition, the process of allowing Member States’ to participate in international forums has helped these nations to better impose their voice. The robust rehearsals before the start of each day during the WHA have helped to understand the topic better as well. The openness for diverse global health issues in the capacity building activities also enable the countries to express their opinions. SEARO views the GH capacity building activities as a process of learning by doing. The process allows each country to draft text on their own that enables delegates to speak up for their country instead of a conventional situation where only larger/more developed countries in the region dominate the GH agenda setting. In this sense, the requests and needs of Member States are usually taken into account. The technical workshops and governing bodies briefing sessions allow for Member States to highlight their respective agenda/policy/strategy and arrive at a consensus on regional/global health issues.

From SEARO’s perspective, the trained personnel are better equipped to handle global health issues and thereby negotiate successfully in GH diplomacy; the appreciation of technical issues along with the art of negotiating helps in reaching mutually beneficial agreements. Greater involvement of those who are involved in health policy decision making at higher levels would result in successful GH diplomacy. 3.4.2 Weaknesses The weaknesses of GH capacity building include the lack of clarity in the content and the lack of mechanisms to promote long-term engagement. For member countries, the lack of a clearcut definition of global health and the unfamiliarity of different issues from other countries might delay the understanding of global health issues among attendees. Some responsible personnel have limited understanding and knowledge in global health, especially those performing indirect responsibilities. It is expected that they should have deep knowledge; however, they know and understand the issue superficially and in a more general picture. Moreover, some Member States indicated that the training programme is on global health diplomacy rather than global health capacity building. As such, the capacity building courses should be more formalized and systematized to comprehensively cover important aspects of both global health diplomacy and capacity building. Additionally, a country senior officer indicated that the 1-hour preparatory meeting held at the WHA was not enough for a discussion of global health issues. The lack of mechanisms to promote long-term engagement – both at country and intercountry levels – is indicated by both Member States and SEARO. Smaller countries often face budget constraints for participation in or arrangement of capacity building. Although there have been many forums and workshops organized for Member States, no information sharing between states has been reported after the meetings. Even though the target participants for the capacity building activities are those who are involved in health policy decision making at higher levels, it cannot be expected that they will continue with country-specific capacity building and interventions after engagement in the WHA. There have not been any mechanisms to monitor the country-level process and outcomes of capacity building and interventions. Also, the training workshop is created to promote awareness and is not able to build immediate capacity; as such, the capacity can be harvested in five years. Such capacity involves recognizing involved stakeholders, knowing techniques and tactics, and feeling comfortable to deal with forefront issues. It is suggested that capacity building should require long-term consistent exposure to partners and subject matters until the necessary skills have been developed in participants.

3.4.3 Impact The representatives from Member States indicated that the capacity building activities resulted in a substantial improvement in documentation preparation, agenda development, constructive feedback provision, negotiation skills, and voicing their rights. Capacity building in negotiation, documentation, and high-level advocacy resulted in the active participation of SEAR countries in dialogues and international forums. The preparation of documentation for ministers and high-level government staff in these countries have been enhanced, and this has aided countries in focusing on health needs in different forums. Moreover, smaller countries have been more vocal on their issues and are able to represent themselves better. The representatives from SEARO indicated that the amount of participation from Member States in the governing bodies meetings have increased. The coordination and cooperation in developing ROVs has considerably improved. This results in the development of effective and quality ROVs through consensus on important agenda items. It also leads to Member States being heard and accommodated on resolutions/decisions at various WHAs. The biggest achievement of GH development for each country in the region is active participation of the Member States. In SEARO’s perspective, Member States now have global health capacity and are utilizing domestic human resources. It is reported that some of the SEAR countries such as Thailand, India, and Indonesia are now placing emphasis on building, retaining, and utilizing their global health capacities, including through inter-ministerial consultations and identification of suitable personnel. As mentioned above, one of the achievements of capacity building activities in global health at the national level was increased contribution in international forums. This achievement was determined by reviewing the number of interventions that each country made on behalf of the region at the WHA. As shown in Figure 1, Thailand was the most active country in terms of participation, resulting in 231 interventions during 2005-2015 compared to other SEAR countries. India, Indonesia, Bangladesh, and Maldives also highly participated in making interventions with 121, 109, 88, and 60 interventions, respectively. However, the number of interventions made by each of the remaining SEAR countries was considerably low with not more than 25 interventions over the past 11 years (2005-2015).

Figure 1 Number of interventions made by SEAR countries from 2005-2015 TH IN ID BD MV LK BT MM NP TL KP 0 231

121 109 88 60 24 23 14 13 12 5 50 100 150 200 250

SEAR countries

Number of intervention made in 2005-2015

The percentage of interventions made per total WHA agenda categorized by country and year (2005-2010) could also imply active participation, interest, and concern in global health issues of SEAR countries. There are two major types of WHA agendas: technical and health matters, and other matters. For agendas on technical and health matters, there is no clear difference in the percentage of interventions made before and after the RC resolution was adopted in 2010 for Thailand and India as shown in Figure 2-3. Considerably, Thailand made at least 86% of the total number of interventions each year in the agenda of technical and health matters from 2005 – 2015. For Bangladesh, Indonesia, and Maldives, an increase in the percentage of making interventions after 2011 can be seen as shown in Figure 4-6. Interestingly, interventions made by Indonesia and Maldives increased significantly after 2013. Sri-Lanka, Myanmar, and Timor-Leste also showed an increase in interventions made after 2013 but it was a very minor trend as shown in Figure 7-9. On the other hand, the percentage of interventions made in Bhutan, Nepal, and DPR Korea was very low, with no interventions made in most years; moreover, a decrease in percentage of interventions made after 2010 can be seen as shown in Figure 10-12. For the agenda on other matters, the percentage of interventions made compared to the agenda was significantly lower than the agenda on technical and health matters in all SEAR countries. Thailand and India showed an increasing trend in interventions made after 2010 but it was lower than 50% and 30%, respectively.

Figure 2 Percentage of interventions made by Thailand

100

Percentage of interventions made

100% 80% 60% 40%

100

100 92

100 90 86

46 21 24 9 11

43 18

20% 0%

7 2005 2006 2007 2008

2009

2010

2011

2012

2013

2014

2015

Technical and health matters

Other matters

Figure 3 Percentage of interventions made by India 100%

Percentage of interventions made

80%

65 60% 40% 21 21 11 15 7 13 57 52 33

56 45

61 42 26

20% 0% 2005 2006 2007 2008 2009

2010

2011

2012

2013

2014

2015

Technical and health matters

Other matters

Figure 4 Percentage of interventions made by Bangladesh 100%

Percentage of interventions made

80% 60% 48 40% 21 20% 10 12 7 9 11 43 40

71 56

65 50

18 8 7 6 2013 2014 2015

0% 2005 2006 2007 2008 2009 2010 2011 2012

Technical and health matters

Other matters

Figure 5 Percentage of interventions made by Indonesia 100%

Percentage of interventions made

80 80% 60% 42 40% 20% 7 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 33 24 18 7 14 29 18 10 11 8 6 41 31

75 63

2014

2015

Technical and health matters

Other matters

Figure 6 Percentage of interventions made by Maldives 100%

Percentage of interventions made

80% 60% 40% 20% 0% 2005 2006 2007 2008 2009 2010 2011 2012 14 7 14 18 21 13 4 5

29 18

2013

2014

2015

Technical and health matters

Other matters

Figure 7 Percentage of interventions made by Sri Lanka 100%

Percentage of interventions made

80% 60% 40% 20% 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 14 18 7 18 4 5 6 6 10 6 14 4 17

Technical and health matters

Other matters

Figure 8 Percentage of interventions made by Myanmar 100%

Percentage of interventions made

80% 60% 40% 20% 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 14 17 8 4 4

Technical and health matters

Other matters

Figure 9 Percentage of interventions made by Timor-Leste 100%

Percentage of interventions made

80%

60% 40% 20% 1 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 1 3 2 2 4 3

Technical and health matters

Other matters

Figure 10 Percentage of interventions made by Bhutan 100%

Percentage of interventions made

80% 60% 40% 20% 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 38 19 3 1 6 10 4

Technical and health matters

Other matters

Figure 11 Percentage of interventions made by Nepal 100%

Percentage of interventions made

80% 60% 40% 20% 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 19 6 5 7 20 13 4

Technical and health matters

Other matters

Figure 12 Percentage of interventions made by DPR Korea 100%

Percentage of interventions made

80% 60% 40% 20% 0% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 14 6 4

Technical and health matters

Other matters

3.5 Regional collective capacity safeguarding regional interests

global

health

Regional One Voice (ROV) is a strategy to implement global health capacity building. It has helped to unite member nations on different agendas. With this, they are able to impart a unified voice on different topics and put forward a diverse agenda in the global forum. Moreover, while ROV represents the wider perspective in terms of region, this platform is important for the smaller countries as they do not have a large delegation. However, some countries have reported that the agenda put forward by certain countries are sometimes the voice of the region rather than their representation. Although ROV has been around for over twenty years, this issue was not active during the past. International dialogues with regards to ROV among the 11 member countries of SEARO were scarce. The situation has since improved as there have been middle-career personnel and junior staff taking part, and ROV has become a good source for learning and sharing. However, some countries, especially smaller ones, have specific concerns such as bureaucratic seniority, while some active countries rotate and allow middle-career personnel and junior staff, guided by coaches and mentors, to perform on behalf of their respective country. In fact, the importance of ROV is inspired by the performance of developed countries such as the United States and United Kingdom, of which the responsible persons are chief delegates – in contrast to developing countries which always depend on specific personnel.

To ensure that the capacity building programmes are aligned with the GH agenda of each individual country, briefings/meetings allow for the involvement of senior officials from Member States and presence of the Regional Director and other senior staff from SEARO to help steer face-to-face discussions. The technical workshops and governing bodies briefing sessions allow for Member States to highlight their respective agenda/policy/strategy and arrive at a consensus on regional /global health issues. From the SEARO perspective, consensus ROVs as well as regional discussions aimed at arriving on common positions prior to global meetings has demonstrated ‘growing regional solidarity’. Similar to the capacity building activities at the national level, the achievements of the SEAR One Voice policy can be determined by reviewing the interventions made at the WHA on behalf of the Member States in the region as shown in Table 7. The difference in the number of SEAR One Voice interventions before and after the first-ever regional capacity building workshop was held in 2010 is evident. Quantitatively, the number of such interventions was low – as high as 4 voices per year at most during 2005 – 2007 and 2009. However, in 2008, the number increased to 8. Subsequently, from 2010 to 2015, interest among SEAR countries in making interventions based on mutual positions increased. Since 2005-2015, there have been 78 SEAR One Voice interventions. Based on the country responsible to make and deliver interventions on behalf of the region in as shown in Figure 13, Thailand and India were likely to play a higher role in expressing a ROV than other SEAR countries. Thailand was the country most responsible for delivering the intervention (11 times or 14% of the total ROV); this was followed by India (10 times or 13% of the total ROV) and Bangladesh, and Indonesia and Sri Lanka, which were at the same level (8 times or 10%). Interestingly, in 2014, delegates from every country voluntarily delivered at least 1 intervention on behalf of others at the Sixty-seventh WHA session.

Table 7 Number of Regional One Voice interventions made by SEAR countries at the WHA, 2005 to 2015 WHA session (year) Country 58 (2005) Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste Total number of ROV 1 1 2 8 4* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 1 12 2 8 1 1 1 9 10 1 2 1 1 1 1 2 1 1 1 1 1 1 2 1 1 59 (2006) 60 (2007) 61 (2008) 1 1 62 (2009) 1 63 (2010) 1 1 64 (2011) 2 1 65 (2012) 66 (2013) 1 2 67 (2014) 1 1 1 1 1 1 1 1 1 1 1 11 1 2 1 1 2 1 1 11 1 68 (2015) 1

Note: One intervention was made by two countries.

Figure 13 Number of SEAR ROVs delivered by each country

TH IN LK 8 8 8 7 7 6 6 5 2 0 2 4 6 Number of ROV 8 10 10

SEAR countries

ID BD NP MV TL BT MM KP

Note: TH, Thailand; IN, India; LK, Sri Lanka; ID, Indonesia; BD, Bangladesh; NP, Nepal; MV, Maldives; TL, TimorLeste; BT, Bhutan; MM, Myanmar; KP, DPR Korea

One of the most important objectives of the GHD workshop is to provide country delegates to WHA with in-depth understanding in global health areas and strategic practices of

negotiation. Since the workshop was initially introduced in 2010 up until 2015, it has built capacity for more than 200 health and international professional across SEAR countries (1). In addition to SEAR countries, the workshop was extended to build capacity in China, Japan, Malaysia, the Philippines, Cambodia, Lao PDR, and Vietnam.

Since 2010-2015, apart from the GHD workshop at the country level, Thailand served in a technical support role for GHD workshops in the following SEAR countries: 1. 2. 3. 4. Bangladesh (July 2013) Indonesia (August 2013) Maldives (August 2014) Sri Lanka (September 2014)

The contribution to the WHA session of the trained personnel from the GHD workshop conducted in Thailand was clearly noticeable. According to information obtained from the questionnaire, there were 54 participants that attended GHD workshops in Thailand during 20132015 (45 participants from Thailand, 5 from Vietnam, 3 from Indonesia, and 1 from Malaysia). Among these, 54% (n = 29) participated in the WHA after participating in a GHD workshop and 39% (n = 21) were responsible to make and deliver at least 1 intervention at the WHA sessions. However, for Sri Lanka, while there were 21 participants in GHD workshops, only 1 participated and delivered an intervention at the WHA. For Bangladesh and Indonesia, all participants who attended the GHD workshop did not participate in the WHA.

3.6 Enabling and impeding factors development in global health

that

affect

capacity

Information from the interviews showed that the factors that make GH capacity building at the country level successful include the government’s commitment as it provides opportunities to gain experience in international forums and international relations. The quality of participation was also related to the experiences of the delegates in attending international meetings or preparing statements for global health meeting. The economy, politics, continuity of personnel, funds, governance, international diplomacy, and lack of experts were some of the impending factors affecting global health capacity building. Some of the Member States claimed that they lacked the funding to continue holding workshops at the domestic level. The lack of funding from the WHO for the participants of smaller countries also led to an inability to attend capacity building in the some of the Member States.

For SEARO, the effectiveness of capacity building was demonstrated via the engagement of Member States at a global public health forum (i.e. the WHA). Support from the WHO, cooperation from Member States, the importance of global public health, shared concern on emerging global health issues, and academic and institutional support were indicated as enabling factors that affected the development of global health capacity building. There were several contextual factors that may have contributed to the success of global health capacity building. In terms of the institutional context, many of SEAR Member States have professional institutions of excellence in diverse areas including universities, foreign affairs, and health and management which could be utilized for successful global health capacity building. Achieving the right mix of professionals for such orientation and retaining them would be a challenge. In terms of the socio-political context, SEAR Member States are stable and peaceful socio-politically, which is a great enabling factor in helping meeting consensus on important regional and global health issues. Socio-political context is important for cohesion and healthy lifestyles in populations which are largely young and aspirational. SEAR Member States are transitional economies which are growing well compared to other areas in the world. It is well understood that health is an important pre-requisite for improved productivity and economic activity. This makes it easier for health professionals to address domestic concerns and build an effective bridge between such concerns and way forward on global health issues through nuanced health diplomacy. Greater economic progress could lead to more domestic resources, state and non-state, being made available for human resource training. However, in terms of impeding factors to the development of GH capacity building, economic prosperity has also led to waning donor interest in the region which would make predictable and sustainable funding challenging. As a result, while GH capacity building activities are generally funded by the SEARO, the funding of SEARO has declined. It appeared that most member countries preferred regional courses which tended to be more costly but benefited less people as compared to country-specific courses. Importantly, the lack of continuity in country’s delegates’ participation in global health forums appeared to be an important factor that hampered the effectiveness of capacity building. Although SEARO provides regular GH capacity building activities that have been embedded in the attendance of the WHA each year, many countries’ delegates are holding temporary political positions and might not be able to continuously carry out country-level capacity building and continue the advocacy for GH agenda setting in the following years. Those delegates, especially the ones in the WHA, are not considered real delegates reflecting countries’ capacities in global

health issues; they are bureaucrats - mostly ministers, permanent secretaries, and directorsgeneral – who attained their positions as a reward. However, there have also been more middlecareer personnel and junior staff who are well-versed in global health issues participating and becoming involved. As such, the long-term capacity building and inclusion of more permanent GH staff is vital to make GH capacity building more effective in the long run. Some countries that have actively participated in GH capacity building are advanced as they can assess such threats to the country’s GH diplomacy. Thailand is now a leading country among SEAR Member States that have a visible programme for capacity building in junior staff to ensure long-term capacity. Meanwhile, other countries such as India and Indonesia have also started such strategic, proactive programmes.

3.7 Plan for future development and support required from SEARO for each country Regional collective capacity can be further strengthened through inter-country training programmes, cross-border collaborations, and targeted position papers before important global meetings/inter-governmental negotiations. At the country level, some Member States have plans to conduct in-country training or to establish a new unit dedicated for global health capacity building. For example, Indonesia plans to conduct several trainings on speech writing and health diplomacy. The trainings are to be funded by the Indonesian government together with USAID. Meanwhile, Bhutan is planning to have a full-fledged international health coordination unit to build capacity at the Policy and Planning Division, Ministry of Health. However, the lack of funding for capacity building activities at the country level appears to be the main concern and might hamper the sustainability of global health capacity in countries with limited resources. There is a need for a pool fund between the Member States and upon the requirement of the fund, any Member State should be able to use the fund. There were also recommendations from respondents in the survey for improving global health capacity building activities. It was found that, overall, most of the respondents recommended that their countries require more capacity building programmes in global health to be conducted at both country and regional levels. Regular workshops to sharpen capacity in global health and to jointly identify several common issues which need to be scaled up from SEARO to the global level are needed. Target participants in capacity building programmes should be expanded to people from multi-sectors or all related ministries to improve overall health status. However, there were particular recommendations to improve global health capacity from

certain countries. These include: (1) raising awareness for global health issues among all related ministries; (2) preparing international diplomacy or health diplomacy protocol or reference documents for SEAR Member States; (3) introducing modern methods in building capacity such as online training courses offered by universities in partnership with the WHO; (4) increasing advocacy on the benefits of building capacity in countries to encourage active participation in global health forums; and (5) focusing on strengthening the capacity in junior staff. Most of the respondents also mentioned the requirement of support from SEARO. They required technical support and some mentioned that financial support was also necessary. In some countries, support from SEARO as well as global and regional institutes/organizations were also important in order to achieve the Sustainable Development Goals (SDGs). Some respondents recommended that their counties also require SEARO – in collaboration with other experts or institutes – to conduct training to train focal points from the Ministry of Health so that they are able to further train their local staff.

Chapter 4 Conclusion and recommendations There are some limitations in this study and these come mainly from data collection. Although it was expected that data should have been obtained from all SEAR Member States, the assessment team faced several limitations which were mainly related to the inaccessibility of potential informants. For example, the e-mail addresses of some country senior officers and WHA delegates that were available were not up-to-date as many recipient failures were reported. To solve this issue, the assessment team searched for contact information from the Internet and made phone calls to reach those informants. After the calls were made, it was found that many potential informants were holding temporary positions at the time and had since moved to other divisions or other organizations, and thus were unavailable to participate in the assessment. Since the research team obtained responses only from some SEAR countries, the results in this study were based on such countries and may not represent all SEAR countries. In addition, there were doubts regarding the validity of the assessment team due to it being a third-party organization as it was not directly related or did not have a direct relationship with the informants, all of whom were high-ranked country officers. Eventually, the assessment team sought the IHPP for assistance and was able to reach a few country representatives by the end of data collection period. To solve these issues, the assessment team would suggest that future assessments might be conducted at the WHA annually to ensure the availability of potential informants. This could be done in the form of focus group discussions or in-depth interviews to obtain information about: (1) how the capacity building activities were executed at regional and country levels; (2) countries’ global health agendas for the past and current year and the extent that the capacity building improved global health diplomacy for themselves; and (3) the contributions that the trained personnel made to global health policy agenda setting and formulation at different policy forums, etc. Alternatively, if the assessment cannot be conducted at the WHA, WHO-SEARO may act as a mediator between the assessment team and the potential informants to increase the response rate. In conclusion, this study suggests that SEAR Member States are aware of the need for strengthening their capacity in different policy areas concerning global health. During the past decade, a significant number of countries’ delegations to international policy forums, mainly from health agencies, have developed their negotiation and networking skills through participating in training workshops convened by SEARO and domestic institutes. It has also been found that these capacity building programs, run at both regional and country levels, have been proved successful to a certain extent. Clearly, collaborations between country representatives at the WHA have become closer as equal partnerships in the region are enhanced. Furthermore, individual officers have benefited not only from the training programmes but also by learning at 50

the site of global health policy making when they attend briefing sessions facilitated by SEARO staff. At the same time, there is still room for improvement. This study identifies key impediments in the introduction of the regional resolution on capacity development in global health among Member States. This includes inadequate financial support for the training programmes, which has resulted in the discontinuity of such activities, especially in SEARO. The movement of trained/experienced officers to different positions is also emphasized as a crucial factor hampering the building of a country’s capacity in global health. In part, this result s from the lack of explicit policy framework for global health in most countries. Drawing on the findings of this study and suggestions of some key informants, we propose recommendations as follows: (1) Strategic frameworks for global health at the country and regional levels – both short- and longer-term – are essential. At the country level, a strategic framework would be very helpful not only in the strengthening of capacity of respective health and diplomat officials but also in the priority setting of global health policy issues, formulating relevant measures to deal with particular problems, and enhancing coordination among national authorities. The strategic framework at the regional level should be based on the global health needs and common interests of countries in the region. This will help SEARO in allocating resources or designing activities to support Member States in building capacity in global health and other related activities. It will also help SEARO set a framework for monitoring and evaluation activities that will be conducted at the national or regional levels. A human resource plan should be integrated as a key component of a country’s long-term global health strategy. This needs serious consideration on different facets of production, recruitment, retention, and development of human resources for global health. In addition, building capacity for young professional staff may need to be considered as a priority along with establishing a clear career path for global health officers. The appointment of delegations to international policy forums is among the crucial elements that require context-specific solutions. Moreover, strengthening capacity in global health for diplomats or other non-health staff should be included in the plan. In order to create a decent human resource plan, the mapping of key stakeholders in each country is needed. This mapping will show gaps or missing pieces of important stakeholders, to which capacity needs to also be built. SEARO can play a leading role in mobilizing resources inside and outside the region to address the shortage of experts and budget for capacity building of

(2)

(3)

Member States in global health. Within SEARO, coordination between departments is key as each of them is responsible for particular global health issues such as universal health coverage, non-communicable diseases, international health regulation, etc. Staff from all departments can be considered resource persons for any kind of capacity building programmes as they possess up-to-date information in certain policy areas, given that global health capacity involves not only negotiation skills but also technical/analytical competency. (4) Based on the success of ROV at international forums, SEARO should continue to build and maintain a platform for countries to create and expand their networks in the region. Additionally, SEARO may serve as facilitator for sharing experiences and drawing lessons among experts from different institutes, country delegations, and development partners. This platform can help each country in the region learn techniques used in different contexts at international forums. It can also help them explore other situations that have occurred, which can also help them in reducing conflict between each other. As requested by the RC, standard courses for capacity building in global health still need to be developed. However, it should leave some room for adjustment to shape the course according to the country’s situation and needs. Information technology and electronic media can be employed to support distance-learning programmes for global health officers. As such, proper support for two-way communications between trainees and resource persons should be installed for making the course run effectively. Monitoring and evaluation of the introduction of the regional resolution and country’s strategy for global health should be established. The framework for monitoring and evaluation should be set based on a strategic framework that will be used to determine capacity building activities. A set of proper indicators should also be created and every country in the region should be informed.

(5)

(6)

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Appendix 1 Survey questionnaire: situation and awareness of capacity building activities Questionnaire for country focal persons Regarding global health capacity in your country, to what extent do you agree with the following statements? Strongly disagree 1 (1) Capacity building in global health is necessary (2) Global health capacity building is a high priority on your country’s agenda (3) Your country has clear policy/strategy for capacity building in global health (4) Global health capacity in most government agencies in your country is inadequate (5) Health officers’ awareness and understanding on global health has been improved after the Regional Committee resolution was adopted in 2010 (6) Foreign Affairs officers’ awareness and understanding on global health has been improved after the Regional Committee resolution was adopted in 2010 (7) Trade/Commerce officers’ awareness and understanding on global health has been improved after the Regional Committee resolution was adopted in 2010 (8) Activities listed in the table above (in question #2) were effective in building capacity in global health (9) Capacity building in global health in your country requires support from SEARO (10) Capacity building in global health in your country requires support from other institutes in your countries (11) Capacity building in global health in your country requires support from respective institutes in other countries Disagree Neutral Agree Strongly agree 5

Please provide your recommendations to improve global health capacity in your country and/or in SEAR.

Questionnaire for resource persons in capacity building activities 1. Please identify the meetings/workshops on global health your institute (or team) convened to build capacity of government officers and stakeholders in your country and at international level. Title of meeting/workshop Venue (country, WHO region) Date Objectives Target groups and numbers of participants Results of the training evaluation/ feedback (put N/A if not available)

(1) (2) (3)

2. In addition to short-course training activities, what do you think is an effective strategy to build global health capacity in SEAR countries? (a)……………………………………………. (b)…………………………………………… (c) ………………………………………….. 3. Focusing on capacity building in global health in SEAR countries, to what extent do you agree with the following statements? Strongly disagree 1 (1) Global health capacity in most countries in SEAR is inadequate (2) Global health capacity building in the region is a high priority on most countries’ agenda (3) Most countries in SEAR have clear policy/strategy for capacity building in global health (4) Among different issues in global health, global health diplomacy capacity is the most lacking discipline in SEAR countries (5) Most of the attendants in your training courses were appropriately selected by their supervisors (6) Performance of SEAR country delegations at the World Health Assembly has improved after the Regional Committee resolution was adopted in 2010 (7) Your institute/team has relevant experiences in global health to share with training participants Disagree Neutral Agree Strongly agree 5 Do not know

Strongly disagree 1 (8) Your institute/team has an adequate number of resource persons in global health to train the participants (9) The contribution of SEAR’s One Voice strategy is a good indicator of global health capacity development in SEAR countries (10) Shortage of country’s budget is a crucial impediment in building global health capacity in SEAR countries (11) Evaluation of your training courses should be strengthened

Disagree

Neutral

Agree

Strongly agree 5

Do not know

4. Please provide your recommendations to improve global health capacity in your country and/or in SEAR …………………………………………………………………………

Questions for participants in capacity building activities 1. Why did you decide to participate in this meeting/workshop? (Select all answers that best apply to your situation) (a) You were assigned by your supervisor or your department (b) It was your personal interest to learn about global health issues (c) You wanted to improve your knowledge and skills (d) Knowledgeable persons joined the training faculty (e) Others (please specify) ……………………………………….. Before you participated in this meeting/workshop, have you ever had any experience in global health capacity building activities? (Select all that apply) (a) Never (b) Yes – through university training courses (c) Yes – through training courses organized by government agencies (d) Yes – through other approaches (please specify) ……………………………………. Regarding the meeting/workshop you participated, to what extent do you agree with the following statements? Strongly disagree Disagree Neutral Agree Strongly agree Do not know

1 (1) This meeting/workshop was in line with your country’s policy on global health (2) This meeting/workshop was helpful in improving your knowledge and/or skills in global health (3) Your professional background was not relevant in attending this meeting/workshop (4) This meeting/workshop did not meet your expectations (5) Knowledge and/or skills acquired from this meeting/workshop are relevant to your work responsibilities (6) The duration of this meeting/workshop was too short (7) The training activities were well planned to achieve the meeting/workshop’s objectives (8) The training faculty or resource person of this activity provided the participants with clear guidance on respective issues (9) Training materials were useful (10) If similar meeting/workshops are to be held in the future, you will recommend your colleagues to attend

4. Please provide your recommendations to improve global health capacity in your country and/or in SEAR …………………………………………………………………………

Appendix 2 Survey questionnaire: In-country capacity building activities on global health of SEAR Part 1: Personal Information Please provide your information below

First name: Last name: Current Position: Affiliation: Country: Email address: Skype ID (optional): Tel. (optional):

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to choose a country Click here to enter text. Click here to enter text. Click here to enter text.

Part 2: Information on global health capacity building activity Please provide information of capacity building in global health in your country

Note: Capacity building in global health in this form refers to any strategies and processes which aim to improve global health practices of Member States of WHO South-East Asia Region. Capacity building activity covers workshops, trainings, seminars, conferences or other approaches that were conducted to build capacity in global health in any aspects. For example, for a capacity building in global health diplomacy (GHD) workshop, an annual international workshop conducted in Thailand aims to strengthen understanding and capacities on global health and prepare Thai health professionals in the World Health Assembly (WHA) or other global health governing bodies.

1. During 2011-2015, were there any activities (e.g. workshops, trainings, seminars, conferences, etc.) to build capacity in global health conducted by your country? For annually conducted activities, please list every year that the activity occurred. Please select No or Yes by clicking in the boxes below. Cancelation of the answer can be made by clicking the same box again. If you answered yes, please provide the number of activities and the name of the activities conducted in each year.

2011

☐ No

☐ Yes

How many activities? Name of all activities

Choose an item. (1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to add more activities.

2012

☐ No

☐ Yes

How many activities? Name of all activities

Choose an item. (1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to add more activities.

2013

☐ No

☐ Yes

How many activities? Name of all activities

Choose an item. (1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to add more activities.

2014

☐ No

☐ Yes

How many activities? Name of all activities

Choose an item. (1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to add more activities.

2015

☐ No

☐ Yes

How many activities? Name of all activities

Choose an item. (1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to add more activities.

2. Please provide information of all activities that you recorded in Question 1. Activity 1 2.1 2.2 2.3 Year Name of this activity Category Choose a year. Click here to enter text. ☐ Workshop ☐ Training ☐ Seminar ☐ Conference Involves participants practicing their new skills during the event under the watchful eye of the instructor. Very intense and dedicated learning session with a highly-specific focus. Features one or more subject matter experts delivering information primarily via lectures and discussions. Features keynote presentations delivered to all attendees.

☐ Other, please specify 2.4 2.5 Duration of activity Venue From Place City

Click here to enter text. To Click here to enter a date.

Click here to enter a date.

Click here to enter text. Click here to enter text.

Country Choose a country. 2.6 Objective(s) of the activity

Example: (1) To raise awareness on the role of global health regulations and initiatives among health officers. (2) To build capacity on global health diplomacy for health officers.

(1) Click here to enter text. (2) Click here to enter text.

(3) Click here to enter text. (4) Click here to enter text. (5) Click here to enter text. Click here to add more objectives 2.7 Organizing institute (s)

Note: the institute (s) that hosted this activity

(1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to enter text. Click here to add more institutes 2.8 Name Email address

Name and email address of head of activity organizer Click here to enter text. Click here to enter text.

2.9

Target group(s) of participants in this activity

Example: (1) Mid-level officers in Departments of Disease Control and Health Promotion (2) Food and Drug Drug Directorate

(1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to enter text. Click here to add more group 2.10

Number of participants by affiliation of participants that participated in this activity (please order the numbers from the highest to lowest number of participants)

Example: (1) Ministry of Health. How many participants, 3 (2) Ministry of Foreign Affairs. How many participants, 2

Alternatively, you may consider sending the list of participants to Akanittha.p@hitap.net

☐ Provide this information via the given email. (1) Click here to enter text. (2) Click here to enter text. (3) Click here to enter text. (4) Click here to enter text. (5) Click here to enter text. (6) Click here to enter text. (7) Click here to enter text. (8) Click here to enter text. (9) Click here to enter text. (10) Click here to enter text. 2.11

How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item. How many participants, Choose an item.

Names and email addresses of at least 3 participants from different affiliations Name Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

(1) Email address Name (2) Email address Name (3) Email address Name (4) Email address Name (5) Email address 2.12

Names and email addresses of at least 3 facilitators from different affiliations

Name (1) Email address Name (2) Email address Name (3) Email address 2.13

Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

Main content of this activity Example: (1) Landscape and evolution of global health (2) Global health issues (3) Global health diplomacy

Alternatively, you may consider sending the agenda of this activity to Akanittha.p@hitap.net

Main activities (select all that apply)

☐ Lectures

☐ Group work/group discussions ☐ Role-play ☐ Other (Please specify)

2.15

Expected outcome of this activity Example: (1) Better understanding of participants on current global health issues and their impa ct on the country’s health systems.

(2) Improved negotiation and networking skills in global health among participants.

Alternatively, you may consider to sending the document providing this information to Akanittha.p@hitap.net

End of activity 1   If there was only one activity conducted during 2011-2015, please submit this form. If there were other activities, please continue to record them in the next page.

Appendix 3 The Interview guidelines for country’s senior officers and delegates Section 1. Personal Information 1.1 Please indicate the country you represent, your organization, your position and the length of time in the current position. 1.2 Please explain how you/your organization are related to or responsible for global health (GH) issues, including your experience of attending the WHO’s Global Health capacity building activities.

Section 2. GH issues and specific GH activities/program 2.1 Please indicate specific GH issues in your country and their importance. 2.2 Are there any capacity building programs on GH organized in your country? If no, how are people trained to work on GH issue? If yes, please provide a detailed information in regards to types, target groups, and formality of the programs and the extent that the programs are aligned with the country and regional-level GH agenda/policy/strategy. 2.3 What are the strengths and weaknesses of the GH capacity building programs? In your or your country’s perspective, what are the key indicators of the success of a GH capacity building program? To what extent has your country achieved that success. Any plans for improvement in the future?

Section 3. Regional Collective Capacity on GH Capacity Building 3.1 How did you select your country’s representatives to attend GH capacity building training/workshops? What do you expect from the workshops (e.g. body of knowledge about GH, communication skills, sharing knowledge, etc.)? Are the trained persons nominated to become representatives of your country at the World Health Assembly, Executive Board or regional meeting? 3.2 Are there any other organizations in your country that are responsible for GH issues? If so, to what extent that your organization collaborates with them? How is the collaboration formalized? 3.3 Does your country have collaboration with other countries on GH issues? If so, to what extent that your organization collaborates with them? How is the collaboration formalized? 3.4 Please share your experience in the “Regional One Voice” movement. In your perspective, to what extent does participation in international forums or workshops (particularly the WHO’s GH ones) can improve regional collective capacity on global health?

3.5 Overall, what are the factors (e.g. institutional context, socio-political context, or economic context, etc.) that make GH capacity building in your country and among the region successful or unsuccessful?

Section 4. Challenges and Recommendations 4.1 How do you think WHO GH agenda and policies at regional level reflect GH issues of individual member countries, particularly among developing countries? 4.2 Please provide your recommendations for improvement of the GH capacity building program at both country and regional levels.

Appendix 4: Interview questions formatted for E-mail interview Dear Sir/Madam, We would like to invite you to participate in the “Assessment of Capacity Building of Member States of WHO South-East Asia Region in Global Health” being conducted by the Faculty of Social Sciences and Humanities, Mahidol University, in collaboration with the Health Intervention and Technology Assessment Program (HITAP), Thailand, for WHO South-East Asia Regional Office (WHO-SEARO).

The assessment aims to obtain a better understanding of strengths, weaknesses and impact of five-year experience in capacity building activities in global health in eleven Member States, and to provide recommendations on effective management of capacity building in global health.

We request you to participate in an e-mail interview for the assessment as you have been identified by the WHO-SEARO as a country senior officer or a country delegate having direct roles in global health diplomacy. We hope the e-mail format will facilitate your participation in this assessment with ease and flexibility, considering your busy schedule.

The attached files include project information and the interview questions for your consideration. Once you agree to participate in this assessment, please give us a short reply with the following consent message: “I hereby express my consent to participate in the research project entitled: Assessment of Capacity Building of Member States of WHO South-East Asia Region in Global Health” . Your response will imply that you have read and understand the project information as attached.

The interview questions are attached in this word document in the following pages, comprising of five sections. Please provide your answers to them as best you deem correct, and send us your response at shmuglobalhealth@gmail.com by July 10th, 2017. Your responses in interview will be kept confidential. This information will only be used for assessment purposes and your name will not be mentioned in any report.

Thank you for your kind consideration and support.

Assessment of Capacity Building of Member States of WHO South-East Asia Region in Global Health

Section 1. Personal Information

1.1) Please indicate a) The country you represent: b) Your organization and department: c) Your current position: d) When did you start working for your position? Please answer here:

1.2) Is your position (or your organization) related to or responsible for global health (GH) issues and related capacity building activities/programs? If yes, please explain more details such as: a) What issues are you (or your organization) responsible for? b) What are the capacity building programs/activities accounting for GH issues and how are these programs/activities implemented? c) Are the issues and programs/activities contributed at country level or at regional level? d) If your organization is responsible for only a particular GH issue, please tell whether there are other organizations responsible for GH issues? If yes, what GH issues are they responsible for? Please answer here:

1.3) Have you (or your organization) continuously participated in the WHO GH workshop? If yes, please explain little more details such as: a) Have you (or any member of your organization) participated as participant? b) Have you (or any member of your organization) participated in the workshop as host? (e.g. a country-level agency for organizing the workshop) c) How many times have you participated in the workshop? Please answer here:

Section 2. Overall GH Agenda and Issues

2.1) What do you understand by the term “Global Health” and “Global Health Capacity Building”? Please answer here:

2.2) Are global health (GH) issues important in your country?

If yes, please explain more details such as: a) What are the specific GH issues in your country? b) How important are these issues in your country? Please answer here:

2.3) Which organization in your country is responsible for GH issues?

a) Is it a new organization just set up for working specifically on the GH issues? b) What are its responsibilities? c) If there are different organizations separately handling different GH issues, please specify the names of these organizations and which GH issues they are responsible for. Please answer here:

Section 3. Specific GH Activities/Programs

3.1) Are there any capacity building programs on GH organized in your country?

If no, why? And how are people in your country trained to work on GH issues?

If yes, a) Are they formal or informal programs? Please give example of these programs. b) Are those programs aligned with GH agenda/policy/strategy of your country? Please explain how those programs are related to such agenda/policy/strategy. c) Is the GH agenda/policy/strategy of your country also aligned with any regional-level GH agenda/policy/strategy? If no, please specify what the issues are and how different these issues are. Please answer here:

3.2) Is there any standardized program for GH capacity building?

If no, does your country have any future plan to set up any standardized program?

If yes, a) What are the structure and operation of the program? b) What are major motivations of the program initiative? (e.g., from your own needs or by international recommendations) Please answer here:

3.3) Where does the main financial support for the GH capacity building program come from? Is it funded by the government or international organizations (e.g. WHO)? Or is it jointly funded by the government and international organizations? Please select one of the following 4 choices and explain more details.

1) If the support comes only from the government, please explain more details such as: a) How could you obtain such support? b) How is the sustainability of the program? c) Are there any specific reasons or difficulties of why it is not supported by international organizations (e.g., WHO)?

2) If the support comes only from international organizations (e.g. WHO), please explain more details such as: a) How could you obtain such support? b) How is the sustainability of the program? c) Are there any specific reasons or difficulties of why it is not supported by the government?

3) If the support comes from a joint funding between the government and international organizations (e.g. WHO), please explain more details such as: a) How could you obtain such support? b) How is the sustainability of the program? c) Are there any specific reasons or difficulties with the joint funding?

4) If there is not any financial support, does your country have any future plan to get it? If yes, please explain a plan and process. Please answer here:

3.4) Is there any monitoring or evaluation process for the program?

a) If no, why? Please specify difficulties or obstacles. b) If yes, what are the indicators used to measure its success? What are the results? Please answer here:

3.5) Is there any collaboration between your country’s authorities and other countries’ organizations or international organizations (e.g. WHO or Graduate Institute Geneva) in setting up GH capacity building program? If yes, which organizations? And how was the collaboration initiated? Please answer here:

3.6) What are the strengths and weaknesses of those capacity building programs? Please answer here:

3.7) What are the main factors that make those capacity building programs successful or unsuccessful? Please answer here:

3.8) What is the improvement plan on building capacity on GH of your country in the future? Does your country plan to get any support from other organizations apart from the government? Please answer here:

Section 4. Regional Collective Capacity on GH Capacity Building

4.1) Has your country ever sent staff to attend trainings or workshops arranged by other countries or international organizations?

If yes, please explain more details such as: a) Why did your country decide to do so? b) How did you select participants? What was the selection process? c) What were benefits you expected from sending the staff to attend the trainings or workshops? d) Do the benefits you expected include the following elements: body of knowledge, communication skills, sharing knowledge or others. If others, please specify. Please answer here:

4.2) Are the trained persons nominated to become representatives (focal persons) of your country at the World Health Assembly (WHA), EB or regional meeting?

a) If not, how do you choose your country’s representatives (focal persons) to participate in GH forum in order to attend activities such as training/workshop/seminar/conference? What is the selection process? b) Do you think participants, especially from developing countries, feel free to raise their voices easily in such international meetings? If no, are there any reasons? Please explain why. Please answer here:

4.3) Is there any collaboration among organizations in your country on GH capacity building? If yes, which organizations? How does the collaboration work? What does the collaboration achieve? (e.g., sharing knowledge, working as partner, MOU etc.) If others, please specify. Please answer here:

4.4) Does your country have collaboration with other countries on GH issues?

If yes, please explain more details such as: a) Which organizations? b) Is it formal or informal collaboration? c) How does the collaboration work? What does the collaboration achieve? (e.g., sharing knowledge, working as partner, MOU etc.) If others, please specify. d) What are the major enabling factors or impediments of that collaboration?

In addition, e) Do you believe whether sending staff to attend international trainings or workshops can improve the collaboration? Please answer here:

4.5) Do you know what Regional One Voice is? Does your country give importance to the Regional One Voice? Why? What is the perspective of your country on regional collective capacity on global health? Please answer here:

4.6) Do you have any experience of the ‘Regional One Voice’ movement?

If yes, please share more details such as: a) How was it initiated and operated? b) What are factors associated with its success or failure? c) If it is successful, does the success bring about any plan for further improvement? d) If it is unsuccessful, how do you deal with it?

In addition,

e) Do you believe whether active participation in international forums or workshop (e.g., sending staff to attend trainings or workshops, particularly the WHO GH workshop) can improve regional collective capacity on global health? If yes, please explain how? Please answer here:

4.7) Overall, what are the factors that make GH capacity building in your country and among the region successful or unsuccessful? How?

Please explain more details in terms of the following aspects: a) Institutional contexts such as policies, regulations, or collaborations at country- and regionallevels b) socio-political contexts such as social or political supportive policy environments at country- and regional-levels c) Economic contexts such as financial support and sustainability at country- and regional-levels Please answer here:

Section 5. Challenges and Recommendations

5.1) What is the desired mechanism to build up GH capacity in terms of country and region? Please answer here:

5.2) What are the major outcomes or impacts of having someone who have built capacity in GH? Please answer here:

5.3) Do you believe WHO GH agenda and policies at regional-level reflect GH issues of each individual member countries at country level, particularly among developing countries? Please answer here:

5.4) Do you think the development of regional-level GH agenda incorporate well with the GH issues of developing countries? If not, please explain why. Please answer here:

5.5) Do you think the GH workshop (training/workshop/seminar/conference) can improve skills such as communication skill, negotiation skill, knowledge-sharing skill, presentation skill and/or others at international meetings? If others, please specify. Please answer here:

5.6) Please provide your recommendations for improvement of the GH capacity building program at both country level and regional level. Please answer here:

5.7) Please give suggestions or comments for WHO SEARO? Please answer here:

Appendix 5 Ethical approval

Appendix 6 Full responses of Global Health Capacity Building Survey for Country Focal Point in 5‐point scale Question (1) Capacity building in Global Health is necessary (2) Global Health capacity building is high priority on your country’s agenda (3) Your country has clear policy/strategy for capacity building in Global Health (4) Global Health capacity in most government agencies in your country is inadequate (5) Health officers’ awareness and understanding on Global Health have been improved after the Regional Committee resolution was adopted in 2010 (6) Foreign Affairs officers’ awareness and understanding on Global Health have been improved after the Regional Committee resolution was adopted in 2010 (7) Trade/Commerce officers’ awareness and understanding on Global Health have been improved after the Regional Committee resolution was adopted in 2010 (8) Activities conducted in your country were effective in building capacity in global health (9) Capacity building in Global Health in your country requires support from SEARO (10) Capacity building in Global Health in your country requires support from other institutes in your countries (11) Capacity building in Global Health in your country requires support from respective institutes in other countries (1) Strongly disagree 7% 0% 0% 7% 0% (2) Disagree 0% 13% 7% 27% 0% (3) Neutral 0% 20% 27% 33% 33% (4) Agree 13% 40% 47% 27% 53% (5) Strongly agree 80% 27% 20% 7% 13%

40%

47%

20%

53%

20%

0% 7% 0% 0%

13% 0% 0% 13%

20% 14% 27% 13%

53% 36% 47% 40%

13% 43% 27% 33%

Informations clés

Organisation Organisation mondiale de la santé (OMS)

Type de document Governing Bodies documents

Date d'adoption 25 juillet 2017

Source Organisation mondiale de la santé