Fiftieth Regional Committee for Europe: Copenhagen, 11-14 September 2000: collaboration with agencies and organizations active in health in Europe

Provisional agenda item 2(d) WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE COPENHAGEN REGIONAL COMMITTEE FOR EUROPE Fiftieth session, Copenhagen, 11 - 14 September 2000 EUR/RCS0/6 7 July 2000 00872 ORIGINAL: ENGLISH COLLABORATION WITH AGENCIES AND ORGANIZATIONS ACTIVE IN HEALTH IN EUROPE The agenda for health involves all elements of society, and multisectoral and multilevel participation is accordingly a fundamental part of the Health for All philosophy and of necessary public health action in countries. Partnership and collaboration are therefore strongly emphasized in the Regional Office's current reform process. These functional requirements can be met only if a wide variety of health-interested organizations and actors work together with countries in a systematic, structured and coordinated way. This paper reviews the Regional Office's collaborative activities during 1999-2000 in this context. CONTENTS Page Introduction ......... .. ..... ..... .. .. .. .... ................... .. ...... ... ..... ............. ... .................. .. .......... ......... ............. ......... .... 1 Actors and partners in health in Europe ... ......... ... ...... .......... ..... ... ..... ... ....... ....... ...... .. .... ........ .... ......... 1 A framework for partnership ..... .. .. .............. .. ...... ....... .... .... .......... .... .. ..... .. ........ ....... ...... ... .... .......... ... 1 WHO' s comparative advantage ................... ............................. ............. ... ..... ........ ..... ........... .. .... .... ... 2 WHO's country-based activities ...................... .. ........ .... .. .............................. ............. ..................... .. . 2 Examples of partnership activity during 1999-2000 ........................................... .. ..... .................................. 2 Collaboration with the European Union ......... ......................................... ........................................... 2 Council of Europe .. .... ...... .......... .. ................ .. .... .... .. .......................... .. ... ...... ... ................................... 4 Collaboration within the United Nations system ..... ......... .. ... ... .... ... ... ....... .... ...... ...... .................................. . 4 United Nations Development Programme (UNDP) ....... .. .... ........ .... .. ....................................... .. ....... 4 United Nations Children's Fund (UNICEF) .... ... ............................ ..... ............. ......... ..................... .... 4 United Nations Population Fund (UNFPA) ..... .... ....... ................................ ... ........... .. ........................ 5 World Bank ..................................................... ........................................... ....... .................................. 5 Other United Nations partners ............................................................................................................ 5 Other specific partnerships, including nongovernmental organizations ...................................................... . 6 Disaster preparedness training ...................... .. .... ... .................. .. .. .. ... .. ... .. .. ..... .................................... 6 Health information .. .... ....................... .... .. .................... ............ .... .... .... .... .......... .... .. ... ..................... .. . 6 Poliomyelitis eradication .. ... ....................... .... ...... .... .... ...... .......... .... ......... ...... .. ............. ................ .... 6 Malaria ................................................................................................................................................ 6 Tuberculosis ............................................. ...... .. ... .. ............. .. ....... ...... ....... ....... .. .............................. .... 7 Sexually transnritted infections .......... ....... ... .......... ........................... .. .............. ...... .... ... ................. .... 7 Nursing and nridwifery ............................................................... .. ............... .. ..................................... 7 Fanrily medicine .......................................... .... ................................... .... .... ..... ................................... 7 Pharmaceuticals ....................................... .... ... .......................... .......... ...... ........ .................................. 7 Child health .... .. ...... ... ........................... ....... ..................................... .......... .. ... .. ............................. ... .. 8 Health care reform ............................... ... .................................... ...................................................... .. 8 Other activities .......... ............. .............................. ... .. ................. ...................... .. ..... ......................... ... 8 The Regional Office's collaborative networks .. .. .... ............................ .. ...... .. ...... ................................... ...... 8 INTRODUCTION EUR/RC50/6 page I 1. The European Region is one of great political, economic, social and institutional contrasts. The public health situation, too, is very variable, with profoundly unsatisfactory conditions in the eastern part of the Region. The complex interplay between the multiple genetic, environmental and societal factors affecting health form the background to the thinking behind the work of any organization concerned with health improvement. The achievement of better health will therefore necessarily entail a process involving many actors. HEALTH21, the health for all policy framework for the WHO European Region collectively adopted by the Member States in the Region, accordingly offers a structured strategic framework for this collective action in partnership. 2. The purpose of this paper is to reflect on the Regional Office's experience of promoting and sustaining partnerships for health with other organizations interested in health over the past twelve months. Actors and partners in health in Europe 3. The Regional Office has a wide variety of interested partners, including the European Union, the Council of Europe and the international financial institutions, most notably the World Bank. Also important are the United Nations development organizations (such as the United Nations Development Fund - UNDP) and humanitarian organizations (for example, the Office of the United Nations High Commissioner for Refugees - UNHCR and the United Nations Children's Fund- UNICEF). 4. The Regional Office has continued to cooperate actively with many intergovernmental and nongovernmental organizations (NGOs), such as the International Federation of Red Cross and Red Crescent Societies (IFRC) and Medecins sans frontieres (MSF), as well as with a wide variety of organizations of various sizes dealing with specific health-related issues or illnesses. In the coming year, a review will be made of the scope and content of the Regional Office's collaboration with NGOs. The aim will be to create opportunities for a more strategic, and at the same time more regular and informal, dialogue with this sector. A framework for partnership 5. One important priority for the Regional Office will be to develop a more explicit corporate strategy for the development and maintenance of partnerships. A number of important principles are already clear, however, and these will guide the development of the strategy. 6. High-level joint political commitment to collaboration and partnership is necessary, but not sufficient. Common goals and strategies must be sought by negotiation and renegotiation; differences must be recognized and respected. Several models of collaboration are possible. 7. The overall goal is to develop and sustain an ongoing structured dialogue between organizations concerning both policy development and implementation. The resulting aim is to see ongoing technical collaboration between.the organizations' programmes, projects and activities supporting this larger strategy of political and policy partnership. 8. In each case, the level and content of collaboration need to be clear. In addition, there must be some structural and functional expression of joint commitment and activity. The more the collaboration is structured around a shared strategy, involving the sharing of programmes and activities, the more formal the expression of joint commitment is likely to be (exchanges of letters, memoranda of understanding, joint management committees, establishment of "intermediary bodies" to conduct the work on behalf of all the involved partners, etc.). EUR/RCS0/6 page 2 WHO's comparative advantage 9. WHO's comparative advantage consists of the following elements: • it has privileged relations with national health bodies; • it is an expert public health body; • it is a partner before, during and after a humanitarian emergency or disaster; • it is able to integrate humanitarian and development work; • it can carry out rapid public health surveillance and information analysis and, based on this, health- related coordination; and • it can design and implement expert public health programmes. WHO's country-based activities 10. The Regional Office's country-based activities and its capacity to deliver purposeful activity to support Member States are vital to the development of successful partnerships. Currently, support is provided at several levels: • universally applicable intercountry policies and programmes; • programmes of in-country assistance; and • national, regional and local networks for health improvement. In addition, a number of complex emergencies over the last few years have led to increasing experience in the area of humanitarian assistance programmes. 11. Overall, with the exception of humanitarian assistance, the working stance of the Regional Office up to now can be characterized as essentially intercountry, with an important but relatively limited country-based operational presence. Increasingly, however, the profile which best reflects the Organization's purpose and competitive advantage will be to act within countries, alongside the governments of Member States, as a policy adviser and supporter during discussions with other, larger development actors, such as international financial institutions and the European Union. Such a collective partnership would give the best chance of drawing up and carrying out sound political, economic, environmental, social and institutional policies that are owned by the government and sustainable in the medium to long term. 12. These objectives are those of the Regional Office's new country health strategy (see document EUR/RC50/10). The Office will assign very high priority to developing its work in countries in this way, so as to give policy direction and focus to its activities in support of governments, and to make its best overall contribution to a soundly based partnership between itself, the government concerned, and the other large development actors. EXAMPLES OF PARTNERSHIP ACTIVITY DURING 1999-2000 13. Illustrative, but not exhaustive, examples of current collaboration are provided below. Collaboration with the European Union European Commission (EC) 14. The Regional Office has had a number of collaborative projects with the EC in the area of health infonnation. The aim of these projects is to strengthen health information systems and their use at European, national and local levels, in order to pinpoint areas for public health action and for the purposes EUR/RCS0/6 page 3 of management and monitoring of health services and public health. The projects are supported by various EC directorates-general (for health and consumer protection, for research, and for the environment), and the contracts for several of the larger-scale ones have been won in open competition. The Regional Office also continues to support and advise the EC and the European Union's Statistical Office (EUR OST AT) on the development of their own health information programmes. 15. In the area of nutrition, the Regional Office has been collaborating with the Directorate-General for Health and Consumer Protection on the European Union's "Eurodiet" project. PHARE programme of reconstruction in central and eastern Europe 16. The Regional Office has collaborated with the directorates-general for enterprise and the information society and for health and consumer protection, as well as with the European Medicines Evaluation Agency, on information on medicines and pharmaceutical policies in EU countries. A member of the Regional Office staff took part in a European Conference on Medicinal Products and Public Health, held in April this year under the Portuguese presidency. There are ongoing projects in Bosnia and Herzegovina, and other countries of central and eastern Europe, as well as the PHARE-sponsored Pan- European Regulatory Forum. European Community Humanitarian Office (ECHO) 17. Malaria control activities in Tajikistan, financed by ECHO, were executed by WHO, Medical Emergency Relief International (MERLIN) and Agence de l' aide a la cooperation technique et au developpement (ACTED) during 1999-2000. An evaluation at the beginning of the year showed a significant impact of this assistance on the malaria epidemic in the country. The Regional Office has also received support for a project in Tajikistan on improving access to essential drugs - the second phase is under way, and the third phase is in the planning stage. European Sustainable Cities and Towns Campaign 18. The Regional Office's Healthy Cities project continues to be an active and committed member of the Coordinating Committee of the European Sustainable Cities and Towns Campaign. This campaign is partially supported by the EC Directorate-General for the Environment. The campaign aims to promote the development of local Agenda 21 action plans in Europe. At present, more than 300 local authorities representing more than 75 million people have joined. EU surveillance networks 19. Following a proposal by the EC's informal group of national focal points for surveillance of infectious diseases (known as the Charter Group) and WHO, the EU's surveillance networks have recognized the need for close collaboration with the Organization and agreed that the Regional Office has observer status at meetings of the Charter Group. The work done both by the Regional Office and by WHO headquarters is relevant in this connection. 20. Decision-makers from 27 Member States attended a recent consensus meeting on surveillance of infectious disease, held in Rome at the beginning of April 2000. EU representatives were also invited to share their objectives and strategies. At the end of the meeting, all the participants signed a declaration on common standards for surveillance of infectious disease in the European Region, and a set of recommendations was addressed to Member States, WHO and international partners. EU accession process 21. WHO is committed to contributing its policies, expertise and experience to assist its Member States concerning the health aspects of accession to membership of the European Union. In 1999, for example, the Regional Office assisted the government of the Netherlands in selecting priority areas and countries to receive funds to facilitate the accession process. EUR/RCS0/6 page 4 Other EU activities 22. A memorandum of understanding between WHO and the European Monitoring Centre for Drugs and Drug Addiction was signed in April this year. 23. The Regional Director participates as an observer in the meetings of the Chief Medical Officers of the European Union, and he attended the meeting in March this year in Evora, Portugal, the aim of which was to review the scientific evidence on the determinants of health in the EU. 24. A project on city cycling, "Promotion of energy-efficient personal transport in a network of European cities" (SA VE II) was initiated in February this year. This project is partly funded by the Directorate-General for Transport and Energy and is a 20-month project involving eight European Healthy Cities. Council of Europe 25. The Regional Director paid a visit to the Council of Europe in March this year, the main aims of which were to develop a joint programme of work promoting peace and stability, democracy and free elections, building civil society and fostering human rights in south-east Europe, in the context of the Pact for Stability in the Balkans. Following the signature of a letter of intent between the Council of Europe and the Director-General's Special Representative in Russia, two Council staff members are to be based in Moscow, to strengthen its action in tackling tuberculosis in Russian prisons. 26. The Regional Office continues to be represented on and involved in the work of the Council of Europe's European Health Committee (CDSP). COLLABORATION WITHIN THE UNITED NATIONS SYSTEM United Nations Development Programme (UNDP) 27. In October 1999 a joint WHO-UNDP team went to the Caspian Sea area of Kazakhstan and Turkmenistan, in order to identify the major health problems affecting the population that could be linked to environmental causes and to develop specific remedial environmental health actions. The visit was co- funded by UNDP, and a follow-up mission is planned for July 2000. 28. A joint project has been developed to help Azerbaijan build capacity in carrying out environmental health impact assessments, in order to investigate the effects of the past and present hazards posed by the highly polluting industrial activities that used to be carried out in the city of Sumgait. 29. The Minister of Health of Turkey has approved a plan to conduct a United Nations "Training in Management" exercise (organized by UNDP) on the general aspects of national disaster management programmes. This will be followed by a two-week "Train the trainers" course on the health aspects of disaster management. The Regional Office will provide support to both of these events. United Nations Children's Fund (UNICEF) 30. UNICEF is widely involved in community-based and local action to improve the health of young children and pregnant women, its prime targets. UNICEF is committed to increasing its support for the Roll Back Malaria programme by strengthening training and surveillance activities, providing basic equipment, reagents and drugs for early malaria diagnosis and treatment, and improving the skills of health personnel. 31. A joint project on training trainers in family health nursing concepts is under way in the former Yugoslav Republic of Macedonia. The trainers will then train all community nurses from four rural areas. EUR/RCS0/6 page 5 The Regional Office has also collaborated with UNICEF on a "Youth in transition" project, as well as on four country assessment missions on adolescent health and in the interagency working group on adolescent health. 32. WHO works predominantly with UNICEF on all aspects of the Expanded Programme on Immunization. The Vaccine Independence Initiative is being jointly implemented in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. WHO is part of the Global Alliance on Vaccines and Immunization/Global Fund for Children's Vaccines, together with the Bill and Melinda Gates Foundation, UNICEF, the World Bank, IFRC, the International Federation of Pharmaceutical Manufacturers' Associations (IFPMA) and the Rockefeller Foundation. 33. The elimination of measles is one of the major objectives of the Regional Office. WHO works in partnership with the Centers for Disease Control (CDC) in Atlanta, Georgia (United States), the United States Agency for International Development, UNICEF and IFRC in central Europe, the Balkans, and the central Asian republics and Kazakhstan. United Nations Population Fund (UNFPA) 34. The Regional Office has been involved in country activities, financed by UNFP A, to strengthen reproductive health in Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Georgia, Kazakhstan, Romania, the Russian Federation, Tajikistan, Turkmenistan and Ukraine. Furthermore, the Office collaborates with UNFPA on producing Entre nous, the European magazine for reproductive health. World Bank 35. The World Bank continues to be a key partner for the Regional Office. The World Bank group has strongly supported the Roll Back Malaria global partnership. The Bank also supports health sector reforms, one example being the master plan for health care reforms in Kyrgyzstan. 36. In Azerbaijan, an important development over the past few years has been the support provided by the Bank to rehabilitate the Apsharon canal, to review the rural social infrastructure and to prepare a second project on irrigation. 37. The Regional Office's nutrition programme is providing input to the World Bank's nutrition strategy paper for countries of central and eastern Europe (CCEE) and newly independent states (NIS). The Office's Maternal and Child Health unit has collaborated closely with the World Bank over the past year, particularly on projects in Romania, the Russian Federation and Uzbekistan. 38. The World Bank and the Regional Office have jointly prepared an agreement on short-term clinical courses for trainers in Uzbekistan, and the Bank has provided a loan. One of the objectives of this project is to develop the skills of health personnel in rural medical centres in three pilot regions, through the short-term training of general practitioners. Other United Nations partners 39. Close operational collaboration continues with the Office of the United Nations High Commissioner for Refugees (UNHCR) in all theatres of humanitarian operations, currently Albania, the Federal Republic of Yugoslavia, Kosovo, the former Yugoslav Republic of Macedonia, the Russian Federation (the North Caucasus) and Tajikistan. 40. The World Food Programme (WFP) is also a key humanitarian partner. As an example, to stimulate government staff to improve their perf orrnance in the field, WFP supplied food to field workers involved in carrying out a malaria control campaign in Tajikistan during 1999. A new project proposal to continue such support is being considered by WFP. EUR/RC50/6 page 6 41. The International Labour Organization (ILO) provided technical contributions to and comments on the development of two Regional Office documents, Guidelines on quality management in multidisciplinary occupational health services, 1 and Occupational medicine in Europe: scope and • 2 competencies. OTHER SPECIFIC PARTNERSHIPS, INCLUDING NONGOVERNMENTAL ORGANIZATIONS Disaster preparedness training 42. The Regional Office participated in preparing a module on "Disaster preparedness and emergency health management" for a training course organized by the International Children's Centre and held in Ankara in April this year. Health information 43. One of the problems often mentioned in connection with the international collection and exchange of data is that the various international organizations active in this field are collecting the same or similar data from their Member States. Not only does this impose an unnecessary workload, it also reduces the international comparability of the information owing to the existence of different definitions or standards. Better international harmonization of health data collection and definitions is needed, primarily between the Organisationfor Economic Co-operation and Development (OECD), EUROSTAT and the Regional Office's health monitoring programme. This work is ongoing: WHO and OECD continue to have informal agreements for the mutual exchange of data of common interest, and attempts are being made to harmonize the definitions of common indicators. Poliomyelitis eradication 44. The Regional Office's poliomyelitis programme has continued to cooperate closely with UNICEF in organizing national immunization days in recently endemic countries. UNICEF and CDC (Atlanta) have provided technical assistance with improving the surveillance of poliomyelitis and acute flaccid paralysis in the Region, including participation in surveillance assessment missions. Malaria 45. Roll Back Malaria is an initiative which brings together a wide variety of partners, including those from the private sector. Within countries, the Roll Back Malaria movement has the backing of governments and development agencies, nongovernmental organizations and private sector groups, researchers and the media, all working together. In support of these country partnerships, WHO and its partners encourage malaria-related action to be taken in the context of national strategies to develop the capacity and outputs of the health sector. • In Tajikistan, Agence de ['aide a la cooperation technique et au developpement (ACTED) is focusing on the promotion of community-based approaches to malaria prevention. Thousands of mosquito nets have been distributed and impregnated by communities, under the supervision of technical personnel from ACTED. Entomological studies related to the use of mosquito nets were also carried out in selected districts of the southern part of Tajikistan. • In 1996, IFRC launched a programme in Azerbaijan to combat the re-emergence of malaria in the southern districts of the country. In Armenia IFRC has been active in malaria control activities since 1997; the programme targets 100 000 people, supporting health education and information activities and active case detection. 1 Available from the Regional Office (document EUR/ICP/EHBI 02 02 03). 2 Available from the Regional Office (document EUR/ICP/EHBI 02 02 04). EUR/RCS0/6 page 7 • ENI (an Italian oil company) has been present in Azerbaijan through its subsidiary, Agip Azerbaijan, since 1995. Its involvement in malaria control activities dates back to 1997, when it started to collaborate with WHO in assisting the Ministry of Health to combat the disease, by supplying antimalarial drugs and biodegradable insecticides. • The Regional Office hopes that support will be forthcoming for Roll Back Malaria interventions planned for 2000 in Georgia and Tajikistan, while UNDP, UNICEF, the European Union, the Japan International Cooperation Agency (JICA) and the South-East Anatolia Project (Global Action Plan for the Earth, Turkey) will provide assistance in kind for malaria control in Turkey. Tuberculosis 46. WHO is working with a number of international and bilateral institutions and agencies to promote tuberculosis control and implementation of the DOTS (directly observed treatment, short course) strategy. These include USAID, the United Kingdom's Department for International Development, the governments of Finland, France and Norway, as well as ECHO. Implementing partners include CDC (Atlanta), Project HOPE, Abt Associates Inc., Medecins sans frontieres, MERLIN, the International Committee of the Red Cross (ICRC), the Soros Foundation, the French Institut de Veille Sanitaire (In VS), the International Union against Tuberculosis and Lung Diseases (IUATLD) and various national tuberculosis institutions. Sexually transmitted infections 47. In February 1998 WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and international agencies created a task force to mobilize and coordinate international support to help control the rapidly evolving epidemics of sexually transmitted infections (STI) in many newly independent states (NIS). The Regional Office hosts the secretariat of the Task Force. The Task Force advocates policy changes and structural reforms in health care delivery and STI prevention and assists countries in developing the capacity to carry out those reforms. Nursing and midwifery 48. The purpose of the Second WHO Ministerial Conference on Nursing and Midwifery in Europe (held in Munich from 15 to 17 June 2000) was to identify and analyse the unresolved obstacles which have prevented the nursing and midwifery professions from contributing more forcefully to meeting people's needs for care over the past decade, and to prepare strategies for overcoming these obstacles. One implicit aim of the Conference was to secure the commitment of ministers of health and other government ministries to carrying out the necessary changes. Family medicine 49. The Regional Office has contributed to the sixth edition of the reference book issued by the European Union of General Practitioners.3 The document Framework for professional and administrative development of general practice/family medicine in Europe4 will also be included in this publication. Pharmaceuticals 50. The Regional Office has collaborated with the Russian Federation on a project to foster good manufacturing practice among Russian manufacturers of anti-tuberculosis drugs, with the aim of improving the control of tuberculosis and HIV infection. 3 European Union of General Practitioners reference book 1999-2000. London, Kensington Publications, 1999. 4 Available from the Regional Office (document EUR/ICP/DL VR 04 01 01). EUR/RC50/6 page 8 Child health 51. The Regional Office has worked on joint projects in countries, such as training activities in child health. The contacts made with representatives of the different organizations at country level have laid the foundation on which to build much closer partnerships. 52. The Asian Development Bank invited the Regional Office to take part in a mission on community- based early childhood development in Kyrgyzstan in December 1999, and a follow-up mission took place in July this year. Health care reform 53. A grant of US $100 000 was received from the Open Society Institute - Soros Foundation for developing national clinical guidelines in the Russian Federation. This project, which includes activities related to health care reform, is expected to be completed by the end of 2000. Other activities 54. Medecins sans frontieres Belgium is active in three regions of Azerbaijan, helping the Ministry of Health to improve the quality of services for the local population. Two main programmes have been carried out: a laboratory programme ( 1996-1998) and a specific malaria programme ( 1998-1999). THE REGIONAL OFFICE'S COLLABORATIVE NETWORKS 55. The annual meeting of the European Forum of Medical Associations and WHO (EFMA) took place in Warsaw in March 2000, hosted by the Polish Chamber of Physicians and Dentists. The Forum adopted various statements (on control of tuberculosis in prisons and patenting of the human genome, among other subjects), as well as a declaration on physicians' autonomy. 56. The network of pharmaceutical associations and WHO (EuroPharm Forum) has collaborated on the development of best pharmacy practice in the areas of asthma care, diabetes care, hypertension management, HIV/ AIDS, and tobacco control. 57. The European Observatory on Health Care Systems is a partnership between the Regional Office, the governments of Norway and Spain, the European Investment Bank, the World Bank, the London School of Economics and Political Science, and the London School of Hygiene and Tropical Medicine, in association with the Open Society Institute. The Observatory supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe. 58. A memorandum of understanding between the Regional Office and the Tipping the Balance network was signed in 1998, and since then there have been a number of activities with this network, especially with regard to supporting implementation of the HEALTH21 policy framework in the area of primary health care. 59. The European Network of Health Promoting Schools is a project which is supported jointly by the European Commission and the Council of Europe. This collaboration has ensured the development of an international consensus on the concept of the health-promoting school, and has made it possible to avoid duplication of effort within the area of health promotion and health education in the school setting.