Fiftieth Meeting of the Regional Director with the WHO Representatives New Delhi, 26-30 November 2001

SEA-WRM-50 Distribution: Restricted Fiftieth Meeting of the Regional Director with the WHO Representatives New Delhi, 26-30 November 2001 Report of the Meeting WHO Project: 000 GBS 001 World Health Organization Regional Office for South-East Asia New Delhi April 2002 (C) World Health Organization (2002) The contents of this restricted document may not be divulged to persons other than those to whom it has been originally addressed. It may not be further distributed nor reproduced in any manner and should not be referenced in bibliographical matter or cited. Page iii CONTENTS Page SECTION 1: INTRODUCTION.................................................................................1 SECTION 2: INDIVIDUAL DISCUSSIONS WITH DEPARTMENTS...........................2 SECTION 3: BUSINESS SESSION..............................................................................3 3.1 Regional Director’s Opening Remarks................................................................3 3.2 Programme Development and Management .....................................................4 3.3 Technical Updates ..........................................................................................14 3.4 Managerial Issues ............................................................................................23 SECTION 4: ACTION POINTS ...............................................................................26 SECTION 5: CLOSING SESSION ............................................................................29 5.1 Concluding Remarks by the Regional Director .................................................29 Annexes 1. Agenda............................................................................................................30 2. Programme......................................................................................................32 3. List Of Participants...........................................................................................34 Page 1 Section 1 INTRODUCTION The fiftieth meeting of the Regional Director with the WHO Representatives was held in the Regional Office, New Delhi, from 26-28 November 2001. The WHO Representatives (WRs), Head of the WHO Office in East Timor, Regional Director, WHO’s American Region, and Director, Combating Communicable Diseases, WHO Regional Office for the Western Pacific, as well as senior staff from the Regional Office, attended the meeting. The meeting was opened by Dr Uton Muchtar Rafei, Regional Director. While Section 3 of this report contains the salient points of the discussions arising from the meeting, Section 4 includes the important action points. Report of the Fiftieth Meeting of the RD with the WRs Page 2 Section 2 INDIVIDUAL DISCUSSIONS WITH DEPARTMENTS 2.1 Specific Issues Relevant to Each Member Country The last two days were devoted to individual discussions with Departments on issues relating to implementation of country and ICP-II plans of action in the 2000-2001 biennium, lessons learned during the formulation of Programme Budget for 2002-2003 and development of detailed work plans, and other managerial and administrative issues concerning the WHO collaborative programme in Member Countries. The details of issues, discussions and conclusions arising out of these discussions will be sent to the concerned WRs separately, for follow-up actions wherever necessary. Report of the Fiftieth Meeting of the RD with the WRs Page 3 Section 3 BUSINESS SESSION 3.1 Regional Director’s Opening Remarks Addressing the WRs, the Regional Director stated that during the past one year, there had been several changes and developments within WHO as well as the outside world. These changes had directly and indirectly affected the health of the people and the way WHO worked. Therefore, Dr Uton urged the WRs to be alert and look for opportunities beyond health programmes to improve the health of the people. Dr Uton stated that programme implementation had improved considerably during the current biennium, particularly at the country level. Despite this improvement, an estimated US$13 million would be carried forward as reserves to 2002. To reduce the surrender of funds to HQ to the minimum, it was critical that all earmarked funds were immediately obligated and all obligated funds liquidated to the maximum extent. Dr Uton stated that joint efforts by WHO and the Member Countries had resulted in greatly improving both the content as well as the quality of the country and intercountry work plans. Member Countries had been fully involved in the preparation of intercountry work plans, through the High-level Task Force, which approach had been well received by delegates from all Member Countries. The 54th session of the Regional Committee had adopted a resolution urging all concerned to implement 85 per cent of the total budget by end-December 2002. In order to meet this target, country work plans should be modified and proposals for implementation of planned activities finalized as soon as the new biennium started. Report of the Fiftieth Meeting of the RD with the WRs Page 4 3.2 Programme Development and Management (Agenda item 2) Liquidation of reserves, 1998-1999 Ø Of the $ 16 million reserves carried forward from 1998-1999, a total of more than $ 3.6 million (22.5%) has been surrendered to Miscellaneous Income. Ø During the last three biennia, SEARO has surrendered a total of over $ 12 million. Implementation, PB 2000-2001 Ø SEARO has done very well in the current biennium with over 95% implementation as at 31 October 2001; only AFRO (98%) has a higher implementation rate. The countries have done particularly well - nine of out of 10 have achieved 100% implementation by 30 June 2001. Ø The challenge now lies in liquidating the remaining outstanding obligation of $ 11.6 million, and obligating $ 1.9 million that has been earmarked. Implementation, PB 2002-2003 Ø The 85% target set by RC54 for implementation (i.e. obligation + earmarking) by 31 December 2002 will present a challenge to all staff in the Region. Highlights of presentation by WR, Nepal Ø Improved monitoring, close collaboration with the staff of the Ministry of Health, the availability of international staff and national officers as well as stability in the Ministry of Health have helped Nepal to improve its implementation from 59% (of 75% allotment) on 15 June to 99% on 15 October 2001. Ø Achieving realistic planning still presents a challenge. Ø Impediments to good quality implementation included, on the WHO side, repeated change in plans of action structure and poor communication between Technical Units and BFO in SEARO. On the government side, low absorption capacity and weak monitoring and coordination are obstacles. Report of the Fiftieth Meeting of the RD with the WRs Page 5 Ø There is a need to ensure that programme activities are of high quality and sustainable. Ø There is a justification for the WR to be authorized to accommodate unplanned activities e.g. emergency preparedness. Also, WHO support is spread over too many programmes which causes difficulty in monitoring programme implementation. Ø WRs should be authorized to manage independently some pooled funds at the end of the biennium. They should also have greater discretion in incurring expenditure. Highlights of presentation by WR, India Ø The appointment of National Programme Officers will greatly facilitate the preparation and implementation of Plans of Action for 2002-2003. Ø In monitoring the rate of financial implementation, it is important not to lose sight of the requirement to maintain the technical quality of programme implementation. Ø WHO should review globally its policy on Local Cost Subsidies with a view to raising the current limits. Experience in other countries Ø In Indonesia, the importance of WHO staff screening draft proposals within the Ministry of Health, before they reached the WR office, was stressed. Ø In Bangladesh, nongovernmental organizations and professional associations have been used very successfully to implement programme activities. Ø In Sri Lanka, experience has shown the importance of good initial planning. Ø Difficulties in effectively identifying programme priorities at the country level were highlighted by a number of WRs. Ø The increase in Local Cost Subsidies from 15% of the Programme Budget in 1998-1999 to 21% in the current biennium may reflect the effect of economic crisis. Report of the Fiftieth Meeting of the RD with the WRs Page 6 Conclusions (a) The drive to convert obligations into liquidations and earmarkings into obligations must continue unabated. (b) The effective 23-month biennium in 2000-2001 for country allocations, resulting from the closure of accounts for country programme on 30 November 2001, may result in a slightly larger carry forward of reserves than anticipated. However, it is hoped that these unliquidated obligations are based on better planning and, therefore, will be less likely to be subject to surrender because of non- or under-implementation. (c) There is a need for the Region to agree on a clear policy to ensure that the 85% target set by the Regional Committee is taken very seriously by WHO staff and national counterparts. Work plans for PB 2002-2003 including programme evaluation at country and regional levels Ø While noting the work plans for 2002-2003 for country and Regional Office/Intercountry programmes, the 54th session of the Regional Committee called for a strong commitment and joint endeavours by Member Countries and WHO to meet the implementation target of 85% of planned activities by the end of the first year of the biennium (Resolution SEA/RC54/R1). Ø The External Auditor had recommended that the Regional Director should approve the detailed work plans prior to the start of implementation. Therefore, all countries should refine their work plans and submit them to the Regional Office for budgetary clearance and approval by the Regional Director. Ø The WHO governing bodies had stressed the importance of close monitoring and effective evaluation of the WHO collaborative programme within the overall framework of WHO managerial process for programme development and management. Ø Based on the evaluation framework endorsed by the 107th session of the Executive Board, the WHO Secretariat, at all levels, had to adopt the monitoring and evaluation mechanisms and processes for the biennium 2002-2003 and also for future bienniums. Report of the Fiftieth Meeting of the RD with the WRs Page 7 Ø Based on the experience gained during the formulation of detailed work plans for the 2002-2003 Programme Budget, improvements would be made while undertaking a similar process for the 2004-2005 Programme Budget. Orientation training on result-based planning and management within the overall managerial process would be provided. Country programme formulation teams would update the WHO Country Cooperation Strategy through a coordinated formulation process with the full involvement of the national health administration. Ø Monitoring and evaluation were different tools of managerial process and their applications and purpose should be clearly understood. Monitoring of implementation of activities was a continuous process to assess the progress made and also to identify strengths and weaknesses encountered while implementing planned activities. Ø Evaluation is done to assess effectiveness in relation to expected results planned for a particular biennium or more bienniums. All countries would undertake evaluation of the performance of the WHO collaborative programme. At the regional level, at least one thematic programme would be evaluated per biennium. Specific evaluation guidelines would be issued by WHO/HQ. Highlights of presentation by WR, Bangladesh Ø Programme managers encountered considerable difficulty in clearly understanding the application of some of the new terminologies used during the formulation of detailed work plans for 2002-2003. One such example was “baseline” information. Ø The six-monthly reporting format needed broadening as the current format did not provide for information on “schedule or delivery of products/services”, “need to make changes to products”, “financial implementation” and “lessons learned”. Ø The proposed country programme for 2002-2003 was not expected to yield measurable or perceptible results, which could be evaluated in terms of their impact. Clear evaluation criteria and terms of reference should be provided. Ø The format for evaluation is at present limited to the work plan level and does not provide a holistic approach. The scope of evaluation is limited to Report of the Fiftieth Meeting of the RD with the WRs Page 8 Regular Budget and ignores WHO’s core function activities which are significant, such as advocacy, partnership and EB-supported programmes. It does not take into account the role and contribution of WHO to the country’s overall health programme. Highlights of presentation by WR, Maldives Ø Regular periodic meetings of the Government of Maldives/WHO Joint Coordination Mechanism ensured close monitoring of progress of implementation of planned activities. Since AMS is not yet operational in Maldives, PDM monitoring sheets are used to review financial implementation. Reports are generated at regular intervals for joint meetings and six-monthly reports are sent to the Regional Office for comments. Conclusions (a) The format for the six-monthly reporting should be enlarged to include information on the schedule of delivery of products and lessons learned. (b) Detailed guidelines on evaluation should be provided. Integrated Programme Budget 2004-2005 and WHO Country Cooperation Strategy Ø All countries of the Region had prepared the WHO Country Cooperation Strategy (CCS) document for the period 2002-2005, which is used for preparing the regional component of PB 2002-2003 and the detailed work plans for the biennium. These documents would be updated as necessary. Ø As a first step, the Regional Office would undertake an evaluation of CCS to suggest changes in the content and process of development. The evaluation would determine the process, relevance and utilization of CCS in relation to strategic and operational planning for the 2002-2003 biennium. It would also suggest changes in the process and format of CCS. Ø Following the receipt of the Director-General’s procedural guidance for the preparation of PB 2004-2005, extensive consultation would take place between staff responsible for each area of work in SEARO with their Report of the Fiftieth Meeting of the RD with the WRs Page 9 counterparts in HQ for the formulation of PB 2004-2005 Part-I. The initial draft would be finalized by the GPMG meeting in March 2002, and reviewed by the Global Cabinet in April 2002 before presentation to the 55th World Health Assembly. Ø Simultaneously, SEARO would initiate the development of the regional component or Part-II of PB. In order to have country inputs into this regional component, a meeting of Planning/Management Officers in the WHO Country Offices and their national counterparts would be convened in January 2002. Ø The draft of the regional component (Part II) of 2004-2005 PB would be reviewed by the Health Secretaries of the Countries of the WHO South- East Asia Region, at their seventh meeting, to be held in Nepal in April 2002. This would be submitted to the 39th Meeting of CCPDM and the 55th session of the Regional Committee in September 2002, in Indonesia, for review and noting. Highlights of presentation by Mr Helge Larsen, Director Budget and Management Reform, WHO/HQ Ø The Global Cabinet, at its meeting in November, had cleared the draft of the procedural guidance from the Director-General for the preparation of the Programme Budget 2004-2005. Some key features of PB 2002-2003 would be retained. Ø The Programme Budget would be jointly developed by the WHO headquarters and the Regional Offices through a better consultation process, and promoting ownership and commitment at all levels of the Organization. Ø The preparation of PB 2004-2005 would be simpler compared to PB 2002-2003. The basic structure would remain the same as that of PB 2002-2003, with 35 Areas of Work, 5 Headings and 11 Organization- wide priorities. A new priority area on “Health and Environment” would be included in PB 2004-2005 in place of “Investing in Change in WHO”. Ø Sharper focus would be placed on Expected Results and Indicators and fine-tuning of areas of work would be done to eliminate overlaps. Report of the Fiftieth Meeting of the RD with the WRs Page 10 Ø The Meeting of DPMs and Executive Directors would finalize the initial draft of PB 2004-2005 in March 2002, which would be reviewed by the Global Cabinet in April 2002, and the final draft document despatched to the Regions by July 2002. Highlights of presentation by WR, Bhutan Ø In line with the WHO Corporate Strategy, the Common Country Assessment (CCA) in Bhutan, which is a country-based process involving all UN Agencies, reviews and analyses the national development situation. It also identifies key development challenges as a basis for advocacy, policy dialogue and preparation of the United Nations Development Assistance Framework (UNDAF) for 2002-2007, in tune with the country’s Ninth Five-Year Plan. Ø CCA identified people-centred themes and formulated strategies for health services delivery in the country. The main goals and objectives of CCS and CCA are highly complementary. Ø CCA, incorporating WHO’s strategic directions, core functions and priorities, serves as the platform for collaboration for the UNDAF. Ø The overall development philosophy of the country was maximising “gross national happiness” which includes human development as its first objective. Ø UNDAF’s activities are expected to contribute to a reduction in poverty in Bhutan through good governance and social services delivery. Operating within the context of the Royal Government’s vision of accomplishing poverty elimination goals by the year 2020, the UN system is committed to achieve reduction of 50% in poverty by 2015. Highlights of presentation by WR, Sri Lanka Ø A series of processes were envisaged towards operationalizing CCS. The Regular Budget resource allocation for 2004-2005 would be directly linked; mapping of WHO activities in the health sector; selection of evidence-based priorities; and projection of future health sector would be undertaken. Report of the Fiftieth Meeting of the RD with the WRs Page 11 Ø With regard to issues related to the preparation of PB 2004-2005, the current planning format was a reflection of the continuation of project planning rather than programme planning. The current planning format did not provide enough scope for indicating staff responsibility and accountability. Ø There should be clear linkages between country work plans and the areas of work at the global level. Ø There should be adequate emphasis on how resources are reflected and linking and or mapping of relationship between country work plans and intercountry work plans. Ø There is a need to address specific country requirements and sector funding situation, a shift from top-down approach to bottom-up planning. Conclusion SEARO AOW focal points in consultation with the WHO country offices and national counterparts would provide the regional input to the formulation of Part I of PB 2004-2005. SEARO and WROs would jointly prepare the draft of Part II of PB 2004-2005. Collaboration between South-East Asia Region and WHO headquarters Ø Increased dependence on extrabudgetary funds for staff positions. HQ mobilized 80% of resources generated from extrabudgetary sources. Ø WHO’s presence throughout the world should be effectively used in promoting its leadership role in health-related activities and not in comparison to other donor or partner agencies. There should be a shift in focus from the regional offices to the country offices for technical guidance. Ø There should be Improved interaction and collaboration through modern communication technology such as e-mail. Ø In the case of resource mobilization at the country level, the issue of sharing of Programme Support Cost was raised. This was still a contentious issue and was being debated at WHO headquarters. Report of the Fiftieth Meeting of the RD with the WRs Page 12 Ø HQ should cooperate in more effective ways to push the country offices in order to have a technical cutting edge. Unless and until the technical capacity of the country office is strengthened, it was difficult to convince partners and donors regarding mobilization of additional resources for health-related sector activities. Ø HQ should give clear indication as to the extent of availability of extra- budgetary resources mobilized by it to be spent in the Region and countries in order for them to be clearly indicated in the relevant country and regional work plans. Ø There was considerable delay in the flow of extrabudgetary funds reaching the country offices. This would, in the long run, result in losing WHO’s reputation of competitiveness. Conclusions (a) HQ would streamline the flow and utilization of extrabudgetary resources at the country and regional levels. (b) More and more joint programming would result in a better understanding of resource allocation and some flexibility. (c) The Director-General’s procedural guidance lays down basic principles of programme formulation but would not indicate any budget allocation by country. It would be in accordance with the WHA resolution WHA51.31. (d) The issue relating to budget allocation would be discussed by the Director-General with the Regional Directors after the 109th session of the Executive Board in January 2002. In the context of an Integrated Programme Budget for 2004-2005, the allocation for the Region, both for Regular Budget and Extrabudgetary funds, would be given with no indication of further breakdown. It was up to the Regional Directors to decide on the country allocations. Collaboration between South-East Asia and American Regions Ø AMRO’s technical collaborative programme is supported by seven Technical Divisions including one Special Programme for Health Analysis based on the values and principles of equity and “Pan Americanism”. It is specially committed towards preventing additional 25000 infant deaths Report of the Fiftieth Meeting of the RD with the WRs Page 13 every year, eliminating measles, maintaining the Region as polio-free, promoting safe blood, tobacco-cessation, mental health and reducing maternal mortality. Ø An integrated management system incorporating the best practices in the UN system provides effective planning, execution, monitoring and evaluation within the framework of overall managerial processes. Staff could take advantage of the system to provide efficient and effective technical support to the Member Countries. Ø Participatory and results-based management, accountability and transparency are the basic tenets of technical cooperation. National expertise is used in promoting technical cooperation through training and use of collaborating centres and other regional and local support. Ø PAHO has a self-sustaining revolving fund with a clearly defined procurement arrangement between suppliers and buyers of vaccines, enhancing the “Pan-American” approach, which is one of the founding principles of the Organization. It provides countries with a continuous source of fund for buying good quality vaccines and syringes without interruptions to maintain programme activities at constantly lower prices. Ø SEARO could draw lessons from the collaborative process in PAHO and explore the possibility of sharing information and ideas in order to improve programme delivery to the Member Countries. Progress report on Activity Management System Ø AMS has been introduced in India, Indonesia, Sri Lanka and Thailand for financial and pipeline monitoring only. Ø In the forthcoming biennium, there will be a choice between two approaches - decentralized (with AMS database in the WR’s office) and centralized (AMS database in SEARO). The choice depends on whether reliable Internet connectivity exists. Ø SEARO has developed two web-based systems which are allied to AMS - Technical Monitoring and Financial Monitoring, which will be extended to WR offices in early 2002. These developments are based on business rule reviews involving countries and the Regional Office which took place in the last quarter of 1999. Report of the Fiftieth Meeting of the RD with the WRs Page 14 Discussion Points Ø AMS needs to be made more user-friendly on the lines proposed by SEARO. Ø The future of the PDM system, which currently provides the key financial implementation data, needs to be kept under review with a view to possible replacement. Ø Countries that lack access to AMS should be supported strongly. 3.3 Technical Updates (Agenda item 3) Update on GAVI and Polio Eradication Ø Key immunization programme goals for 2002-2005 are: polio eradication, measles mortality reduction, NNT elimination, 80% EPI coverage in all districts, institution of safe injection practices, and introduction of hepatitis B vaccine in all countries. Ø As of November 2001, wild poliovirus transmission in the Region continues only in India. To date, 164 cases have been reported. Ø Strategies will focus on supplemental immunization activities, AFP surveillance, and improved routine immunization. Ø Measles remains a major cause of child mortality, causing an estimated 223000 deaths per year. NNT has been eliminated in five countries, but remains a problem in the Region. Ø GAVI applications for India and Indonesia are still under review. All other eligible countries have received approval, conditional approval, or approval with clarifications. Ø Challenges for polio include improving social mobilization and ensuring adequate planning and supervision, government and donor support and training of health workers. Ø Challenges for other immunization programme activities include: improving routine EPI without losing sight of polio priority; finding sustainable methods for immunization safety; implementing hepatitis B vaccine programmes and ensuring financial sustainability for new and continuing vaccine programmes. Report of the Fiftieth Meeting of the RD with the WRs Page 15 Experience in other countries Ø Implementing hepatitis B vaccine will require careful consideration of cold chain capacity. Ø Improving routine EPI includes strengthening management training, service delivery, cold chain and logistics capacity, and increased emphasis on injection safety. Ø WRs should work closely with Ministries of Health and other partners to emphasize the importance of sustaining high coverage of routine immunizations and facilitate the introduction of new vaccines. Ø Coverage data can be highly political issues. Governments should be fully consulted before publishing data in WHO publications. Ø Certification of polio eradication is undertaken on a regional rather than County basis. Conclusions (a) Polio eradication remains the key priority for immunization activities in SEAR. Strategies are in place to meet this target by 2005. (b) At the same time, WHO and Ministries of Health must give additional attention to improve routine EPI systems, both to facilitate the introduction of new vaccines as well as to further increase the coverage of basic vaccine preventable diseases. Global Fund for AIDS and Health / regional coordination Ø Purpose, Scope and Principles of Fund Ø Coordination of global partnership to halt and reverse the trends and spread of these diseases Ø Role of Transition Working Group (TWG) and Technical Support Secretariat (TSS) Experience in other countries Ø Taking a lead from the experience of GAVI Report of the Fiftieth Meeting of the RD with the WRs Page 16 Ø A new initiative to combat three different major public health problems. Conclusions (a) GFATM will support countries who meet the eligibility criteria in scaling up effective interventions against these three diseases. (b) Mechanisms being established to address issues relating to governance, eligibility criteria and country implementation processes. (c) TWG to decide (before end-2001) the target date for making the Fund operational. (d) WHO and Member Countries should be ready to prepare proposals and implement activities. Mobilization of resources from other global funds, such as Global TB Fund, UN Fund, Bill and Melinda Gates Foundation, etc. Ø The current biennium has seen a notable increase in extrabudgetary resources. The main source of EB resources traditionally has been contributions from the governments. However, the current positive trend is not without concern. The level of commitments and contributions from donor governments may not remain the same. In the current global economic recession, a decline in ODA is not unlikely. Ø In this context, the newly established large foundations of a global stature, such as UNF and Gates and Melinda Foundation, are a positive development offering new potentials and opportunities for SEAR for mobilizing additional resources. Ø It is necessary to make all possible efforts to explore these global foundations in order to broaden the WHO resource base, sustain the current increase in EB funds, safeguard against the effects of global economic recession affecting donors’ contributions and utilize opportunities offered by these foundations. Ø In SEAR, contributions from foundations received through HQ accounted for 9.2% during 1998-1999 and increased to 13.2% during 2000-2001 (as of November 2001). Report of the Fiftieth Meeting of the RD with the WRs Page 17 Ø The UN Foundations, as a matter of policy, encourage project development by UN country teams and joint country projects with partnership among the UN agencies. They also encourage submission of all country project proposals through the Resident Coordinator system. WHO encourages the partnership and the joint programming approach. It has no objection to submission of proposals by the UN Resident Coordinator but channelling of funds to WHO through the Resident Coordinator is not acceptable to the Organization. An understanding has been reached with UNF that funds for WHO implementation would be transmitted through WHO only. Ø The Bill and Melinda Gates Foundation has shifted its focus from broad- based health to more specific and selective health priorities. All project proposals for funding, either from regional offices or country offices, are to be channelled through WHO/HQ. Ø How best the Resident Coordinator System for UNFIP funds, including the potential for joint programming in partnership with other UN agencies, has to be decided in the light of the WRs’ experience in the country. Ø Important issues relating to delegation of authority to the Regional Office and WHO country offices, simplification of EB management procedures, equitable sharing of AS funds etc. have already been raised by RD and DRD at the appropriate forums. Experience in other countries Indonesia Ø WHO engages itself in mobilizing funds both for WHO programmes and the country’s national health sector. Ø Country-level fund raising is important and successful since most donor agencies have delegated authority to the country level; donors take part in formulating local projects and WHO country office staff collaborate closely with donors, MoH, RO and HQ; WHO’s knowledge and expertise are recognized. Ø Competent technical staff on the country team, the Organization’s ability to respond quickly to donors’ needs and transparency by financial and technical reporting on the utilization of donors’ fund are essential for confidence building in the countries. Report of the Fiftieth Meeting of the RD with the WRs Page 18 Ø Among the key problems that constrain resource mobilization efforts in the countries are: lack of understanding on the part of WHO technical staff of the fund-raising and donor collaboration process, inadequate understanding of WHO by the donors, insufficient attention to health advocacy, time-consuming process involved in UN consolidated appeals and slow and complex WHO process in contract clearance, transfer of funds and recruitment and procurement. Myanmar Ø Since the late 1980s, the UN has been the major source of supporting social sector and other essential needs of the community. From the year 2000, some major donors have shown interest in supporting health programmes in Myanmar. However, due to political reasons, the funds are channelled through UN agencies and international NGOs. WHO Regular Budget is a major source of support to the national health programmes. Ø Apart from political reasons, there are other challenges and constraints in resource mobilization, which includes: complexities of the local rules and procedures, absorption capacity of the different programmes, lengthy processing time in the implementation of WHO’s RB and EB funds and donors concern with the Programme Support Cost. Ø For successful resource mobilization, adequate technical staff, decentralized financial management and complete strategic guidelines for fund raising in the context of Myanmar situation are needed. Discussion Points Ø Confidence building among stakeholders at the country level should be strengthened by establishing the credibility and visibility of WHO. Ø Close collaboration at all levels and with MoH. Ø There is a need for intelligent information sharing with donors about the programmes and need for funds. The WHO country staff should be well oriented to carry on these functions. Ø Sri Lanka has initiated the process of training the WHO field staff and national programme managers in aid negotiation and project writing skill development; it has also started renewing contracts with local missions of donors; Report of the Fiftieth Meeting of the RD with the WRs Page 19 Ø Decentralization of authority to receive and manage funds at the country level is critical for successful resource mobilization; at times, WRs are offered funds by donors at short notice which requires quick action on the part of WRs. Ø There is a need to define the roles of different levels of the Organization for fund raising and to establish financial management system at the country level. It is also necessary to make the present system and the environment conducive to fund raising at the country level. WHO should target not only the global foundations but also private and other sources available at the country level. Ø WHO should be seen as a credible partner among the UN agencies capable of providing reliable technical advices. UNCAP should not be viewed only as an instrument for fund raising but also as a mechanism for promoting partnership. Ø WHO should not be seen as a donor agency although the funds are raised for health development. Conclusions (a) Resource mobilization should remain one of the key functions of WHO at all levels. (b) Country offices should be adequately staffed and trained. (c) Decentralization of financial management should be pursued. The purpose of rules and regulations is to facilitate resource mobilization. WHO/HQ may explore the feasibility of introducing a format of model agreement to simplify the legal process. (d) Donors should be persuaded to accept the Organization’s reporting and project presentation format. (e) WHO strategy for resource mobilization should be better understood at all levels and the responsibility appropriately shared between WHO/HQ, the Regional Office and the WHO country offices. (f) Appropriate guidelines should be developed for delegation of authority to sign contracts, and to receive and use funds at different levels of the Organization. Report of the Fiftieth Meeting of the RD with the WRs Page 20 (g) Formal and informal donor groups should be promoted locally for sharing information and advocacy. (h) Capacity should be developed at the regional and country offices to tap funds from local foundations, particularly, from local philanthropic organizations. WHO’s preparedness and response to emergency humanitarian assistance in countries, including deliberate use of biological and chemical agents to cause harm Ø All disasters are public health challenges; therefore, they are core to WHO’s presence and functions. Ø Maximum effectiveness – investment in health sector preparedness and mitigation and a need for national capacity building. Ø WHO’s commitments run across all areas of health, putting enormous pressure on the WHO country office to deliver a well-coordinated effort. Ø WHO’s field presence and operational capacity are important to strengthen coordinated public health management, collective learning and health sector accountability. Ø WHO’s core corporate commitments in emergencies presented during the 2nd Global WR’s Meeting in Geneva. Ø Health disaster reduction: Health sector and MoH have the most challenging and visible responsibilities on their response during disasters. Ø EHA recommendations for biological, chemical and radiological (BCR) emergencies: Ø BCR preparedness should be included in all emergency and disaster response plans covering early detection, rapid diagnosis and immediate response. Ø Expert commissions on bio-terrorism should be created. Ø A rapid response team should be established/strengthened. Ø A laboratory network prepared to diagnose agents most frequently used in bio-terrorism should be established. Ø Laboratory bio-security should be strengthened. Report of the Fiftieth Meeting of the RD with the WRs Page 21 Ø National plans to attend BCR emergencies should be developed. Ø Fact sheets and technical information as well as training on surveillance and laboratory aspect should be updated. Ø Cooperation among countries including through sub-regional networks should be supported. Ø Steps for preparedness in case of biological and chemical emergencies. Ø Information on poison centres in SEAR. Ø Fact sheets on chemical warfare agents. Experience in countries Ø WHO has seen as well as coordinated public health work under EHA programme. Ø Importance of media and public information in disaster management. Ø Immediate field presence and work together with interested partners was an asset for extrabudgetary resource mobilization (e.g. Gujarat earthquake). Ø EHA/WHO seen as a resource for best public health practice during emergencies. Importance of having internal agreement with the government in health sector coordination in emergencies. Conclusions (a) Strengthen/establish EHA focal points both in MoH and WHO country offices. (b) Establish regular networking mechanism as part of disaster preparedness. (c) Allocate more RB funds for emergency preparedness plan of action. (d) Update national disaster/emergency plans, including BCR emergencies. Commission on macroeconomics and health Ø WHO's Commission on Macroeconomics and Health was formed by the Director-General to provide a solid evidence base for future action. It had Report of the Fiftieth Meeting of the RD with the WRs Page 22 collected some powerful evidence to show underestimation of the devastating effect of ill-health on the economic prospects of the world's poor communities. Ø The objectives of the Commission are to make a case for health as cause and result of development; mobilize increased investment in health and to be the new champions for health. Ø The Commission has 18 Commissioners with Professor Jaffrey Sacchs as the Chair. The Commissioners are chosen from eminent academia, international organizations, private sector, national governments, economists and public health professionals. Ø The work of the Commission has led to some key findings and recommendations. Investment in health is good economics. The current level of investment in health was too low. Ø The Commission recommends the establishment of a “National Commission on Macro Economics on Health” with epidemiological baseline, operational targets and framework for long-term donor financing. The domestic resources needed to be raised from the current levels. Ø External financing would be needed to augment the current development assistance and to seek new funding mechanisms. Ø The Commission would soon be launching its report detailing the suggested steps for the Member States to work with its own ministries, agencies, civil society, external partners, UN system, media and other partners in bringing this important agenda into focus of action to attract greater investment in public health. Follow-up of 19th Meeting of Health Ministers Ø The list of action points arising from the decisions, resolutions and recommendations of the 19th Meeting of Health Ministers and the 54th session of the Regional Committee, held in September 2001, were provided in the background documentation which the WRs would bring to the attention of the nationals. Ø A consolidated list was also sent to the WRs recently. The WHO Representatives were requested to review the list carefully and suggest Report of the Fiftieth Meeting of the RD with the WRs Page 23 measures to address the action points, with a view to preparing a consolidated report on follow-up actions, to be submitted to the 20th meeting of Health Ministers and the 55th session of the Regional Committee, to be held in September 2002. Ø One of the significant decisions taken by the Health Ministers was that from 2002 the meetings of CCPDM, Health Ministers and the Regional Committee would be held immediately following one another. Ø The list of follow-up action taken on the Action Points arising from the 49th Meeting of RD with the WRs, held in November 2000, was also reviewed. 3.4 Managerial Issues (Agenda item 4) Human resources reform Ø With regard to SSAs, it was clarified that the contract reforms applied only to staff contracts at present. In the next phase, non-staff contracts (APWs, SSAs, etc.) will be reviewed. Ø The introduction of term-limited contracts will have cost implications. The full impact will not be felt until 2004-2005. Ø It was clarified that persons recruited on the temporary track could not be extended beyond four years. An 11-month contract is the maximum permitted at a time. Ø Mobility and Rotation: Mobility was seen as very important for both WHO and the staff members. It is difficult for some staff members to get postings to other countries. There was a need to have a regular pattern of moves. A minimum period of posting in a country will need to be worked out. Frequency will depend on the type of duty station. Role of WRs in security Ø Slightly different approaches to security exist in SEAR countries. Ø Security arrangements for the UN system staff should be totally independent from any other body. Ø Staff and visitors’ lists should be updated regularly. Report of the Fiftieth Meeting of the RD with the WRs Page 24 Ø The UN security coordination system in the countries have not only an advisory role but they can give instructions to UN staff in the country. Ø The local security plans and UN Resident Coordinator’s instructions should be followed. Supplies and equipment Ø Need for on-line or CD-ROM-based catalogues of common items. Ø Delegation of authority to WRs – RD’s delegation of authority to WRs is based on delegation of authority given by HQ and Manual provisions to RD/SEARO. Ø More realistic cost estimates are required. Sometimes prices were over- estimated, resulting in significant savings at the time of liquidation when it is not possible to reprogramme funds. Ø Standard agreements with manufacturers on specific items on an annual basis could simplify the process of purchase of those items. Ø Outsourcing for purchases was a possible solution to an apparent bottleneck. However, if the S&E mechanism is made more efficient, outsourcing may not be the answer. Ø For better monitoring, SEARO is developing a web-based system to allow the WR’s Office access to the Supply Management Information System (SMIS) tracking aspect in the Regional Office. IT update Ø Infrastructure issues: SEAR is focusing on improved collaboration and coordination within the Region through shared information. An important step to enable this is the further strengthening of the Information and Communication Technology (ICT) infrastructure at country offices. WR- India has been provided Global Private Network (GPN) connectivity. The same facility will be extended to other country offices in the Region, for which two preferred vendors have been identified through a global initiative. The importance of data security was highlighted. The need for a firewall and three levels of virus protection was emphasized. WRs were informed that the central procurement of Microsoft Licenses by SEARO for five country offices resulted in substantial cost saving. Report of the Fiftieth Meeting of the RD with the WRs Page 25 Ø Country information system: In response to a request from one WR’s office, a preliminary prototype of the Country Office Information System has been developed. The purpose of the prototype is primarily to understand the needs of all WRs’ offices, so that a production system can be designed for wider use. Ø SEAR countries web sites: An initiative to develop a tool for easy designing of web sites by country offices was discussed. The tool will ensure that country web sites reflect a common corporate WHO image and will be easy to update. The country offices will be able to update the web site contents without the need to learn complicated IT web development tools. The advantages of remote web hosting were also highlighted. Discussion Points Ø Infrastructure issues: WRs welcomed the initiative of extending GPN to the country offices and emphasized its usefulness in bringing country offices and the Regional Office closer to each other. There were some concerns, however, about the high cost of GPN connectivity (US$ 2,500 per month). Ø Country information system: The WRs welcomed the efforts. A lot of work has been undertaken by WR Sri Lanka to define more precise information requirements. The prototype will be made available to all WRs’ office for their advice and needs assessment. Ø SEAR countries web sites: The WRs welcomed the concept of templates for building country web sites. They also offered opportunities for cost sharing. It was agreed that WHO country offices should have their own web sites. Joint UN web site should have links to the WHO web site. With the help of these templates, the process of web site development will be very easy and rapid. The only regular effort required from the country office will be for content updating. Report of the Fiftieth Meeting of the RD with the WRs Page 26 Section 4 ACTION POINTS Ø Efforts should be made to liquidate 2000–2001 obligations as early as possible to minimize reserves and surrender of funds. (Action: WRs, Directors) Ø WRs should expedite the finalization of detailed work plans for 2002-2003 in accordance with Regional Committee resolution SEA/RC54/R1 and the recommendations of External Audit. SEARO should provide allotment notification upon the Regional Director’s approval of the work plan. (Action: WRs, DAF) Ø SEARO should provide WRs with appropriate guidelines for the preparation of six-monthly and annual monitoring and reporting. SEARO also should provide guidance to allow the WRs to expand the end of biennium performance evaluation to include elements of country programme evaluation. The capability of AMS should be improved to facilitate generation of these reports. (Action: DRD/EIP/PLN) Ø SEARO should organize a series of orientation/training workshops at country and regional levels to strengthen WHO programme, planning and management, and to facilitate resource mobilization. (Action: DRD/DAF/SCN/EIP/PLN) Ø Based on the results of the SEARO CCS review, joint country/SEARO teams should be organized to update WHO CCS, as required. (Action: DRD/EIP/LCO/PLN) Ø SEARO AOW focal points should consult with the WHO country offices (WCO) and national counterparts in providing regional input into the Report of the Fiftieth Meeting of the RD with the WRs Page 27 formulation of Part I of PB 2004-2005. SEARO and WROs will jointly prepare the draft Part II (Regional) of PB 2004-2005. (Action: DRD/EIP/PLN) Ø SEARO/WRs should actively engage with WHO/HQ, other regions, and development partners, global foundations etc. in mobilizing additional resources for country and intercountry/regional collaborative programmes. SEARO should follow-up with EGB/HQ to obtain appropriate procedural guidelines to streamline the resource mobilization process at the country level. (Action: WRs/DRD/ERO) Ø The WRs should follow-up on their countries’ application process to comply with the GAVI board requirements. (Action: WRs) Ø SEARO and WPRO (including WRs of high endemic countries) in collaboration with HQ, should organize a bi-regional secretariat meeting on GFATM during first quarter of 2002. (Action: CDS) Ø WRs – advocacy on outcome of global commission on Macro Economics and Health and initiate/advocate on establishment of national commissions. (Action: DRD/SDE) Ø EHA focal points in WCO should follow-up on national EHA preparation and mitigation plans. (Action: WRs/SDE) Human Resources Reform Update Ø Decide and enforce, a target period of posting for each duty station with regard to mobility and rotation. (Action: DAF/HQ) Ø Keep WRs abreast of progress in the process of HR reforms. (Action: DAF/HQ) Report of the Fiftieth Meeting of the RD with the WRs Page 28 Role of WRs in Security Ø Systematic briefing of new staff on security needs to be systematized throughout the Region. (Action: DAF/WRs) Supplies and Equipment Ø Develop on-line information or CD-ROM-based catalogues of common items. (Action: DAF/HQ) Ø Review delegation of authority for local purchases. (Action: DAF/DRD/RD) IT Update Ø Review WR Office security policy and practices, including virus protection. (Action: WRs/DAF) Ø Develop a corporate web site for WRs’ offices. (Action: DAF/WR/HQ) Activity Management System (AMS) Ø AMS has been made more user-friendly by SEAR. Further enhancements to be made as and when required by end-users. (Action: DAF/ISM) Ø Keep under review the future of the PDM system, which currently provides the key financial implementation data, with a view to possible replacement by AMS when the AMS reporting element has been enhanced. (Action: DAF/ISM/BFO) Ø Provide strong support to countries that lack access to AMS. (Action: DAF/ISM/PLN) Report of the Fiftieth Meeting of the RD with the WRs Page 29 Section 5 CLOSING SESSION 5.1 Concluding Remarks by the Regional Director In his concluding remarks, the Regional Director stated that it was a good opportunity to exchange views with colleagues from the Region as well as friends from PAHO and WHO headquarters, which would help in improving day-to-day work. It was useful to arrive at a common understanding between the Regional Office and the country offices, and to prepare for launching the next stage of implementation. The outcome of the meeting and action points should, therefore, be closely followed up. In the next two days, Dr Uton stated, the WRs would also have the opportunity to discuss with the respective departments details of implementing their country work plans for the ensuing biennium. The Regional Director expressed his gratitude to Dr George Alleyne, Regional Director, AMRO-PAHO, for his insights on health-related issues and ideas on possible areas for collaboration among the two Regions. Dr Uton complimented Dr Asamoa-Baah for his elucidatory clarifications on many issues and Dr Helge Larsen for the insights provided on a number of planning and managerial issues. Speaking on behalf of the WRs, Dr Klaus Wagner stated that the meeting offered a good opportunity for them to be prepared for facing substantive future challenges. The training organized prior to the meeting provided a good impetus for improving the work performance. He thanked the Regional Director and the other Regional Office staff for the excellent arrangements and the hospitality extended to them during their stay in New Delhi. Report of the Fiftieth Meeting of the RD with the WRs Page 30 Annex 1 AGENDA 1. Opening 2. Programme Development and Management: (a) Implementation of PB 2000-2001 (b) Work plans for PB 2002-2003 including programme evaluation at country and regional levels (c) Integrated Programme Budget 2004-2005 and WHO Country Cooperation Strategy (d) Collaboration between South-East Asia Region and WHO Headquarters (e) Collaboration between South-East Asia and American Regions (f) Collaboration between South-East Asia and the Western Pacific Regions (g) Progress report on Activity Management System 3. Technical Updates: (a) Update on GAVI and Polio Eradication (b) Global Fund for AIDS and Health / Regional Coordination (c) Mobilization of resources from other global funds such as global TB Fund, UN Fund, Bill and Melinda Gates Foundation, etc. (Lessons Learned) (d) WHO’s preparedness and response to emergency humanitarian assistance in countries, including deliberate use of biological and chemical agents to cause harm (e) Health and Human Development - luncheon presentation by Regional Director, AMRO/PAHO (f) Commission on Macro-economics and Health 4. Follow-up of 19th Meeting of Health Ministers, 54th session of the Regional Committee and 49th Meeting of RD with WRs Report of the Fiftieth Meeting of the RD with the WRs Page 31 5. Managerial Issues: (a) Human resources reform update (b) Role of WRs in security (c) Supplies and equipment (d) IT update 6. Meeting with the Executive Committee of the Staff Association 7. Private session with the Regional Director 8. Closing Report of the Fiftieth Meeting of the RD with the WRs Page 32 Annex 2 PROGRAMME Monday, 26 November 2001 0830 hrs Opening 0930-1030 hrs Programme Development and Management (agenda Item 2) Implementation of PB 2000-2001 (DAF, WRs-Nepal & India) 1030-1130 hrs Work plans for PB 2002-2003 including programme evaluation at country and regional level (EIP, WRs-Bangladesh & Maldives) 1130-1230 hrs Integrated Programme Budget 2004-2005 and WHO Country Cooperation Strategy (Mr Helge Larsen, PLN, WR-Bhutan & WR-Sri Lanka) 1400-1500 hrs Collaboration between South-East Asia and American Regions (Dr George A.O. Alleyne, RD/AMRO) 1500-1515 hrs Collaboration between South-East Asia and Western Pacific Regions (Dr E.B. Doberstyn, DPC/WPRO) 1530-1615 hrs Collaboration between South-East Asia Region and WHO Headquarters (Dr A. Asamoah-Baah, EXD, EGB/HQ) 1615-1700 hrs Progress report on Activity Management System (ISM, PLN & All WRs) Tuesday, 27 November 2001 0830-0915 hrs Technical Updates (agenda Item 3) Update on GAVI and Polio Eradication (VAB & WR-India) 0915-1000 hrs Global Fund for AIDS and Health/ Regional Coordination (HSI-STB, WR-Thailand & Dr Doberstyn) Report of the Fiftieth Meeting of the RD with the WRs Page 33 1030-1130 hrs Mobilization of resources from other global funds such as Global TB Fund, UN Fund, Bill and Melinda Gates Foundation, etc. (Lessons learned) (ECO, WRs-Indonesia & Myanmar) 1130-1230 hrs WHO’s Preparedness and Response to Emergency Humanitarian Assistance in countries, including deliberate use of biological and chemical agents to cause harm (EHA & WR-DPR Korea) 1230-1330 hrs Luncheon presentation on “Health and Human Development” (Dr George A.O. Alleyne, RD/AMRO 1330-1400 hrs Commission on Macro-economics and Health (Dr A. Asamoah-Baah, EXD, EGB/HQ) 1400-1415 hrs Follow up of 19th Meeting of Health Ministers, 54th session of the Regional Committee and 49th Meeting of RD with WRs (agenda item 4) (PLN/LCO) 1415-1545 hrs Managerial Issues (agenda item 5) ¨ Human Resources Reform ¨ Role of WRs in Security (DAF Group) ¨ Supplies and Equipment ¨ IT Update 1600-1630 hrs Meeting with the Executive Committee of the Staff Association (agenda item 6) 1630 hrs Informal meeting of the WRs in preparation for their private session with the Regional Director Wednesday, 28 November 2001 0830 hrs Private session with the Regional Director (agenda Item 7) 1030 hrs Closing (agenda Item 8) Report of the Fiftieth Meeting of the RD with the WRs Page 34 Annex 3 LIST OF PARTICIPANTS WHO Representatives Dr Suniti Acharya Bangladesh Dr Orapin Singhadej Bhutan Dr R.J. Kim-Farley India Dr Georg Petersen Indonesia Dr Eigil Sorensen DPR Korea Dr Ei Kubota Maldives Dr Agostino Borra Myanmar Dr Klaus Wagner Nepal Dr Kan Tun Sri Lanka Dr Bjorn Melgaard Thailand WHO Office in East Timor Dr A.G. Andjaparidze Head, WHO Office WHO/AMRO (PAHO) Dr George A.O. Alleyne Regional Director WHO/HQ Dr A. Asamoa-Baah Executive Director External Relations and Governing Bodies Mr Helge Larsen Director Budget and Management Reform Ms Marijke van Drunen Littel Country Analysis Support Team Department of Cooperation and Communication External Relations and Governing Bodies WHO/WPRO Dr E.B. Doberstyn Director, Combating Communicable Diseases Resource Group Dr Vijay Kumar Director Department of Communicable Diseases Dr N. Kumara Rai Ag Director Department of Health Systems and Community Health Dr A. Sattar Yoosuf Director Department of Sustainable Development and Healthy Environment Secretariat Dr Uton Muchtar Rafei Regional Director Ms Poonam Khetrapal Singh Deputy Regional Director/Director Programme Management Dr Than Sein Director Department of Evidence and Information for Policy Report of the Fiftieth Meeting of the RD with the WRs Page 35 Mr David M. Nolan Director Administration and Finance Dr Sawat Ramaboot Liaison Officer with Country Offices & Ag Director Department of Social Change and Non-Communicable Diseases Dr Harry Feirman Planning Officer Dr Jai Narain Regional Adviser HIV/AIDS/STI/Stop TB Dr Brent Burkholder Regional Adviser, Vaccines and Other Biologicals Dr Luis Jorge Perez Calderon Technical Officer Emergency and Humanitarian Action Mr S.G. Muktader External Cooperation Officer Mr Daniel Walter Budget & Finance Officer Ms Jyotsna Chikersal Technical Officer Information System Management Mr P.K. Bansal Short-term Professional Regional Director’s Office Mr Avinash Singh Special Assistant Office of Dy Regional Director Mr P.P. Singh Administrative Assistant Regional Director’s Office Mr K. Ratnakaran Programme Assistant Programme Coordination Unit Mr R.K. Dhingra Clerical Assistant Programme Coordination Unit Page 36