AFR/RC59/7 12 June 2009
REGIONAL COMMITTEE FOR AFRICA Fifty-ninth session Kigali, Republic of Rwanda, 31 August–4 September 2009 Provisional agenda item 8.5
ORIGINAL: ENGLISH
WHO PROGRAMME BUDGET 2010-2011: ORIENTATIONS FOR IMPLEMENTATION IN THE AFRICAN REGION Report of the Regional Director
Executive Summary 1. The present document recalls the health priorities of the African Region and proposes orientations for the implementation of the WHO Programme Budget for the biennium 2010-2011. 2. The World Health Assembly has adopted the WHO Programme Budget for the biennium 20102011 from which the African Region will receive a share of US$ 925 684 million for WHO core programmes, excluding partnerships and crisis response funds. The resources will be provided through Assessed contributions (23%) and Voluntary contributions (77%). 3. The Programme Budget is structured around 13 strategic objectives and related organizationwide expected results defined in the WHO Medium Term Strategic Plan 2008–2013. Budgetary resources have been allocated to each strategic objective and expected result. 4. The Regional Committee is requested to note and adopt the proposed orientations.
CONTENTS Paragraphs INTRODUCTION ......................... …………………………………………………………………1–5 PRIORITIES ............................................. …..……………………………………………………6–13 LESSONS LEARNT ................... ………………………………………………………………..14–15 PROGRAMME BUDGET 2010-2011 .......................... ……….………………………………...16–23 GUIDING PRINCIPLES FOR IMPLEMENTATION.................................... …………………..24–28 ROLES AND RESPONSIBILITIES ........................... …………………………………………..29–30 CONCLUSION..................................................................................... ………………………….31–32 ANNEXES Page Tables: 1a: Programme Budget 2010-2011: budget allocations by strategic objective and major office for WHO programmes, excluding partnerships and outbreak and crisis response (US dollars thousands).................................................................................................................... 6 1b: Programme Budget 2010-2011: total allocations to major offices by strategic objective (US dollars thousands) ................................................................................................................... 7 2: Programme Budget 2010-2011: allocations to the African Region by strategic objective split into Regional Office and Intercountry Support Teams and Country Offices (US dollars thousands) ................................................................................................................... 8 Programme Budget 2010-2011: allocations to countries by source of financing (US dollars thousands) ................................................................................................................... 9
3:
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INTRODUCTION 1. The WHO Eleventh General Programme of Work (GPW) sets a global agenda for action to address health gaps in social justice, responsibility, implementation and knowledge. The responsibility for action lies with all stakeholders: communities, governments, civil society and private sector. The eleventh GPW acknowledges the unique opportunity provided by an everincreasing number of partners for health, with WHO as the lead agency in international health. 2. WHO has defined its contribution to the global health agenda in its Medium Term Strategic Plan 2008-2013 (MTSP) recently amended by the WHO governing bodies. The MTSP articulates 13 strategic objectives with corresponding organization-wide expected results (OWERs) for each. The MTSP is being implemented through three biennial Programme Budgets and related operational plans (workplans), respectively formulated for the periods 2008-2009, 2010-2011 and 2012-2013. 3. In its effort to maximize support to Member States, the Regional Office has established three Intercountry Support Teams (ISTs) based in Ouagadougou for West Africa, Libreville for Central Africa, and Harare for southern and eastern Africa. The Regional Office is striving to provide the ISTs with the necessary human, financial and logistical resources to promptly address country requests. 4. In May 2009, the World Health Assembly adopted a resolution on WHO Programme Budget 2010-2011. The resolution allows WHO offices at all levels to formulate workplans for the biennium 2010-2011. The workplans will be based on the priorities identified by Member States in their national health development plans and also reflected in the WHO Country Cooperation Strategies. 5. This document briefly describes the global and African Region health priorities and proposes orientations for the implementation of the WHO Programme Budget for the biennium 2010-2011. PRIORITIES Global priorities 6. The MTSP set up a six-item agenda related to health development and security, systems and evidence, partnerships and performance. In the context of these global priorities, the WHO DirectorGeneral has indicated that, under the current leadership, the success of WHO action would be measured by the results obtained in Africa and through interventions aimed at improving the health of women. This represents special opportunities to Member States and the WHO Regional Office for Africa. 7. All partners and development agencies now recognize the crucial role of national health systems to deliver quality health interventions. However, the health systems in the African Region are facing daunting challenges with regard to resources needed for infrastructure, equipment, supply of essential medicines and basic operations. 8. The occurrence of severe acute respiratory syndrome and influenza A (H1N1) has highlighted major threats to global health security against which the African Region is ill-prepared. Therefore, there is an urgent need to strengthen national capacities for detection, confirmation, notification and
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rapid response to public health emergencies of international concern, in the framework of the International Health Regulations (2005) which came into force in June 2007. 9. The eradication of poliomyelitis remains a priority of the global community which has invested enormous resources in interventions. Three WHO regions—African, Eastern Mediterranean and South-East Asia—still need to maintain the momentum to definitely free the world of wild poliovirus. Regional priorities 10. The analysis of the WHO Country Cooperation Strategies has shown that the main priorities include strengthening health policies and systems; fighting HIV/AIDS, tuberculosis and malaria; enhancing response to disease outbreaks and emergencies, including human-made and natural disasters; improving maternal and child health; combating neglected diseases; controlling noncommunicable disease common risk factors; and promoting the scaling up of proven costeffective health interventions. 11. Among several initiatives, Member States and partners in the African Region have endorsed, in 2008, three major declarations: (i) the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: achieving better health for Africa in the new millennium, (ii) the Algiers Declaration on Research for Health, and (iii) the Libreville Declaration on Health and Environment in Africa. These declarations urge Member States to strengthen their health systems using the Primary Health Care approach, to make every effort in line with the 2005 Paris Declaration on Aid Effectiveness, and to establish a health-and-environment strategic alliance as the basis for joint plans of action. 12. While an increasing number of partners and global initiatives in the African Region are providing support to countries for the improvement of health outcomes, the World Health Organization continues to play a leadership role in international health. More than ever there is need to strengthen WHO presence and action at country level in order to better support the promotion of internal and external efforts and partnerships towards improving the health of populations. 13. Only a few countries in the Region are on track towards the achievement of the Millennium Development Goals. There is need, therefore, to mobilize and sustain political commitment and advocacy to increase resources; realize effective intersectoral collaboration; enhance awareness and response to key determinants of health; and promote the scaling up of essential health interventions related to priority health problems. LESSONS LEARNT 14. The implementation of previous Programme Budgets shows a steady increase in Voluntary contributions, often earmarked, and no increase in Assessed contributions. While the amount available from Assessed contributions is known and can be easily allocated, the amount available from Voluntary contributions has a high degree of uncertainty, in both volume and timely availability. 15. Past experience has shown that unforeseen expenditures due to big operations in acute and complex emergency situations such as wars often occur in the implementation of the Programme
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Budget. As a result, there is a need to withhold a proportion of the Assessed contributions at the beginning of the biennium to face any unforeseen situation. PROGRAMME BUDGET 2010-2011 16. The Programme Budget 2010-2011 is founded on the principles of results-based management and integration. The WHO Secretariat has refined Medium Term Strategic Plan 2008–2013 indicators and targets for organization-wide expected results (OWERs). On this basis, the Regional Office has adjusted the regional expected results, giving way to the various Divisions and Country Offices to define office-specific expected results (OSERs) for the new biennium. 17. The Programme Budget 2010-2011 is composed of three budget segments: (i) WHO Programmes, covering activities for which WHO has the exclusive budget control; (ii) Partnerships and Collaborative Arrangements (PCA), which WHO is executing in collaboration with partners; and (iii) Outbreak and Crisis Response (OCR), covering WHO response to natural or human-made emergencies. 18. The approved global budget for WHO Programmes, excluding response to outbreaks and crisis, and partnerships, is US$ 3 367 907 000. The African Region will receive US$ 925 684 000, representing a proportion of 27.4% of the WHO global budget (Table 1a). In terms of sources of funds, US$ 209 600 000 (23%) will be provided by Assessed contributions and US$ 716 084 000 (77%) by Voluntary contributions. 19. Additional budget allocation to the African Region for Partnerships and Collaborative Arrangements, and Outbreak and Crisis Response will be funded from Voluntary contributions. They represent, respectively, US$ 256 430 000 and US$ 80 750 000. Thus, the overall budget allocation for the African Region amounts to US$ 1 262 864 000 (Table 1b), representing a proportion of 83% for Voluntary contributions and 17% for Assessed contributions (Table 2). 20. The allocation of the budget to WHO Country Offices as a whole and the Regional Office by source of financing is detailed in Table 2 (annex). Details of budget allocation to countries are also provided in the annex (Table 3). WHO Country Offices will receive 64% of regional funds, and the Regional Office, including the Intercountry Support Teams, will receive 36% of funds. Since the IST allocations are earmarked to be spent in countries, the proportion of the total amount that will be used in countries is 81%. The balance of 19% constitutes the real portion that will be spent at the Regional Office. 21. The proposed budget distribution by strategic objective reflects the emphasis put on communicable diseases (SO1, 34%), in particular the global partnership and engagement towards poliomyelitis eradication. With 16% of the budget, efforts to tackle HIV/AIDS, malaria and tuberculosis are in second place (SO2). The work of the WHO Secretariat, including strengthening WHO presence in Member States (SO12 and 13), will benefit from 14% of the Programme Budget. 22. Strengthening health systems (SO10 and 11) has also been given prominence with 12%. Child and maternal health, along with adolescent health, sexual and reproductive health and ageing are also given due attention with 9% (SO4) while 8% is devoted to emergency response (SO5).
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23. The other strategic objectives to be covered in Programme Budget 2010-2011 relate to nutrition and food safety with 3% of the budget; health promotion and reduction of risky behaviour and risk factors for communicable and noncommunicable diseases with 2%; control of noncommunicable diseases with 2%; healthy environment with 1%; and social and economic determinants of health with 1%. GUIDING PRINCIPLES FOR IMPLEMENTATION Results-based management 24. Regional expected results have been defined. The different Divisions of the Regional Office and WHO Country Offices will define their office-specific expected results that will provide the basis for the preparation of biennial workplans, specifying the activities, responsibilities, timeline and both human and financial resources needed for achievement. Country workplans should be informed by CCS documents. Decentralization 25. The ongoing decentralization policy and process have been strengthened with an enhanced delegation of authority from the Regional Director to Divisional Directors, WHO Representatives and IST Coordinators on issues related to the management of human, financial and logistical resources. Accountability 26. The implementation of the Programme Budget engages both Member States and the WHO Secretariat vis-à-vis the governing bodies and partners. All are accountable for the use of WHO resources and the achievement of planned results. To this end, there is need for strengthening the monitoring, evaluation and reporting processes at all levels. Partnership 27. WHO will pursue efforts to strengthen partnerships for health in the Region. Collaboration with the African Union and regional economic communities will be strengthened for synergistic action. The Organization is participating in the ongoing United Nations reform process while ensuring fulfillment of its constitutional mandate. There is a shared responsibility to ensure compliance with the Paris Declaration on Aid Effectiveness, the Accra Agenda for Action and the Harmonization for Health in Africa by UN agencies, bilateral and funding agencies, private sector and civil society groups involved in health action. Inter-programme collaboration 28. The need for coordinated inter-programme support to countries is recognized in order to ensure integrated implementation and synergy of results attainment across strategic objectives.
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ROLES AND RESPONSIBILITIES 29. The countries are expected to engage in the implementation of Programme Budget priority activities which have been identified in line with their national health plans, Country Cooperation Strategies and the agreed strategic objectives of the Medium Term Strategic Plan 2008–2013. Ministries of health should ensure that appropriate action is taken for timely approval of workplans. 30. The WHO Regional Office will give support to countries in the Region to implement the Programme Budget, and to increase efforts in advocacy and resource mobilization while continuing decentralization in the context of an increased delegation of authority. The Regional Director will sign off on 2010-2011 workplans at the end of October 2009. CONCLUSION 31. The Medium Term Strategic Plan 2008–2013 defines 13 strategic objectives for the WHO contribution to the global health agenda. For the biennium 2010-2011, the African Region will receive a budget of US$ 1 262 864 000, representing a proportion of 28% of the WHO global budget. 32. The Regional Committee is invited to note and adopt the proposed orientations for the implementation of the Programme Budget 2010-2011 in the African Region.
AFR/RC59/7 Page 6 ANNEXES Table 1a: Programme Budget 2010-2011: budget allocations by strategic objective and major office for WHO programmes, excluding partnerships, and outbreak and crisis response (US dollars thousands) Strategic Objective To reduce the health, social and 1 economic burden of communicable diseases To combat HIV/AIDS, malaria and 2 tuberculosis To prevent and reduce disease, disability and premature death from 3 chronic non-communicable conditions, mental disorders, violence and injuries To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, 4 childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals To reduce the health consequences of emergencies, disasters, crises 5 and conflicts, and minimize their social and economic impact To promote health and development, and prevent or reduce risk factors for health conditions associated with 6 use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex To address the underlying social and economic determinants of health through policies and programmes 7 that enhance health equity and integrate pro-poor, genderresponsive, and human rights-based approaches To promote a healthier environment, intensify primary prevention and 8 influence public policies in all sectors so as to address the root causes of environmental threats to health To improve nutrition, food safety and food security throughout the life9 course and in support of public health and sustainable development To improve health services through better governance, financing, staffing 10 and management, informed by reliable and accessible evidence and research To ensure improved access, quality 11 and use of medical products and technologies To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other 12 stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. To develop and sustain WHO as a flexible, learning organization, 13 enabling it to carry out its mandate more efficiently and effectively TOTAL Percentage of total AFR 155 203 208 208 AMR 24 950 41 449 SEAR 80 907 83 461 EUR 22 510 29 755 EMR 88 110 47 540 WPR 34 345 50 526 HQ 135 919 94 941 TOTAL 541 944 555 880 % 16 17
19 444
9180
16 603
14 674
17 594
20 261
48 193
145 949
4
107 735
25 362
44 702
12 937
36 114
23 329
42 019
292 198
9
31 532
14 518
14 002
10 860
8077
5031
25 003
109 023
3
23 943
12 898
13 702
9713
22 119
28 172
38 133
148 680
4
8495
6422
4501
6944
11 835
2 011
22 439
62 647
2
16 335
10 437
11 002
17 220
14 053
10 702
33 434
113 183
3
37 182
13 566
11 670
5501
8375
17 898
22 193
116 385
3
123 022
32 224
42 007
40 728
59 568
41 441
81 297
420 287
12
19 663
7731
10 002
5952
15 069
10 227
46 483
115 127
3
49 735
16 710
16 503
25 572
31 659
15 779
66 759
222 717
7
125 187 925 684 27%
29 550 244 997 7%
44 508 393 570 12%
36 593 238 959 7%
31 008 391 121 12%
32 910 292 632 9%
224 131 880 944 26%
523 887 3 367 907 100%
16 100
AFR/RC59/7 Page 7 Table 1b: Programme Budget 2010-2011: total allocations to major offices by strategic objective (US dollars thousands) Strategic Objective To reduce the health, social and 1 economic burden of communicable diseases To combat HIV/AIDS, malaria and 2 tuberculosis To prevent and reduce disease, disability and premature death 3 from chronic non-communicable conditions, mental disorders, violence and injuries To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal 4 period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals To reduce the health consequences of emergencies, 5 disasters, crises and conflicts, and minimize their social and economic impact To promote health and development, and prevent or reduce risk factors for health conditions associated with use of 6 tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex To address the underlying social and economic determinants of health through policies and 7 programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches To promote a healthier environment, intensify primary prevention and influence public 8 policies in all sectors so as to address the root causes of environmental threats to health To improve nutrition, food safety and food security throughout the 9 life-course and in support of public health and sustainable development To improve health services through better governance, financing, staffing and 10 management, informed by reliable and accessible evidence and research To ensure improved access, 11 quality and use of medical products and technologies To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and 12 other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. To develop and sustain WHO as a flexible, learning organization, 13 enabling it to carry out its mandate more efficiently and effectively TOTAL Percentage of total AFR 424 120 208 208 AMR 30 450 41 449 SEAR 180 357 83 461 EUR 28 560 29 755 EMR 134 357 47 540 WPR 48 485 50 526 HQ 422 024 172 941 TOTAL 1 268 353 633 880 % 28 14
19 444
9180
16 603
14 674
17 594
20 261
48 193
145 949
3
107 735
25 362
44 702
12 937
36 114
23 329
82 519
332 698
7
98 782
20 118
63 202
17 960
84 277
7581
72 103
364 023
8
23 943
12 898
13 702
9713
22 119
28 172
51 133
161 680
4
8495
6422
4501
6944
11 835
2011
22 439
62 647
1
16 335
10 437
11 002
17 220
14 053
10 702
34 615
114 364
3
37 182
13 566
11 670
5501
8375
17 898
26 193
120 385
3
124 035
32 224
44 321
50 528
60 968
42 441
119 687
474 204
10
19 663
7731
10 002
5952
15 069
10 227
46 483
115 127
3
49 735
16 710
16 503
25 572
31 659
15 779
66 759
222 717
5
125 187 1 262 864 28%
29 550 256 097 6%
44 508 544 534 12%
36 593 261 909 6%
31 008 514 968 11%
32 910 310 322 7%
224 131 1 389 220 31%
523 887 4 539 914 100%
12 100
AFR/RC59/7 Page 8 Table 2: Programme Budget 2010-2011: allocations to the African Region by strategic objective split into Regional Office and Intercountry Support Teams and Country Offices (US dollars thousands) Strategic Objective To reduce the health, social and economic burden of communicable diseases 2 To combat HIV/AIDS, malaria and tuberculosis 3 To prevent and reduce disease, disability and premature death from chronic non-communicable conditions, mental disorders, violence and injuries 4 To reduce morbidity and mortality and improve health during key stages of life, including pregnancy, childbirth, the neonatal period, childhood and adolescence, and improve sexual and reproductive health and promote active and healthy ageing for all individuals 5 To reduce the health consequences of emergencies, disasters, crises and conflicts, and minimize their social and economic impact 6 To promote health and development, and prevent or reduce risk factors for health conditions associated with use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex 7 To address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rights-based approaches 8 To promote a healthier environment, intensify primary prevention and influence public policies in all sectors so as to address the root causes of environmental threats to health 9 To improve nutrition, food safety and food security throughout the life-course and in support of public health and sustainable development 10 To improve health services through better governance, financing, staffing and management, informed by reliable and accessible evidence and research 11 To ensure improved access, quality and use of medical products and technologies 12 To provide leadership, strengthen governance and foster partnership and collaboration with countries, the United Nations system, and other stakeholders in order to fulfil the mandate of WHO in advancing the global health agenda as set out in the Eleventh General Programme of Work. 13 To develop and sustain WHO as a flexible, learning organization, enabling it to carry out its mandate more efficiently and effectively TOTAL Percentage of total 1 Regional Office & ISTs AC VC Total 4 875 109 782 114 657 Country Offices AC VC 11 780 297 683 Total Total 309 463 AC 16 655 VC 407 465 Total 424 120 % 34
4686 3226
79 952 4446
84 638 7672
4662 4934
118 908 6838
123 570 11 772
9348 8160
198 860 11 284
208 208 19 444
16 2
5443
36 244
41 687
10 086
55 962
66 048
15 529
92 206
107 735
9
1563
22 403
23 966
1877
72 939
74 816
3440
95 342
98 782
8
3218
6884
10 102
5151
8690
13 841
8369
15 574
23 943
2
2102
1490
3592
2961
1942
4903
5063
3432
8495
1
1595
5405
7000
3263
6072
9335
4858
11 477
16 335
1
1729
17 372
19 101
2538
15 543
18 081
4267
32 915
37 182
3
8100
32 407
40 507
10 933
72 595
83 528
19 033
105 002
124 035
10
2457
3796
6253
2826
10 584
13 410
5283
14 380
19 663
2
8847
6526
15 373
34 362
0
34 362
43 209
6526
49 735
4
28 831
53 965
82 796
37 555
4836
42 391
66 386
58 801
125 187
10
76 672 6%
380 672 30%
457 344 36%
132 928 11%
672 592 53%
805 520 64%
209 600 17%
1 053 264 83%
1 262 864 100%
100
AFR/RC59/7 Page 9 Table 3: Programme Budget 2010-2011: allocations to countries by source of financing (US dollars thousands) Assessed Contributions 132 928 5315 127 613 Voluntary Contributions 672 592 672 592 Total Budget 805 520 5315 800 205
Approved Budget Withholdings Allocated budget Country Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Congo, Democratic Republic Cote D'Ivoire Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Reunion Rwanda Saint Helena Sao Tome & Principle Senegal Seychelles Sierra Leone South Africa Swaziland Tanzania, United Republic Togo Uganda Zambia Zimbabwe TOTAL
1924 3513 2534 2078 3155 3072 2450 2177 2793 3090 2505 2354 3564 2406 1825 2385 4891 2019 2177 2398 3074 2393 2945 2540 2821 2752 2852 3332 2655 1672 3381 2182 3357 4639 203 3189 147 1855 2598 1605 2809 3853 2155 3434 2432 3122 3237 3069 127 613
946 51 338 5931 1805 16 732 8144 3457 1083 3448 7178 1534 4638 80 543 7828 1636 7722 76 793 2743 4448 11 376 6920 1108 23 636 3626 5902 20 380 19 163 5915 5001 1281 13 813 2867 10 452 102 404 8089 908 5896 732 14 948 10 863 6008 35 911 4148 17 007 14 358 31 933 672 592
2870 54 851 8465 3883 19 887 11 216 5907 3260 6241 10 268 4039 6992 84 107 10 234 3461 10 107 81 684 4762 6625 13 774 9994 3501 26 581 6166 8723 23 132 22 015 9247 7656 2953 17 194 5049 13 809 107 043 203 11 278 147 2763 8494 2337 17 757 14 716 8163 39 345 6580 20 129 17 595 35 002 800 205