Regional Director's Thirty-eighth Meeting with the WHO Representatives, New Delhi,14-28 November 1989

f l WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA Regional Director's Thirty-eighth Meeting with the WHO Representatives, New Delhi, 14 - 28 November 1989 SEA/WR38/11 8 December 1989 REPORT OF THE THIRTY-EIGHTH MEETING OF THE REGIONAL DIRECTOR WITH THE WHO REPRESENTATIVES AND SUMMARY OF ISSUES%TH ACTION POINTS TABLE OF CONTENTS 1. 1.1 1.2 2. 3. 4. 5. 6. Inter-Agency Coordination and Collaboration 8 7. WHO Liaison work with the United Nations in 10 New York and the Role of UN Resident Coordinators at the Country Level 8, 9. 10. 11. 12. Page Introduction 1 Opening address by the Regional Director 1 Statement by UNICEF Representative 2 WHO Programme Review 2 Ecology, Health and Sustainable Development 4 Joint Government/WHO Coordination Mechanism 5 Strengthening of National Management Capacities 6 for Achievement of HFA/2000 - Follow-up of RIGA Meeting WHO/ESCAP Collaboration - Present Situation and Future Prospects AIDS - An Update Health Care Financing and Mobilization of Resources for Health Development Computerized Information System for Programme Monitoring at WR's office level Conclusion 16 11 12 14 15 1. INTRODUCTION The Thirty-eighth annual meeting of the Regional Director with the WHO Representatives was held in the Regio.nal Off ice, New Delhi, from 14. to 28 November.1989. 1.1 Opening Address by the Regional Director Inaugurating the meeting, the Regional Director referred to the period of financial stringency and uncertai,nty experienced by WHO which made it imperative to improve programme and financial management, i.e. to make better, more efficient, and effective use of the available resources. It was also imperative to intensify efforts to mobilize additional resources for priority programmes and maintenance of the health infrastructure, especially at the primary and first referral levels. .With the .Executive Board evincing keen interest in the monitoring and evaluation of WHO collaborative programmes at all levels, Member Countries and WHO Should not only improve the quality of WHO programme management through proper planning’ and implementation but alS0 adh.ere more closely to WHO’s financial rules and regulations. The Executive Board was currently carrying out a study on the criteria used at the different levels of the Organization for determining priorities for WHO’s collaboration with the Member Countries with a view to ensuring the optimum use of the limited resources of the Organization. In the context of continuing resource shortage, health economics and alternative financing of health care has emerged as a critical issue. While many old scourges, such as malaria and tuberculosis, were still rampant, morbidity and mortality due to emerging health problems, ,such as ,cancer, cardiovascular and cerebrovascular diseases, accidents, and degenerative diseases were on the increase. Though still not counted as a major problem, AIDS seems to pose a significant threat in at le”ast two countries of the Region. Referring to the concern that gripped the World Bealth Assembly and the Executive Board over the introduction of *politic&l issues that were not directly related to international health work of WHO, the Regional Director recalled that the Director-General proposed to reschedule the world Health Assembly in October or November of each year, effective from 1991. While deliberating on the proposal, the f.orty-second session of the Regional Committee preferred rescheduling of all governing bodies starting with the World Health Assembly. A decision on this issue’ is expected to be taken by the Assembly at its forthcoming session in May 1990. The .Regional Committee, in this context, requested the Regional Director to take necessary action for submitting a single regional programme budget document, starting with the 1992-1993 programme budget, in alternate years of the biennia. This would, allow countries to plan specific activities nearer the implementation period, taking into account the situation and emerging needs. It may -also enhance the flexibility in the use of WHO’s resources to best respand to real needs in countries. In conclusion, Dr Ko Ko reiterated that good programme monitoring remained essential for efficient and effective programme implementation. The monitoring mechanism had to be built into the implementation process ‘itself for ensuring its continuity, He hoped that increasing use will be made of the joint government/WHO coordination mechanism existing in the countries in the development and ., management of WHO*.s _ callaborative programmes, especially through joint policy and programme reviews and joint consultative programme budgeting. In view of the limited resources of WPOl the need to ensure effective and optimal utilization of its resources in support of the health development activities in the Member Countries became more important. 1.2 Statement by UNICEF Representative Dr Jon E. Rohde, Senior Adviser to the Regional Director, UNICEF, in his statement, for children. referred to UNICEF’s sustained commitment to work on programmes WHO was UNICEF’s closest ally in the implementation of many important health programmes, such as EPI, CDD, ARI, leprosy, tuberculosis, malaria, nutritional problems such as iodine deficiency, anaemia and vitamin A deficiency. It was notable that during the past decade, when much difficulty was experienced in sustaining development work and most sectors were marked by stagnation, health development moved forward. This was a testimony to WHO’s leadership and its vision and to the governments for preserving investments in health in the face of economic difficulties. UNICEF looked forward, in the context of joint. UNICEF-WHO programmes, in the coming decade to a substantial decrease in infant and under-five child mortality, maternal mortality, substantial improvements in nutrition in protein energy as well as micro-nutrients, and universal accessibility to water and sanitation. The well-being of women, reduction of disparity and decentralized decision-making were integral parts of primary health care concept that will receive particular emphasis. In his programme review, the Director, Programme Management, referred to the zero-level growth of financial resources of the Organization during the past few biennia. This wa$ reflected in the basic planning allocation for the 1992-1993 biennium too. In view of the trend of falling economic growth rate at the global level, there had been a decrease in the availability of funds from donor and bilateral agencies for health development activities., In this context, better management of WHO’S programiires in support of eff&rt$ by Member Countfi,es' to implement their national HFA strategies should receive priority attention. It was imperative, therefore, to make concerted efforts to improve programme delivery at the country level, both qualitatively and quantitatively, through formulation of realistic plans to achieve set targets. He also referred to the decision taken by the forty-second session of the Regional Committee that in future SEAR0 should prepare and submit a single programme budget document for noting by the Regional Committee in alternate years. The process of preparation of a single programme budget document for 1992-1993 would be simplified and the guidelines sent to the WRs/PHA-Bhutan by January 1990. The programme budget document would be finalized during the CCPDM meeting in April 1990. .” Some of the points which arose during the-discussions are: - There is an urgent need for timely and regular feedback by the Regional Office staff to the WRs on the progress 0.f pipeline proposals to help the WRs in their programme review with.the national authorities. - There is a need to include a separate plenary session for reviewing I the latest policy issues and programme trends in the Region as a whole and to share the WRS’ concern and experience in programme formulation and implementation. 3 - The programme review should include programmes executed by WHO with extrabudgetary resources’and their linkage with those under RB. - WRs should be involved in the planning and formulation of intercountry programmes. In his concluding remarks, the Regional Director said that the WRs should continue to develop the programme budget proposals for 1992-1993 as before. He was in favour of maintaining a simplified procedure for its preparation and would not like to introduce any elaborate or complicated procedures. Referring to the suggestion for restructuring of the WRs’ meeting in the future and including a separate plenary session for reviewing the latest policy issues and programme trends in the Region as a whole, he suggested that the WRs might make specific proposals for his consideration. Within the limited time available for the annual meeting with the WRs, it might not be feasible to include regional programme overview and/or elaborate technical discussions on numerous programmes. The Regional Director thought that it might not be necessary since the annual reports of the 0 Director-General and Regional Director, the reports of the Regional Committee, Health Ministers, MRCs and ACHR meetings provided exhaustive accounts of health situation, programme trends and policy and programme issues. However, with the proposed preparation of a single budget document in alternate years, the programme for the WRs meeting during the non-budget years should be looked into. The Regional Director also recalled that due to significant involvement and contributions by members of the CCPDM and RC of the Region, the Executive Board had finally endorsed the recommendations of its Programme Committee to continue with the practice of defining country planning figures and ,not to impose “punitive” action of withholding resources from countries. This did not imply, however, that all was well. Member Countries and the Regional Office should share their responsibility and improve their programme performance, both at the regional and country levels, through proper planning and formulation of collaborative activities and improving the mechanisms for timely processing of activities. Utmost cafe should be exercised to ensure that the activities were implemented within the provisions of WHO’s rules and regulations with a view to avoiding any objections from the auditors. Action Points 0 (1) WRs should take immediate steps for the preparation of plans of action to start implementing activities for 1990 in close consultation with the national authorities. (2) With regard to implementation of the fellowships programme, WRS should initiate timely action to expedite the preparation .of. terms of reference, nomination of candidates and submission of FAFs to ,SEARO as expeditiously as possible, in order to enable the Regional Office to process them quickly. (3) WRs should continue to develop the programme budget proposals for 1992-1993, as was done in the previous biennia. (4) Pipeline activities should be quickly ,‘processed and regular feedback provided by the technical/administrative units to WRs on the status of processing of such pipeline activities. WRs should-‘also keep the Regional Office technical and support units informed regularly of the activities undertaken and expenditures incurred by them using the delegated authority. (5) All staff should go through important technical and policy documents emanating from meetings of the governing bodies, such as the Regional 4 Committee, the Executive Board, and.the Health Assembly, and various other reports of technical meetings to keep abreast of important developments. (6) WRs should be involved in the planning and formulation of intercountry programmes. (7) Discussions on the implementation of country and intercountry programmes during CCPDM meetings should also include qualitative as well as quantitative aspects of the programmes. *** *** *** 3. ECOLOGY, HEALTH AND SUSTAINABLE DEVELOPMENT The subject “Ecology, Health and Sustainable Development” was presented by PEH, who referred extensively to the various technical and management aspects of the broad area of activities that this subject covered. This was followed by a short statement by Prof. Dave who recalled the important technical contributions that WHO had been making in the past decades in global monitoring and laying down of technical and safety standards for water supply, sanitation, as well as other environmental elements. WHO had also actively collabora,ted with the UN and bilateral agencies in protecting and monitoring environmental health. The increasing use of chemicals, pesticides and manufacture of intermediate chemicals for pharmaceuticals is indeed a threat that cannot be entirely removed. There is a need therefore for more careful monitoring of the health consequences of major chemical and other threats to environment and sustainable development. The need to make a more comprehensive assessment of health consequences of major water resource development projects also remains undiminished. WHO may have to take initiatives in the active safeguard of transportation, storage and disposal of hazardous chemicals and chemical wastes. Public education in this regard has to be much more intensive than before and valid information needs to reach all different groups involved, not only the scientific and technical groups. The working paper SEA/WR38/2 formed the basis of discussions on the subject. Some of the important points that emerged from the discussions were: - Public awareness and their capacity to protect the ecological balance and environment along with greater sensitivity of policy-makers to key environmental issues will be required. - A balanced approach is needed on the advocacy for environmental protection and the need for using natural resources for economic and social development in order to meet the goal of sustainable development. - WHO deals mainly with the Ministries of Health, while the national agencies dealing with ecology, environment and sustainable development are usually under other departments/ministries. In view of’ this, it was felt that WHO might not be able to play a leading role in this field. Other international agencies, such as UNEP, UNDP and World Bank, might be more suitably placed to take the role of lead agency. WHO would emphasize on the health aspects. ESCAP is also interested in work relating to ecology, health and sustainable development. There is a need for very close coordination among the multiple agencies both in countries and internationally. 5 - The DG’s report of March 1988 on “Environmental .Prrospective to. the Year 200b and Beyond” contains a list of sectoral issues, goals and recommended actions. A new global strategy for environmental health has already been developed by WHO headquarters. - Based on the HQ document on new global strategy for environmental health, action plans at regional and country levels should be prepared for supporting the Member Countries in the assessment, planning, training, institutional strengthening, implementation and mobilization of extra-budgetary resources. - Appropriate measures to control rapid population growth will have a significant positive effect on environment as one of the main factors of environmental degradation is population density and over-exploitation of natural resources. - Poverty is another major cause of over-exploitation of environmental resources and limits the process of regeneration of these finite resources. The same environmental concern or protection measures may not necessarily be relevant to poor and rich countries. - Priority attention should be given to research in various aspects of environment with a multi-disciplinary approach. The Regional Director recalled that in the past WHO had been involved in major collaborative programmes which were not always executed through the Ministries of Health. In this regard, he cited the example of the programme on drug abuse and the programmes under the International Drinking Water Supply and Sanitation Decade. In the case of the latter, UNDP was the lead agency and WHO was acting as the technical Secretariat to the Decade in ,which agencies such as UNICEF, the World Bank, Asian Development Bank , and bilateral agencies were involved. Similarly, WHO could usefully play a promotional, advocacy and coordinating role as a Secretariat and help in the collation and dissemination of information on the subject of ecology, health and sustainable development, with UNDP or UNEP possibly taking the leading role. Action Points (1) The new global strategy for environmental health developed by WHO headquarters should be forwarded to the WRS for their guidance. (2) More intense public education and information on health effects of environmental pollution should be promoted. (31 WHO should play a catalytic role between governments and other international agencies to highlight the health aspects of environment and help find solutions to health-related environmental problems. 4. .. JOINT GOVERNMENT/WHO. COORDINATION MECHANISM, In his presentation, PLN reviewed the present situation on the role, functions and forms of joint government/WHO coordination mechanism in WHO/SEAR and highlighted the points for discussion and suggested action points for consideration of the meeting. The newly-established intercountry project for strengthening the capacity of WRs’ Offices and joint government/WHO coordination mechanism (ICP MPN 004) was also introduced. Joint government/WHO 6 coordination mechanisms were formally functioning in four Member Countries.~ In other countries, the existing coordination mechanisms are less formal. There is a need to strike a balance between coordination efforts and size and scope of WHO collaboration in the country concerned. The role of joint government/WHO coordination mechanism and of CST are complementary to each other. The main function of CST is to assist the joint government/WHO coordination mechanism and WR in programme development and serve as a focal point for country information at the Regional Office. Support to the joint government/WHO coordination mechanism need not necessarily come only from CST. Support, as needed, should be available from other units and levels of the Organization. The working paper SEA/WR38/3 formed the basis of discussions. Some of the important points which were brought out during the discussions were: - Some defined methodology and procedures for joint actions are necessary for efficient and effective functioning of the joint government/WHO coordination mechanism. But these operational guidelines should be kept flexible as much as possible. - The efficiency and effectiveness of the joint government/WHO coordination mechanism sometimes depend much on officials concerned in the Ministry of Health and the WR's initiatives. - The joint government/WHO coordination mechanism, as defined in the documents DGO/83.1 Rev.1 and DG0/85.1, applies to WHO programmes under the Regular Budget. The programmes funded by extrabudgetary and other resources do not at present come under its purview. - Though members from other sectors and agencies could contribute, in most cases the Ministry of Health do not seem to favour their inclusion. Action Points (1) The existing joint government/WHO coordination mechanism should be reviewed with a view to making it more effective. (2) The possibility of involvement of the joint government/WHO coordination mechanism in programmes funded by extrabudgetary resources, as appropriate, should be explored. (3) WRs should carefully formulate country-level support activities under the new intercountry project ICP MPN 004, which is primarily to strengthen WR's offices in the least developed countries, so that they can give better support to the Ministlry of Health in health development. directing and coordinating national 5. STRENGTHENING OF,NATIONAL MANAGEMENT CAPACITIES FOR ACHIEVEMENT OF HFA/2000 - FOLLOW-UP OF RIGA MEETING Strengthening of national management of health for all in the context of follow-up actions of RIGA meeting was presented along with an information note on Common Framework for Evaluation of HFA strategy (CFE/2). PC1 introduced the subject and referred to several important conclusions of the deliberations at the RIGA meeting in 1988 which took stock of the progress 7 made, challenges emerging, and prospects. for achiev-ing HFA by 2000. Several . issues were raised for discuss’ioh with. reqard.’ to the building up of management capacity in the Member Countries, particularly in the context of new partnerships and new social and political actions that were indispensable if health for all were to be achieved. Many important points emerged during the discussions that followed. There was’a need ‘for new types of management training that took account of effective decentralized management. There was also a need to undertake innovative research, policy analysis, j and interpretation of health, situation trends in economic ter,ms. It was noted that in .19911a, regional consultation on “Mobilization of Health Resources” was’planned. There was a need for continued WHO support for in-country and regional training for management. development, as also’for simplifying and rationalizing management information system and making efficient use of it at all levels. The Regional Director stated that, in the, ultimate analysis, the management capability of institutions and individualsin the countries would 0 determine success in achieving the HFA goal.. Thus, WHO support should focus sharply on the improvement of national “‘ma’nagement ‘capacity and innovative operational research. The,time-table for starting and concluding thesecond evaluation of HFA strategies was presented by HS f0.r information. In this regard, the Regional Director pointed out that it was time that this exercise was carried out as an integral part of managerial process< in the, countries. The practice of contracting individuals to prepare the evaluation report should be discouraged. WRs should familiarizes themseives ‘well with the revised Common Framework for Evaluation (CFE/2) and understand the’ ,process and time-table to support national efforts to prepare this report. in-time. The decision of the Eighth Meeting of Ministers of Health to restructure health system on a need-based approach for different geographical units ,and’to ensure appropriate training for management and technical competence’ was a springboard to start necessary changes in the management system in the countries. The working paper SEA/WR38/4 formed the.ba&s of discussions. Some of the important points which were. brought out during the’discussions were: “.<.‘< - Opportunities for incorporating principles’,of ‘management and the policies evolved at Alma-Ata and Riga, with particular emphasis on people and development, technologies and research, reorientation of health systems, stress on reaching.. . . the undebprivileged and underserved, should b.e ,provided in nat,idnal health pol.icy and plan development. - Decentralization and empowering people’ &as.,~.t,o: take place within the overall political process and ad”mi#istr&?iveL structure. - The variation of health conditions, resources and opportunities within the~countries‘ heed. to. be taken into account. This would enable better management.*of, resources including use of health manpower and community resources efficiently and effectively. - The management capacities at all levels< need to be improved by appropriate training and other development initiatives. In particular, with the emphasis on district health system, management abilities at the district level need to be strengthened. , ’ 8 - The Common Framework for Evaluation (CFE/2) should not merely be a .” questionnaire or a collection of information. Action Points (1) WHO support to countries is required both for micro planning at intermediate and local levels, as well as, for macro planning to strengthen staff competence at the central level. (2) Country-level efforts to start translating health problem reduction targets into quantified activities and time-frame need further support. (3) As part of innovative efforts, a revised set’of management information content as part of decentralized management at the district health systems should be undertaken. (4) Management training modules and materials developed over the past decades need to be carefully screened and their relevance re-examined and, where necessary, revised in ‘consultation with national trainers and training institutions. (5) Innovative types of health services research are to be encouraged to support the managerial processes, especially at the district level and to develop intersectoral coordination mechanisms at different levels. (6) The possibility of introducing a multisectoral approach, such as quality of life programme in Thailand, to transcend the barriers between sectors, needs to be explored since all governments accept in principle the above to consolidate development. (7) WRs should support countries in their completion of the second HFA evaluation exercise by carefully noting the recommended process and time-frame. (8) The subject of “Evaluating the Strategies -for Health for All by the Year 2000, Common Framework : Second Evaluation” be included in the agenda for the next meeting of CCPDM, to be held in April 1990. (9) The Regional Office may also explore the possibility of convening a regional consultation on this subject. 6. INTER-AGENCY COORDINATION AND COLLABORATION The legal basis of WHO’s collaboration with other organizations was presented by ERO, including some aspects of inter-agency collaboration such as the multitude of development assistance institutions: variations in financial terms and other conditions of aid; diversity and sophistication of donors’ roles and procedures regarding aid programming, financing and project reporting; challenge of matching donors’ preferences for particular sectors, projects and approaches with the needs for aid as perceived and defined by receiving countries: and weakness of many recipient governments’ planning, coordination and management capacity. Attention was also drawn to some major trends in inter-agency collaboration, including continuing preponderance of bilateralism; increasing recognition of the role of nongovernmental organizations; and the ascendancy of UNDP as a central funding agency among UN UNDP- and UNFPA-funded projects with a parallel decline in UNDP and UNFPA Support to SEAR0 projects. The working papers SEA/WR38/5 and SEA/WR38/5 Add.1 formed the basis of discussions. Some of the important points that emerged out during the discussions were: - The emerging themes for inter-agency collaboration are sustainable environmental health development, safe motherhood, emergency preparedness and response , and AIDS prevention and control. - The knowledge of the people in different government departments about national public health priorities as well as WHO’s collaborative programmes is inadequate. - Strong technical capacity in the WRs’ offices is a pre-condition for WHO’s effective role in the’ coordination of health activities and mobilization of resources at the country level. - It is necessary for the WRs to have a clear understanding of the interest of the donor agency to be able to play an effective role in facilitating resource mobilization by the national authorities. ‘_ - Problem with external assistance is experienced in some countries as the department coordinating all foreign aid is located in the Ministry of Foreign/External Affairs’ or Finance or Planning. These coordinating ~agencies assign low priority to’the health sector. Dr Jon E., Rohde (UNICEF) stated that in order to sustain good working relationship between WHO and UNICEF, it would be important for WHO to provide sound technical guidance in the operationally-oriented programmes implemented by UNICEF. He also identified certaih ways of further strengthening collaboration between WHO and UNICEF, viz. involvement of UNICEF staff in the .identification of the terms of refere-rice of consultants; regular meetings between WHO and UNICEF staff with a view to keeping the latter abreast of the latest technical information in the health field: provision of selected printed material; identification by WHO ‘of ‘technical issues for support by UNICEF: and effective, participation of WHO staff in: the designing of UNICEF country programmes. The Regional Director pointed that the level of competence amongst the nationals was now much’higher than itwas a few decades ago. It was important, therefore, for the WHO staff to prove their technical credibility while establishing a dialogue both with the national authorities as weil as bilateral and other agencies. He stated that SHARO, had produced a reference document entitled “Donors Profile”, which had recently been updated, for use in briefing health authorities in their efforts to obtain additional funding for high priority health activities. 1t provided information on procedures and methods of collaboration with different donor agencies, and all WRs should make use of this document while preparing proposals for seeking extrabudgetary resources. Action Points (1) WRs to provide support to the countries in preparing aid-worthy projects for attracting extrabudgetary resources. 10 (2) WRs to support the UN Resident Coordinator system, in advising the Resident Coordinator on health matters in regular meetings at the country level, and on substantive issues of policy and programming relating to health and development. (3) Involvement in the preparation of health chapters and follow-up to donor/government consultative groups, such as the UNDP-supported Round Tables or the World Bank-supported Consultative groups. (4) Convening by WRs of meetings with relevant partners to foster inter-agency coordination and collaboration in cases where WHO is the principal organization concerned. (5) Maintenance of contacts by WRs with embassies of bilateral donor governments. (6) WRs to develop regular communication and close relationship with governments' external resources coordination unit (Ministry of Foreign Affairs/Planning/Finance). (7) Regular meetings of staff of WHO and other UN agencies may be held in order to keep themselves informed of programme activities implemented by each agency at the country and regional levels. 7. WHO LIAISON WORK WITH THE UNITED NATIONS IN NEW YORK AND THE ROLE OF UN RESIDENT COORDINATORS AT THE COUNTRY LEVEL Mrs I. Bruggemann, Director/LUN made a presentation on the responsibilities and functions of the WHO Liaison Office in New York. The complex processes through which the liaison office performed the WHO's advocacy role at the UN were explained. The duties of the liaison office included strengthening of the dialogue with the UN system and the missions of the Member States and clarifying and advocating WHO's policies to the various organs of the UN system. Information on the role and functioning of other organs of the UN was also provided, viz. the Economic and Social Council (ECOSOC), which served as the entry point for WHO to reach the UN General Assembly; the 5th Committee of the General Assembly, dealing with personnel matters: the International Civil Servants Commission (ICSC): the Consultative Committee on Administrative Questions (CCAQ): the Consultative Committee on Substantive Questions (CCSQ); the Administrative Coordinating Committee (ACC), which is chaired by the UN Secretary-General and attended by heads of other UN Agencies: and the Committee of Programme Coordination (CPC), which comprises representatives from Member States of the UN. Besides, there were alSO other committees on some important programmes, such as the sub-committee on Nutrition, the Committee on Maternal and Child Health, etc. Important points that came out of the discussions were: - Director/LUN should send selective feedback information on statements made by delegations of SEAR countries at the UN to the Regional Office and concerned WRS. - The missions of the Member States in New York usually have little understanding of WHO's activities. Hence, there is a need to find a pragmatic way to share with them information on WHO's policies, programmes and activities. 11 - There are many entry points for WI-IO in the UN system. To make use of these effectively, intervention at the right moment with appropriate technical information is necessary. - New York press is a potential source to be utilized for the dissemination of information about WHO worldwide. - The WHO Liaison Office with the UN at New York, can work with the regional offices for feeding the press with the relevant information on regional health matters. A case in point was the recent exchange of information on the forty-second session of the Regional Committee, held at Bandung, Indonesia. - The compatibility of personalities of UN Resident Coordinators/WRs and other agency heads has been a factor in the effectiveness of the Resident Coordinator system. However, problem arises in those instances where UNDP Resident Representatives see their role as one of supervisory functions to the point of interfering with the agencies) constitutional mandate and functions. The Regional Director hoped that all professional staff would understand the complex nature of the working of the UN and its various organs and committees relevant to their respective programmes and should study more about their working and functioning. Action Points (1) SEAR0 may provide DGR/LUN with selective information relevant to UN bodies, UN missions of SEAR Member States as briefing. (2) Links between DGR/LUN and SEAR0 may be established on a regular basis through visits of staff to the UN, participation i’n meetings, and short-term secondment of staff to LUN. (3) DGR/LUN may be used as “facilitator” in matters relating to important communications and clarifications to UNDP, UNFPA and UNICEF headguarter offices. (4) DGR/LUN could provide information to SEAR0 on policy and programme matters relevant to SEAR. 8. WHO/ESCAP COLLABORATION - PRESENT SITUATION AND FUTURE PROSPECTS The WHO Liaison Officer to ESCAP ‘made a brief presentation on the structure and functions of ESCAP, the present situation with regard to WHO/ESCAP collaboration was reviewed. He explained the modalities of WHO/ESCAP collaboration including, inter alia, co-sponsoring of seminars and training courses, joint WHO/ESCAP projects, ESCAP activities initiated by WHO, and linkages between information networks. At present, WHO/ESCAP collaboration covered social and health developme,nt, including women, youth, and human resources development; environment: natural resources, including water resources; food and agriculture, including integrated rural development; population; human settlements and statistics. Two scenarios were considered for future development of WHO’s collaboration with ESCAP, ViZ. (a) a “more-of-the-same” approach based on continued WHO inputs into ESCAP programme 12 of work and continued joint WHO/ESCAP projects in the area of “health and development”; or (b) a more dedicated approach to collaborative efforts with ESCAP, based on a “plan of operation” with target-setting, defining ways and means of achieving the targets, identification of resources required and monitoring of implementation. The working paper sEA/WR38/6 formed the basis of discussions. The important points brought out during the discussions are: - The increasing appreciation of the complementarity between WHO and ESCAP was noted. - Under the prevailing economic circumstances, no significant unilateral change in the scale of present collaboration pattern are warranted or realistic. The Regional Director pointed out that WHO was not in competition with any other agency. Its :developmental programmes were mainly directed towards achieving the HFA goals. The role of ESCAP and other UN agencies, such as UNDP, UNICEF, etc. was complementary to the work of WHO and efforts should be made to maintain closer relations with all these agencies. Action Points (1) SEAR0 technical units will continue to provide technical information including briefing notes, documents, reports on intercountry and interregional meetings and WHO publications to LO/ESCAP for meetings, workshops or seminars, as required. (2) SEAR0 technical units may also contribute articles and photographs, as needed, to be published in ESCAP newsletters on various subjects, such as environment, youth and women, drinking water, primary health care. (3) LO/ESCAP will identify ESCAP meetings, workshops and seminars of particular interest to health sector and inform SEAR0 in advance. SEAR0 in turn will advise WRs to discuss with the governments with a view to exploring their interest and willingness to send participants using, if necessary, funds from WHO country budget. (4) LO/ESCAP will enhance liaison work in information exchange between WHO and ESCAP and also identify new collaborative opportunities. (5) WRs to lend support, if requested, to ESCAP missions visiting a country on health and health-related matters, e.g. water resources development, disability prevention and rehabilitation. LO/ESCAP will inform SEAR0 of ESCAP country missions in advance. (6) SEAR0 will send to WRs selected reports and documents received from ESCAP relevant to the country concerned. 9. AIDS - AN UPDATE PCD presented the latest information on the epidemiological situation of AIDS/HIV infection globally and within SEAR, including the present trends of the disease, status of short-term and medium-term plans, assistance f? . 13 provided by WHO to the Member Countries ,in SEAR in the prevention and control of AIDS, organization of meetings during 1989 and, 1990, and achievements of the programme, and problems and constraints. The priority to be given for researchable areas in connection with the prevention and control of AIDS was also highlighted. The need for the Member Countries to be self-reliant in implementing activities to prevent and control AIDS .was emphasized. Phase I of the management review of the GPA programme at HQ had already been completed and the second phase of the review would commence soon at regional and country levels. Juint efforts with UNESCO ‘concerning the control of AIDS are under progress, A WHO UNESCO consultative seminar on health education in schools is planned for February 1990, and a WHO/UNESCO Regional Health Education Exchange Centre on AIDS is being established. The working paper SEA/WR38/7 formed the basis of discussions. The important points brought out during the discussions are:’ There is a need to minimize both the number of participants for any particular meeting. The total number of meetings in a year should be evenly spaced out. Depending upon the magnitude of the problem and availability of manpower in a particular country, the appointment of a full-time programme manager at the country level to look after the AIDS programme may be considered. Alternatively, Someone in the government should be designated as responsible officer for the national AIDS programme. Many of the documents and information material received from the global level do not meet specific country needs, especially in the social, religious and cultural context of the Asian countries. No attkntion has been paid to undertake intervention studies to deal with human aspects of the disease. Careful consideration needs to be given to these aspects. a The Regional Director stressed the need to develop national capabilities, both technical and administrative, through appropriate training programmes using whatever resources were available. He hoped that implementation of the programme for prevention and control of AIDS would improve with the Phase IT review of’ the management by WHO/HQ. Consideration could be’ given to organizing a .meeting of the ‘programme managers fur AIDS programmes. He further pointed out that epidemiology in SEAR countries required careful analysis. Thailand might, ,be no more in Pattern III of the epidemiological scale. Mong'olia and DPR Korea could be in pattern IV if such a classification existed. He thought that a balanced approach ,at the country level was essential and one should not lose sight of other important health programmes while implementing the AZDS control ptogramme in the countries of the Region. Action Points (1) Country-specific AIDS education and’ information programmes need to be prepared taking into account the social, cultural and religious context of the respective countries. Youth and women should also be involved in such programmes. The information material received from HQ should also be adapted to country-specific needs. 14 (2) WRs should send their views on the documents relating to Phase I review and proposed Phase II preview of the AIDS programme to SEAR0 by 22 December 1989. (3) A review of all GEAs for 1990 under the extrabudgetary resources, including those relating to GPA, be undertaken by RPC in order to screen their rationale and compatibility to the Region's needs and also to see if some of , them can be combined or' dropped to minimize the number. 10. HEALTH CARE FINANCING AND MOBILIZATION OF RESOURCES FOR HEALTH DEVELOPMENT In his presentation, PM0 traced the prevailing adverse trends in the world economy, aggravated by debts and deterioration in the balance of trade, which jeopardize the possibilities of reaching the goal of Health for All by the Year 2000. There is, therefore, a need to intensify action to increase economic support for national strategies for Health for All and in particular to mobilize and utilize health resources with emphasis on social relevance, equity, managerial efficiency and effectiveness. Two major topics emerged in the discussions on economic support for health strategies, namely, making better use of available resources, and increasing the level of financial support for health. The Regional Committee for South-East Asia addressed this problem at its forty-second session in September 1989 and urged the Member States, inter alia, to review their current patterns of resource allocation in the health sector and reorient their spending priorities, including allocation of any additional resources in support of primary health care, giving preferential attention to the most needy segments of the population and strengthen their capabilities in financial planning and management at all levels, particularly atthe district level. Five major categories of financing health care can be usefully considered, namely, direct government financing, health insurance, community financing, user charges, and nongovernmental organizations and external cooperation. The document, "Health Economics - A Programme for Action", contains prOpOSalS for WHO action in the field of health economics. This document also outlines WHO actions to improve the quality of economic decision-making in the health sector, with the dual objective of both improving management and increasing the effective resources available for health. The WHO programme for action identifies three areas for WHO action in health economics, namelk, policy analysis on selected issues, training at the policy level, top implementation level and the district level, as the major mechanism for familiarizing health managers with economic principles and practices, and information support and exchange and networking in national and regional groups. The working paper SEA/WR38/8 formed the basis of the discussions. Some of the important points that emerged during the discussions were: - The issues of health economics and financing are of direct relevance to WHO collaboration with Member Countries, particularly in the developing world where resources for health development are stagnant or diminishing. - Innovative approaches. to financing health care are necessary and intercountry collaboration and exchange of information and experience in health economies, community financing and alternative financing in particular should receive WHO support. - More intensive intercountry collaboration will be needed in innovative research and training in this area. Action Points (1) WRs to ‘support national authorities in their efforts to improve their health infrastructure and maintain the delivery of essential health care through better financial management. (2) The current pattern of resources allocation and spending priorities in the countries should be studied. (3) An analysis should be done in SEARS on the results of innovative approaches to financing the health care in the countries of SEAR and other regions, Training facilities available within the Region on health economics and health financing should be identified. After such screenihg, selected information should be transmitted to the WRs. (4) The Regional Office will initiate necessary action for formulating an intercountry programme proposal to support the countries, especially by training health managers on economic principles and practices, information support and exchange, and networking in national and regional groups. 11. CGMPUTERIZED INFORMATION SYSTEM FOR PROGRAMI@ MONITORING AT WR’S OFFICE LEVML The computer application programme designed in SEAR0 for programme monitoring at the WR’s Office level was presented by ORO, He demonstrated, in broad lines, how the system could assist the WR’s office in the management of WHO projects and programmes along the following dimensions: time, programme/project, component, budget. Timely follow-up of programme activities was important because, with several activities at hand both in the Regional Office and at WR-‘s Office Level, it might be difficult to remember when a specific action for programme implementation was started and when it would be necessary to follow it up. The working paper SEA/WR38/Y formed the bii;ris of the discussions that followed. Some of the important points brought out duri.ng the dicussions were: - staff of most WRS’ offices have already received some training in the use of the software developed by SEAR0 for programme monitoring at the country level. - There is a need to streamline procedures and to agree on common definitions. - With the- training provided to (ii3 staff on word-pracestiing and programme monitoring, most W#si off ices cpre using the computers for processing a variety of information that are usefhlr InstalIdtion was a time-consuming process initiaily, requiring some outside assistance on a temporary basis. - There is a need for feedback from the WRs on (a) the information provided in the PDM cards, and (b1 the training provided to the GS staff in order to identify the areas which need further development. - With the introduction of the AFI system and LAN facilities in 1990, it should be possible for DSP/BFO to provide, more upto-date information to WRs and S EAR0 technical units on programme implementation. - The 12th ISS meeting will be held in SEAR0 in December 1989, when the development of a “corporate programme” for organization-wide use will be discussed. - WRs should propose a plan of action for informatics development in their offices involving hardware, software and training required, so that SEAR0 could look into providing the needed support in a planned manner . The Regional Director stated that he was not in favour of institution- alizing pipeline activities, by developing a separate programme for its monitoring. He felt that processing of pipeline activities should form part of routine programme monitoring. Referring t,o the long delays experienced by the Regional Office in processing the recruitment of long-term staff or fellowships, he said thait regular follow-up should be conducted at the country level to expedite government clearance for various activities. In this process, t.he human relationships which the WR maintained with the appropriate national authorities played a more important role, and the computer was only a tool in providing the information. While he would not be averse to further strengthening of informatics support at the WR level, through provision of computers and staff training, he would not like the staff at the regional and country levels to be too much dependent on the computers to facilitate expeditious actions which should normally be done through human relationship. Action Points (1) Starting from 1990-1991, WRs’ Off ices should make use of the software for programme monitoring and provide information on ways to improve it. SEAR0 should provide as soon as possible the new version of the software to WRs with figures for 1990-1991 budget. 12) WRs should explore the need for, and availability of, software maintenance and development as well as for computer training using local expertise which has comparative advantages. (3) Professional staff, including WRs, should be trained in informatics. *** *** *** 12. CONCLUSION The WRs also had a confidential session with the Regional Director as well as separate meetings with the representatives of the staff Association on staff matters and with the Support Programme on administrative matters. 17 In his concluding remarks, the Regional Director stated that the deliberations during the meeting were quite useful and provided an opportunity to exchange views, ideas and experiences at the country and regional levels on various important matters. There were certain actions arising out of this1 meeting which would require further follow-up at the country level, such as the preparation of detailed plans of action/activities for implementation of PB/1990-91, second evaluation of the HFA strategies using CFE/Z, evaluation of the regional fellowship programme, etc. Referring to the DG’s prOpOSa1 for rescheduling of the World Health Assembly, he stated that the Forty-third World Health Assembly in Way 1990 would take a final decision on this matter and its implications on regional matters, such as RC, CCPDPl, WRs’ meeting, etc. would have to be carefully considered. There were some problems encountered in inter-agency coordination which, he hoped, would be solved satisfactorily in due c’ourse. Though the financial situation of the Organization was better, it was imperative for the countries and the Regional Office to share ,responsibility in the proper planning and effective and efficient implementation of collaborative programmes within the financial rules and regulations of the Organization. The countries should promote integrated approach in the delivery of various health programmes and in this context the strengthening of the national managerial capabilities, including improvement of the information system, should receive priority attention. The Regional Director suggested that the WHO staff should further improve and strengthen their technical quality in providing effective and efficient support to the national authorities. They should keep themselves abreast Of the latest developments in their technical programmes and, within the limitations of available resources, the staff development and training activities would be implemented for various levels of staff at regional and country levels in their management and technical work. Finally, he conveyed his good wishes for the New Year to all staff members and their families and wished the WRs bon voyage.