REGIONAL COMMITTEE Fifty-fourth Session
Provisional Agenda item 7.1 SEA/RC54/6 9 July 2001
JOINT EVALUATION OF TWO SUPPLEMENTARY INTERCOUNTRY PROGRAMMES (ICP-II) “TOBACCO FREE INITIATIVE” AND “IMPROVING THE HEALTH OF THE MARGINALIZED AND VULNERABLE GROUPS” The 53rd session of the Regional Committee (RC) recommended proactive involvement and participation of Member countries in all stages of the intercountry programme, from planning to programme evaluation. The Committee suggested an evaluation of the implementation of one priority programme area at the intercountry level selected from the previous RC resolutions. The first meeting of the High-Level Task Force for Intercountry Collaboration, held in December 2000, suggested that a supplementary intercountry programme (ICP-II), selected from among those noted in the previous RC resolutions, be evaluated and reported to its 54th Session. Accordingly, the Regional Director selected the following two programmes for review: (1) Tobacco Free Initiative; and (2) Improving the health of the marginalized and vulnerable groups. The evaluation was undertaken at the country (India, Indonesia, Myanmar, Nepal, and Sri Lanka) and Regional Office levels by a joint team comprising representatives from (1) Member countries, focal points for either of the two programmes or high-level officials familiar with the programmes, and (2) the Regional Office. The country visits lasting five working days took place during the period 30 April to 18 May 2001. Each team interviewed officials and staff involved in programme implementation in the Ministry of Health and/or other focal ministries, the WHO country office staff, members of relevant NGOs and organizations of the United Nations system. The teams reviewed relevant WHO, country and NGO documents. Based on the teams’ individual country analysis, a preliminary draft report was prepared by the Regional Office. Over an intensive two-day period, 24th and 25th May, the full joint evaluation team, chaired by the representative from Nepal, met in the Regional Office to finalize the report (attached), which is now being submitted to the Regional Committee for its consideration .
SEA/RC54/6
Joint Evaluation of Two Supplementary Intercountry Programmes (ICP-II) “Tobacco Free Initiative” and “Improving the Health of the Marginalized and Vulnerable Groups”
REPORT
SEA/RC54/6
CONTENTS Page
1. 2. 3.
BACKGROUND OBJECTIVES OF THE EVALUATION METHODOLOGY 3.1 Selection of Specific Programme Areas for Evaluation, Countries to be Visited and Composition of the Evaluation Team. 3.2 Process
1 1 2 2 3 4 4 5 7 7 9 9 11 11 11 12 12 14
4.
ANALYSES OF THE PROGRAMMES 4.1 Description of the Programme 4.2 Have the Programmes Delivered what they had Committed to Deliver? 4.3 Have the Programmes Made a Difference for the Region and the Relevant Countries? 4.4 Have the Programmes Effectively Complemented WHO Ccountry Programmes? 4.5 Would the Programme have Done Better had it Adopted Different Approaches and/or Mechanisms? 4.6 Has the Programme Proved Relevant, Efficient and Effective?
5.
LESSONS LEARNT AND RECOMMENDATIONS 5.1 Involvement of National Programme Managers and WHO Country Office in Planning and Implementation 5.2 Continuity of Focal Points at the Country and WHO Country and Regional Offices 5.3 Adequacy and Continuity of ICP 5.4 Value of the Joint Evaluation Exercise
Annex: Persons Met by the Joint Evaluation Team
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1.
BACKGROUND
In discussing means to strengthen intercountry collaboration, the 18th Meeting of Ministers of Health, held in August 2000, noted the need for appropriate mechanisms to ensure efficiency, transparency and accountability in the use of intercountry programmes (ICP), and an enhanced role for the Member countries in the evaluation of the activities and projects implemented through these funds. The 53rd session of the Regional Committee (RC), in September 2000, recommended proactive involvement and participation of Member countries in all stages of the intercountry programme, from planning to programme evaluation. The Committee noted that effective and efficient utilization of funds should be given priority and stressed the need for better monitoring. The first Meeting of the High-Level Task Force for Intercountry Collaboration (HLTF), held in December 2000, suggested that a supplementary intercountry programme (ICP-II), selected from among those noted in the previous RC resolutions, be evaluated and reported to its 54th session. Accordingly, the Regional Director selected the following two programmes for review: (a) Tobacco Free Initiative (b) Improving the health of the marginalized and vulnerable groups The joint evaluation is envisaged as a means of providing feedback on the intercountry programme. It is seen as a tool for adapting WHO technical cooperation to meet the challenges created by the globalization of public health problems and assisting Member countries on both collective and individual basis, but with emphasis on collaboration among the countries concerned. Evaluation of the intercountry programme is not viewed as an isolated activity; rather, it is integrated into the overall managerial process and will play a fundamental role in strengthening the dialogue among the countries and the Regional Office. The evaluation also will serve to increase input and participation of the Member countries in the continued development of the intercountry programme.
2.
OBJECTIVES OF THE EVALUATION (a) critically evaluate the intercountry programmes for “Tobacco Free Initiative” and “Improving the health of marginalized and vulnerable groups”; and (b) determine whether the programmes – benefited several Member countries with a catalytic or multiplier effect; – developed partnerships, institutional capacity building and networking; – facilitated technical cooperation through advocacy and influence on policy, and – helped to mobilize further resources to address critical problems in the programme area.
The general objectives of the joint evaluation were to:
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The joint evaluation will also serve to identify areas of intercountry collaboration where the expected results, strategies, approaches and mechanisms may need to be reoriented in future biennia to meet the collective needs of the countries. The specific objectives of the joint evaluation are to determine whether the intercountry programmes for “Tobacco Free Initiative” and “Improving the health of marginalized and vulnerable groups”: (a) delivered what they had committed to deliver; (b) made a difference for the Region and the relevant countries; (c) effectively complemented WHO country programmes; (d) would have done better had they adopted different approaches and/or mechanisms, and (e) proved relevant, efficient and effective in the context of the globalization of public health problems, regional health priorities, WHO corporate strategy and the recommendations and resolutions of governing bodies and relevant global and regional forums (World Health Assembly, Executive Board, Regional Committee, Health Ministers Meeting, Health Secretaries Meeting, CCPDM, etc.). It must be emphasized that the focus of the evaluation is the two ICP-II programmes. Though HLTF noted the difficulties in attempting to isolate the ICP-II components from the other factors affecting the WHO collaborative programme, the evaluation did not attempt to evaluate the countries’ own programmes in these areas nor the joint country/WHO efforts supported through the WHO country budget. It is also worth noting that the planned period of implementation of the ICP-II programmes extends over the two years of the biennium; the evaluation took place approximately two-third through the biennium. It was understood that many, if not all, of the expected results 1 would not have been achieved. Therefore emphasis was given to the managerial process and results achieved so far rather than the overall outcomes or impact of the programmes.
3.
METHODOLOGY
3.1 Selection of Specific Programme Areas for Evaluation, Countries to be Visited and Composition of the Evaluation Team The Regional Director’s selection of programmes to be evaluated was based upon the criteria suggested by the 53rd session of the Regional Committee and the first meeting of HLTF. That is, priority intercountry programmes selected from among those noted in previous RC resolutions. The selection was undertaken with a view to identifying programmes that are representative of the overall intercountry programme and which illustrate characteristics common to all intercountry programmes. This permits the evaluator to draw lessons and develop recommendations that would benefit all intercountry programmes as a whole, as well as the specific programmes evaluated. 1
With the change in terminology introduced for the 2002–2003 biennium, the objectives and expected results discussed in the evaluation report correspond to “expected contribution/expected results” and products respectively.
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The evaluation of the “Tobacco Free Initiative” and “Improving the health of the marginalized and vulnerable groups” was carried out at the country and Regional Office levels. The selection of countries to be visited was based on the extent to which the specific ICP activities were targeted to those countries. India, Indonesia, Myanmar, Nepal, and Sri Lanka were eventually selected to be visited by the evaluation teams. The evaluation, as suggested by HLTF, was undertaken by a joint team comprising representatives from (i) Member countries, either focal points for either of the two programmes or high-level officials familiar with the programmes, and (ii) the Regional Office (SEARO). The five country representatives nominated by the Member countries following invitation2 by the Regional Director included: – Dr M. Hayatie Amal, Director of Narcotics, Addictive Substances Control and Hazardous Substances Safety, National Agency for Drug and Food Control, Indonesia Dr Varabhorn Bhumiswasdi, Director, Institute of Tobacco Consumption Control, Department of Medical Services, Ministry of Public Health, Thailand Dr B. D. Chataut, Director-General, Department of Health, Ministry of Health, Nepal Dr Dula de Silva, Deputy Director-General (Public Health), Ministry of Health, Colombo, Sri Lanka, and Dr Htay Lwin, Director (Public Health), Department of Health, Ministry of Health, Yangon, Myanmar.
– – – –
Members of the joint evaluation team from the Regional Office were: – – – – Dr EL-Naggar, STP, Primary Health Care Dr Ohn Kyaw, STP, Acting Programme Development Officer Dr Abdullah Waheed, STP Planning, and Mr. S. Vedanarayanan, Assistant Planning Officer.
Dr Than Sein, Director, Department of Evidence and Information for Policy, and Dr Harry Feirman, Planning Officer, provided overall guidance and assistance in the evaluation and preparation of the evaluation report.
3.2 Process Building upon a paper prepared for the first meeting of HLTF and its discussion of a mechanism for joint evaluation of the intercountry programme, an evaluation protocol was developed. The protocol, together with background documentation on the two programmes prepared by SEARO, formed the basis for evaluation. The background documents described the objectives, expected results, and other salient features of the “Tobacco Free Initiative” and “Improving the health of the marginalized 2
Invitations were extended to the Ministries of Health and Family Welfare, Bangladesh, and India for nominations to the joint evaluation team. However, prior obligations and conflicts in schedules of the focal points for the ICP-II areas did not permit the ministries to provide nominations.
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and vulnerable groups” programmes. The documents reviewed included resolutions, decisions and recommendations of WHO governing bodies and regional forums relevant to the two areas. Joint evaluation teams consisting of one country member and a SEARO member were formed to visit each of the five selected countries. The team which visited India also undertook evaluation at the Regional Office level. The country visits lasting five working days took place during the period 30 April to 18 May 2001. Each team interviewed officials and staff involved in programme implementation in the Ministry of Health and/or other focal ministries, WR Office staff, members of relevant NGOs and UN organizations. The teams reviewed relevant WHO, country and NGO documents. Based on the teams’ individual country analysis, a preliminary draft report was prepared by the Regional Office. Over an intensive two-day period, 24th and 25th May, the full joint evaluation team, chaired by Dr B.D. Chataut (Nepal), met in SEARO to finalize the draft report. The final report will be submitted to the Regional Director for his consideration and submission later to the 54th session of the Regional Committee as an information document.
4.
ANALYSES OF THE PROGRAMMES
4.1 Description of the Programme (1) Tobacco Free Initiative Tobacco consumption is increasing in the Region, with diseases and deaths attributable to tobacco use becoming a cause for serious concern. Alerted to the health dangers, most countries are making significant progress in promoting tobacco control measures. Two countries in the Region have adopted comprehensive national tobacco control policies. Various measures have currently been implemented in the countries of the Region, such as warning labels, restriction of advertising in specific media and at specific locations, bans on sponsorships, prohibition of smoking in public places and public transport, public education and the declaration of specific tobacco-free islands and districts. However, the impact of these measures has so far been limited. Under the intercountry programme on Tobacco Free Initiative (TFI), technical support is being provided to the Member countries for: – strengthening national capacity for comprehensive tobacco control programme management, including participation in the Framework Convention for Tobacco Control (FCTC) process; – enhancing regional advocacy for tobacco control; – establishing a regional database on tobacco, and – enhancing and widely distributing demand reduction interventions for children, adolescents, women and the poor.
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(2) Improving the health of the marginalized and vulnerable groups Since the early 1990s, efforts have been under way to focus attention on the health needs of the marginalized and vulnerable groups and their lack of or limited access to appropriate, relevant health services. As early as 1991, a regional consultation called attention to the need to give high priority to improving the health of the underprivileged and arrived at a consensus on the new approaches to be taken. Advocacy efforts have been successful in raising awareness of the critical issues that adversely affect the health and access to health care of particularly vulnerable population groups (e.g. women, children, elderly and the poor). However, there are serious gaps in the provision of health services to address these issues and to meet the health needs of the most vulnerable groups. Countries have begun to address these issues, but more information, strategies, models and specific interventions are needed. Under the intercountry programme on “Improving the health of the marginalized and vulnerable groups”, technical support is being provided to Member countries in: – developing technical resources in support of gender mainstreaming in countries; – developing models for making pregnancy safer in six countries with high MMR; – strengthening capacity for IMCI implementation and adolescent health promotion; – developing regional strategies and models for health care of the elderly; – strengthening evidence-based strategies for improving utilization of health care by marginalized and vulnerable groups, and – improving the provision of quality health care to the marginalized and vulnerable groups through promotion of use of a gender perspective in health programmes.
4.2 Have the Programmes Delivered what they had Committed to Deliver? As with all programmes supported through the WHO Regular budget, the intercountry programmes cover a two-year period, with activities planned accordingly. Consequently, none of the objectives would have been achieved nor the expected results completed at the time of the evaluation which was undertaken 16 months into the biennium. Nonetheless, the objectives of the two intercountry programmes, as mentioned in the programme descriptions, appear to be overly ambitious given the level of allocated resources. It is doubtful that WHO input, which is normally technical and catalytic in nature, could achieve the programme’s objectives without significant inputs from other sources. At a practical level, such broad objectives more likely would be achievable by the national health development programmes through direct government funding, supplemented by the combined support of WHO and other development partners. Despite the above, substantial progress has been made during the first two-thirds of the biennium towards the completion of individual expected result. Among the significant achievements are:
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(1) Tobacco Free Initiative – Bangladesh, India, Indonesia, Myanmar and Nepal were assisted in the development of comprehensive national strategic plans for tobacco control. With such support, some of these countries have initiated the formulation and development of legislation and national policies for tobacco control. – A regional strategy on advocacy for policy change in favour of tobacco control was developed. In some countries, the Ministries of Health cooperated with other ministries in drafting laws for tobacco control. Member countries have participated fully in the FCTC process. – Tobacco prevention and cessation guidelines were developed, pretested and piloted in India, Sri Lanka and Thailand. However, in the case of India and Sri Lanka, the pilots did not target the vulnerable groups (women and adolescents). – Studies on tobacco economics and sentinel prevalence of tobacco use were supported. The specific focus of the studies is the economic burden of tobaccorelated diseases and identification of vulnerable/high risk groups. Monitoring and surveillance of tobacco-related diseases were carried out jointly with the focal points for noncommunicable diseases in Bangladesh, India and Indonesia.
(2) Improving the health of the marginalized and vulnerable groups – Gender mainstreaming tools have been developed. – A document “Women’s Health Profile for South-East Asia Region” has been published and distributed. – A core group of IMCI facilitators has been trained. – A core group of doctors and nurses has been trained in managing severe malnutrition. – A regional strategy for Vision 2020 has been developed. Despite these achievements, some characteristic problems have been encountered in the implementation of both programmes’ activities. These include: – Implementation of many of the originally planned activities being extended beyond their initial time-frames. The start of some of the activities undertaken through the Agreement for Performance of Work (APW) mechanism were delayed because of the time spent in the selection and approval of appropriate national consultants. – Delays attributable to unrealistic time-frames for completing the work and inadequate monitoring and follow-up by the WHO country office. The latter is due partly to the country office not receiving adequate information regarding APWs as well as ICP activities being undertaken within country. – Frequent programme changes; however, some programme changes were initiated to correct deficiencies in the original planning of the ICP activities or to adjust the programme to the changing regional and country needs. – Some of the activities have been completed but reports have not been submitted to the Regional Office.
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4.3 Have the Programmes Made a Difference for the Region and the Relevant Countries? It is too early to make a fair judgement on whether the programmes had made a difference, as many of the activities continue through the end of the biennium. However, some of the significant achievements include: – ICP support for drafting of tobacco control legislation, sensitizing multiple sectors and the need for tobacco control. – The Region was able to reach a common understanding and support on most of the issues of FCTC. – Provided an entry point for greater partnership/participation of NGOs in tobacco control activities complementing those undertaken by the national and WHO country programmes. – Training of core IMCI facilitators enabled the countries to expand the national IMCI programmes to an increasing number of districts. For some of the activities which have been completed, it will take some time before their effects are fully felt in the countries. For example, the South-East Asia Anti-tobacco (SEAAT) Flame activities were implemented effectively in the countries. The flame travelled to several areas within each country generating wide media attention, public awareness and temporary partnerships with the NGOs and the media. Yet, it may be some time before one would be able to determine whether these activities have translated into greater tobacco control or cessation of tobacco use. For those activities which do not have a direct impact upon the countries (e.g. “Guidelines for Tobacco Prevention and Cessations Interventions”), additional time will be required before follow-up actions are taken by the countries and their effects are seen. While a judgement cannot be made regarding whether the programme has made a difference, even at this early stage, some comments may be made which reflect on the programme’s potential. – In developing the Plans of Action for TFI, expected results and activities were formulated. The activities, if properly planned, should comprise a set of inter-related tasks which, if successfully completed in a logical sequence, effectively produce the expected result. However, in formulating activities, the necessary logic was not always followed. For example, while the planned activities under the expected result “Regional Database on Tobacco Established” are necessary, they are not sufficient to ensure the achievement of the expected result. – There is limited follow-up at the country level with the national officials and WHO country offices are often unaware of the follow-up activities expected.
4.4 Have the Programmes Effectively Complemented WHO Country Programmes? The ICP-II programme complemented the WHO country programme and national programmes in the planning phase in that there was no or only minor overlap. Each of the programmes concentrated on different aspects and activities contributing to the achievement of national health objectives in those programme areas. For example, activities under:
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– “Regional database on tobacco established” complemented the country collaborative programme in India, Indonesia and Nepal which had planned to introduce the databased information system for tobacco use in specific age groups and prevalence of tobacco use in the countries. – Enhanced and widely disseminated demand reduction interventions for children, adolescents, women and the poor, which focused on cessation interventions, complemented country programme activities in India, Myanmar and Sri Lanka to promote advocacy creation and involvement of the community and NGOs. – Technical resources developed in support of gender mainstreaming in countries complemented the country programmes in (i) Indonesia, which had planned to develop guidelines for health workers in addressing violence against women, and (ii) Bangladesh, which had planned to develop a gender strategy for the health sector. In both these cases, the ICP II input was planned to set the stage and provide a broad reference for the country level activities. – A model developed for making pregnancy safer complemented the country collaborative programme in (i) Indonesia, which had planned to enhance safe motherhood services; (ii) Sri Lanka, which complemented activities to reduce maternal and infant mortality in two underprivileged districts; and (iii) Bhutan, which developed activities to improve safe motherhood practices. In all these cases, the ICP-II input was planned to provide an evidence-based model for country-level activities to make pregnancy safer. In some cases, the complementarity of the planned intercountry and country programmes was limited, even though the programmes focused on different aspects and activities. This may be ascribed to the inappropriate planned sequencing of ICP and country activities. For example, preparation of the regional Tobacco Free Initiative policy advocacy package was planned to be implemented after the Myanmar country programmes’ tobaccofree initiative advocacy meetings. The complementarity between intercountry and country programmes, evident during the planning phase, can also be seen during implementation. For example, – enhancing regional advocacy for tobacco control complemented the World No Tobacco Day activities, undertaken by the national and WHO country programmes in all countries of the Region, and – strengthening capacity for IMCI implementation and adolescent promotion complemented the country collaborative programme in (i) Bhutan, which had planned to introduce the IMCI concept to all health workers and to strengthen the programme; and (ii) Indonesia, which developed IMCI guidelines and to modify preand in-service training. In both these cases, the ICP input was designed to provide a core group of facilitators for the activities planned at the country level. However, the full potential for ICP to effectively complement the country programmes was limited by the following factors: – a lack of communication, understanding and knowledge concerning the existence and support mechanisms provided under ICP among the national officials, some WHO staff and development partners; – inadequate country involvement in the development of the intercountry programme;
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– inadequate involvement of national programme managers and WHO country offices in the implementation and reprogramming of ICP activities, and – inadequate coordination in the reprogramming of the ICP and country plans of action.
4.5 Would the Programme have Done Better had it Adopted Different Approaches and or Mechanisms? The overall approaches adopted by the two intercountry programmes appear to be appropriate. The programmes correctly defined the problems and in general developed expected results and activities that address the problems in an optimal manner recognizing the unique role and limitations inherent in implementing intercountry programmes. For example, in many areas, there is a need for regional strategies to facilitate coordinated multi-country action and/or provide countries with a base upon which they can develop their own approaches and programmes. The intercountry programmes recognized that, to increase the probability of Member countries embracing regional strategies, it is necessary to ensure their meaningful participation in the development of strategies. Consequently, the intercountry programmes adopted an approach which focused on regional consultations that bring together the Member countries to develop strategies based on country-best practices and/or situational analyses undertaken in the countries. Among the examples of this approach are the development of: – regional advocacy strategies for tobacco control and cessation of tobacco use, particularly the SEAAT flame, and – “Vision 2020” strategy. The use of regional training for the introduction of new concepts and methods for addressing regional priorities and multi-country problems is a further illustration of the appropriateness of the approach adopted by the intercountry programmes. The training of a core group of IMCI trainers, and core groups of doctors and nurses to treat malnutrition are among the examples of the regional training approach. Though the approach adopted by the intercountry programmes has been appropriate in general, there are a number of aspects that need to be addressed. These include: – meaningful involvement of nationals at the programme development stage; – more effective management of APWs, through the WHO country offices, including the selection of appropriate consultants, monitoring and follow-up, and – ensuring adequate technical support by the Regional Office.
4.6 Has the Programme Proved Relevant, Efficient and Effective? As noted in the terms of reference, relevance is seen in terms of regional health priorities, the WHO corporate strategy and the recommendations and resolutions of the governing bodies at the relevant global and regional forums. For example, the 52nd World Health Assembly (1999) urged Member countries to undertake specific activities towards the development and negotiation of FCTC. Three critical actions of the resolution are that countries (a) promote intergovernmental consultations; (b) establish relevant structures such as a national commission; and (c) consider further
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development and strengthening of national and regional policies on tobacco control, all in support of the FCTC process. Intercountry programme activities relevant to the above include: – ICP support for active participation of representatives from Member countries in the meetings on FCTC, held in Geneva and in the Region in 2000 and 2001, and – development and dissemination of regional strategy and advocacy in favour of tobacco control. Turning to the intercountry programme for improving the health of the marginalized and vulnerable groups, among the relevant guidance is that provided by the Meetings of Health Ministers. For example, the Regional Health Declaration, adopted by the Health Ministers in 1997, proposed a number of actions to address the marginalized and vulnerable groups. The Declaration noted that one of the foremost challenges in the Region is ensuring basic health services to all, especially the poor, women, children and other vulnerable groups. It also identified gender inequities in health and development as a major public health concern and provided policy direction for their mitigation. Intercountry programme activities relevant to the Regional Health Declaration include examples, such as: – development and dissemination of regional strategies and tools for gender mainstreaming; – development and dissemination of guidelines to collect, analyse and use disaggregated data on women’s health, and – preparation and distribution of “Women’s Health Profile for South-East Asia”. The activities in both intercountry programmes under evaluation, such as meetings held in the Region, intercountry consultations, training of trainers, etc. had a catalytic and multiplier effect in the countries; examples include: – action taken by some countries to develop specific national policies, including increase in taxes, ban on tobacco advertisements, and imposition of a special levy in support of tobacco control activities; – broader participation of NGOs and other civil societies for tobacco control; – expansion of IMCI activities within Member countries; – public awareness and commitment against discrimination against females, and – manuals prepared for home-based care of the elderly. Though the programmes were in general relevant, there were a number of issues which need to be addressed in order to make them more effective. These include: – the relevence of regional definitions of vulnerable groups when applied to countryspecific situations; – lack of continuity of national focal points in specific areas; – lack of provision in ensuring continuity in technical support by WHO, and – inadequate coordination between the WHO Regional Office and country offices and inadequate monitoring.
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5.
LESSONS LEARNT AND RECOMMENDATIONS
5.1 Involvement of National Programme Managers and WHO Country Offices in Planning and Implementation Lesson Learnt The inadequate involvement of national officials and the WHO country offices in the planning and implementation of the intercountry programmes and, thus, the limited awareness of the intercountry programme at the country level, has contributed to: (a) the programmes not adequately meeting the needs of the targeted countries; (b) insufficient coordination between intercountry activities and those being undertaken through the national programmes and/or the WHO country budget; (c) delays in programme implementation, and (d) inadequate monitoring and follow-up.
Recommendation There should be greater involvement of national officials and the WHO country offices in the planning and implementation of the intercountry programme, including implementation mechanisms.
5.2 Continuity of Focal Points at the Country and WHO Country and Regional Offices Lessons Learnt It was observed that for some particular activities, key posts were not filled; focal points were not identified; and appropriate persons were not involved. There was no continuity of the participants in related activities. These have impaired effective programme implementation. Discontinuity of the technical assistance provided by the Regional Office for countrylevel intercountry activities was also observed. This contributed to delays in implementation, frequent programme changes and inadequate monitoring and follow-up.
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Recommendations 1. Countries should ensure, to the extent possible, that appropriate persons are involved in a particular activity and their continuity maintained. 2. Vacant posts at the Regional Office and WHO country offices as well as key posts related to the ICP activities in the countries should be filled most expeditiously.
5.3 Adequacy and Continuity of ICP Lessons Learnt It was observed that some of the objectives appeared to be over-ambitious as compared to the resources provided. It was also felt that the intercountry programmes evaluated need to be continued beyond the current biennium to increase the probability of programme sustainability and achievement of the desired goals. The intercountry programme, in some instances, has not been effective in its catalytic role of encouraging Member countries to initiate action in support of significant health development areas (e.g., health of the elderly, adolescent health, women’s health, TobaccoFree initiative, health of the marginalized groups, etc.).
Recommendations 1. The objectives of the intercountry programmes should be commensurate with the resources provided for their implementation. 2. Areas chosen for support through the intercountry programme should continue over at least two biennia. 3. Intercountry programmes in the above-stated areas should be designed to provide a stronger and more effective advocacy to encourage Member countries to incorporate the above areas in their health development agenda.
5.4 Value of the Joint Evaluation Exercise Lessons Learnt The joint evaluation of the intercountry programmes demonstrates that there is great value in this type of exercise that involves national focal point or high-level national officials familiar with the programmes and the Regional Office staff. The evaluation exercise increases their familiarity with the issues and problems confronting the intercountry programme and increases the likelihood of the evaluation findings being accepted and the necessary changes
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realized. However, as the WHO country offices are to be involved in the implementation of some of the intercountry activities, their greater participation in the joint evaluation team would be appropriate. The advantages of involving national focal points or high-level national officials familiar with the programmes and the Regional Office staff clearly outweigh potential disadvantages in terms of possible reduced objectivity or credibility of the findings.
Recommendations 1. Joint evaluation of the intercountry programme should be within the first three months of the second year of the biennium. 2. The joint evaluation team should comprise representatives from (i) selected Member countries, either focal points for the programme to be evaluated or high-level officials familiar with the programme; (ii) the WHO country offices in those countries to be visited as part of the evaluation; and (iii) the Regional Office. 3. The joint evaluation should focus on managerial process and results achieved at the time of the evaluation rather than the overall outcomes or impact of the programmes.
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Annex PERSONS MET BY THE JOINT EVALUATION TEAM Regional Office 1. 2. 3. 4. 5. 6. 7. Dr Harry Feirman, PLN Dr Martha R. Osei, HPE Dr J.M. Luna, CAH Dr Ardi Kaptiningsig, STP-WMH Dr Rusdi Aliudin, STP-RHR Dr Sanu M. Dali, STP-RHR Dr Neena Raina, TO-CAH 5. 4. 3. Tobacco Control and Alcohol, Ministry of Health and Social Welfare Dr Sukarni, Communication Forum on Tobacco Control, National Quality Control Laboratory of Drugs and Food, Ministry of Health and Social Welfare Drs Dachroni, Director, MPH, Directorate of Health Promotion, Ministry of Health Mrs Ismoyowati Sunoto, Health of Health Promotion Programme, Directorate of Health Promotion, Ministry of Health Mr Mulyatin, Head, Section PHP, Directorate of Health Promotion, Ministry of Health Dr Batunahal P.P. Gultom, MD, MPH, HES, National Consultant (Health Promotion) Dr Tjandra Yoga Aditama Sp., MARS, DTM&H, Vice Director for Medical Services of General Hospital and President, Indonesian Association of Pulmonologists and Vice-Chairman, Indonesian Smoking Control Foundation Ny.L.A. Hanafiah, Chairperson, Indonesian Heart Foundation and Vice-President, National Committee on Smoking Control
India 1. 2. 3. 4. Dr R. Kim-Farley, WR India Dr T. Walia, WR Office, India Dr Manoj, WR office India Dr S. Tata, Deputy Secretary (Public Health), Ministry of Health and Family Welfare Mr Suresh Chopra, Director, Ministry of Information and Broadcasting Dr Maheshwar, Joint Director, Directorate of Field Publicity, Ministry of Information and Broadcasting Dr Srinath Reddy, Coordinator, HRIDAY (Health Related Information Dissemination Amongst Youth) Dr Monica, HRIDAY Dr Kishore Chaudhary, Deputy Director General, Indian Council for Medical Research
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5. 6.
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8. 9.
10. Professor Anna Alisgahbana, Director, WHO Collaborating Center for Perinatal, Maternal and Child Health, Padjadjaran University, Bandung 11. Dr Prastowo, MHA, Directorate of Family Health, Sub-Directorate of Reproductive Age and Family Planning 12. Drg Bita Kurniawati, Directorate of Family Health, Sub-Directorate of Reproductive Age and Family Planning 13. Dr Siti Hariani, Msc, Division of Elderly Health, Directorate of Family Health, SubDirectorate of Reproductive Age and Family Planning 14. Mrs R.I. Batubara, National Consultant (Reproductive Health) 15. Dr Russell Markham Brooks, WHO
10. Mr Shukla, Deputy Director, Nehru Yuvak Kendra Sangathan, Dept. of Youth Affairs and Sports 11. Dr Das, Central Health Education Bureau Indonesia 1. Dr M. Hayatie Amal, Director of Narcotics, Addictive Substances Control and Hazardous Substances Safety, National Agency for Drug and Food Control 2. Dr Dumara Panggabean, Sub-Directorate,
SEA/RC54/6 Page 15 Technical Officer (Planner), WR a.i. 16. Dr Frits R. de Haan, WHO Medical Officer (CAH) 17. Dr Kokila Vaidya, WHO Medical Officer (Reproductive Health) 18. Mr Peter Pachner, MPH, WHO Technical Officer Myanmar 1. 2. 3. 4. 5. 6. Dr Anton Fric, Acting WR, Myanmar Dr Wan Maung, Director General, Department of Health, Ministry of Health Dr Pe Thet Htoon, Director, International Health Division, Ministry of Health Dr Soe Aung, Deputy Director General, Department of Health, Ministry of Health Dr Thein Thein Htay, Assistant Director, MCH, Department of Health, Myanmar Dr Moe Moe Khaing, Deputy Director, Women's Health, Department of Health, Myanmar Professor Saw Naing, Head, Department of Medicine, IM (1), Myanmar Dr Win Myint, Assistant Director, BHS, IM (1), Myanmar Professor Thein Aung, Head, Department of Pediatrics, IM (1), Myanmar 4. 5. 6. 7. Women's Health Project, Department of Health 21. Mr. U Tin Maung, Chief Editor, Science Magazine, Yangon Nepal 1. 2. 3. Dr. Klaus Wagner, WHO Representative Dr. B.D. Chatuat, Director General, Department of Health, Ministry of Health Dr. S.P. Bhattarai, Chief, Policy Planning, Monitoring & Foreign Aid Division, Ministry of Health Dr. Chhatra Amatya, Director, PFA, Teku Prof A.M. Das, Health Planner, WR Office Dr. Shailesh K. Upadhyay, National Liaison Officer, WR Office Mr L .R. Ban, Director, NHEICC, Department of Health Services, HMG Nepal, Teku Dr. Sunlal Thapa, Chief, Child Health Division, Department of Health Services, Teku Dr L. R. Pathak, Director, Family Health Division, DHS, Teku
8.
7. 8. 9.
9.
10. Dr D. B. Shahi, Project Coordinator, Prevention & Control of Blindness, Teku 11. Dr Mike O’dywer, Health Adviser, DFID (Department for International Development) 12. Mr Ramji Dhakal, GTZ, Teku 13. Mr Stewart Mc’Nab, Representative, UNICEF Sri Lanka 1. 2. 3. 4. 5. 6. Dr Kan Tun, WR Sri Lanka Dr Dula de Silva, Deputy Director General (Public Health), Ministry of Health Dr KCS Dalpatadu, Deputy Director General Planning, Ministry of Health Dr Locky Wai, Management Officer, WR Office, Sri Lanka Mr. Nandana De Silva, Administrative Assistant, WR Office, Sri Lanka Dr Vineetha Karunaratne, Director MCH, MOH
10. Professor Aung (CVD Project Manager), Yangon General Hospital 11. Dr Khin Than Oo, Director, HEB, DHP-IEC, 12. Dr Daw Htay Htay Aye, Director, DHPHealth Statistics, 13. Dr U Aung Kyaing, Director, DHP-Health Statistics, 14. Dr Pirko Heinonen, Chief, Health and Nutrition, UNICEF, Myanmar 15. Dr Daw Khin Ma Ma Aye, UNFPA 16. Ms. Michelle Gardner, Population Council 17. Dr Khin Tar Tar, Marie Stoppes International 18. Dr Nyo Nyo Kyaing, Assistant Director, Department of Health, and National Focal Point for Tobacco Free Initiative 19. Dr Win Win Mya, Consultant for Reproductive Health, IM (2), Myanmar 20. Dr Tin Tin Win, Assistant Director,
SEA/RC54/6 Page 16 7. Dr Deepti Perera, Director Youth, Elderly, Displaced and Disabled, Ministry of Health. Dr Kanthi Aryaratne, Health Education Bureau, Ministry of Health Dr Ranaveera, Deputy Director, Health Education Bureau, Ministry of Health
8. 9.