Report of the eighteenth meeting of the Consultative Committee for Programme Development and Management

.WORLD HEALTH ORGANIZATION Eighteenth Meeting of the Consultative Committee for Programme Development and Management, New Delhi, 14 - 17 September 1990 REPORT OF THE EIGHTEENTH MEETING OF THE CONSULTATIVE COMMITTEE FOR PROGRAMME DEVELOPMENT AND MANAGEMENT REGIONAL OFFICE FOR SOUTH-EAST ASIA !XA/PDM/Meet.l8/8 17 September 1990 In pursuance of the directive from the Regional Committee that the CCPDM meet every Six months to carry out a review of the implementation of the Organization's collaborative programmes in the Member States, the eighteenth meeting of the CCPDM was held at New Delhi from 14 to 17 September 1990. A summary of the Committee's conclusions and recommendations are contained in this report, which has four distinct sections. Section 1 contains the discussions of the CCPDM on the "Review of the implementation of WHO's collaborative programmes in the Member States during the first six months of the biennium 1990-1991, i.e. 1 January to 30 June 1990". This section will be discussed by the Sub-committee on Programme Budget. Section 2 contains its comments on the "Outline and frame for Detailed Document for Programme Implementation (Detailed Plan of Action) to be agreed between WHO and individual Member Countries". This section will also be considered by the Sub-committee on Programme Budget. Section 3 contains the comments of the CCPDM on "Review of joint government/WHO evaluation and selection, countrywise, of a priority national programme for evaluation during the 1990-1991 biennium'*. This -section will be noted by the Sub-committee on Programme Budget. Section 4 contains the deliberations of the Committee on *'Operational Activities of the United Nations System at Country Level - A Review in pursuance of UNGA Resolution 441211". This section till be considered by the Regional Committee in the plenary session along with agenda item 12. I INTRODUCTION . SECTION 1 . SECTION 2 SECTION 3 SECTION 4 1 CONTFNrS Review of the Implementation of WHO's Collaborative Programmes in the Member States during the first six months of the biennium 1990-1991, i.e. 1 January to 30 June 1990 Development of an Outline and Frame for a Detailed Document for Programme Implementation (Detailed Plan of Action) to be agreed between WHO and individual Member countries Review of joint Government/WHO Evaluation and selection, countrywise, of a priority national programme for evaluation during 1990-1991 biennium SEA/PDM/Meet.l8/8 1 3 9 11 15 1 9 23 25 27 Operational Activities of the United Nations System at Country Level - A Review in pursuance of UNGA Resolution 441211 A N N E X E S List of Participants Actions to be taken by the Government and the Organization for timely implementation of various components of the collaborative programme Illustrative example of a detailed plan of action Time-table for the preparation of annual detailed plan of action for the biennium 1992-1993 and single programme budget for the biennium 1994-1995 Implications of specific operative paragraphs of resolution A/RES/44/211, with possible response of SEAR0 to them SRA/PDM/Meet.l8/8 INTRODUCTION In pursuance of the directive from the Regional Committee, the eighteenth meeting of the Consultative Committee for Programme Development and Management (CCPDM) was convened in the Regional Office from 14 to 17 September 1990, with the following as the terms of reference: (1) To review the implementation of WHO's collaborative programmes in the Member States during the first six months of the biennium 1990-1991, i.e. 1 January to 30 June 1990; (2) To develop the outline and frame of the Detailed Document for Programme Implementation (Detailed Plan of Action) to be agreed between WHO and individual Member Countries; (3) TO review the joint government/WHO evaluation and select countrywise a priority national programme for evaluation during the 1990-1991 biennium; and (4) Operational Activities of the United Nations System at Country Level - 441211. A Review in pursuance of UNGA resolution Inaugurating the meeting, Dr U Ko Ko, Regional Director, stated that the CCPDM provided an opportunity to country representatives and WHO staff for useful and important discussions on WHO collaborative programmes. He also appreciated the work of the Government/WHO mechanism and other consultative processes in the formulation, implementation, monitoring and evaluation of WHO's collaborative programmes. He referred to some of the recent efforts by WHO, such as intensified country-centred strategies. Recalling the regular budget constraints during the last two biennia, the Regional Director said that WHO had to resort to reduction in programme implementation. There had been a slight relief since then. Yet, delays in receiving assessed contributions, fluctuations in exchange rates, and inflationary and statutory cost escalations continued to strain the budget. The Director-General had to maintain a zero-level budgetary growth for the 1992-1993 biennium, as well. Therefore, efficient and effective management of all resources of WHO remained a critical need. He said that although overall programme implementation during the first six months of 1990 was somewhat reasonable, greater efforts to improve the rate of programme delivery were needed for some countries. The WHO Representatives were reviewing programme implementation and preparing plans of action for 1991 so that the current biennial country programmes could be fully implemented by the end of 1991. Referring to the earlier recommendation made by the Seventeenth CCPDM that annual detailed plans of action be prepared at country level, as the basis of an agreement between countries and WHO for implementation of WHO country programmes, Dr U Ko Ko requested the CCPDM to review the proposed frame and contents of the annual detailed plan of action and arrive at an agreement at this meeting. SEA/PDM/Meet.l8/8 Page 2 The Regional Director recalled that Member countries had carried out joint government/WHO evaluation of several priority programmes of their choice during the period 1984-1986. The CCPDM had considered this joint exercise useful and favoured its continuation. He suggested that the CCPDM might like to indicate the types of national programmes that could be evaluated jointly during the 1990-1991 biennium. In conclusion, Dr U Ko Ko referred to the resolution adopted by the .UN General Assembly (A/RRS/44/211) on 22 December 1989, which had far-reaching implications on the operation of the entire UN system of agencies, including WHO at the country level. The regional committees in 1990 had been requested to examine this resolution in all its aspects and express their views so that the WHO Executive Board and the World Health Assembly could consider this matter in 1991. A consultation meeting had considered all the issues involved in the UNGA resolution and had arrived at certain conclusions. He hoped that the members of the CCPDM would examine the resolution in the light of its implications and arrive at conclusions and recommendations to facilitate the expression of views by the Regional Committee. The Regional Director expressed his deep appreciation to the senior officials from the Member Countries for attending the current meeting of the CCPDM, and expressed the hope that the partnership between the countries and WHO would continue to remain strong. Dr Somsak Chunharas (Thailand) was elected Chairman and Dr Deddy Ruswendi (Indonesia) as Rapporteur. A list of participants is attached (see Annex 1). SRA/PDM/Meet.l8/8 Page 3 The CCPDM noted that the programme delivery in financial terms during the first six months of 1990 was 33% for the Region as a whole. If the pipeline activities under processing were also taken into account the overall delivery for the Region came to 47%. The CCPDM noted that the overall programme delivery during 1990 was better than that in the corresponding period of the 1988-1989 biennium. But the delivery rate in some countries in individual programmes needed acceleration. The delivery of fellowships, LCS and CSA/SSA components had been slower than others. A point was raised as to how to convert the pipeline activities into firm obligations expeditiously. In this context, the definition of a pipeline activity, and the stages through which a firm obligation was established were explained. The CCPDM recognized that a clear description of terms of reference for consultants, fellowships, study tours, etc., was essential. Early clearance of requests by governments, nomination of candidates for fellowships, provision of full details of supplies and equipment required at the time of submission of supplies and equipment lists, early drawing up of proposals for implementation of activities under the local cost subsidy component, etc., were some of the particular steps at the country level which could improve programme delivery. Steps ,were also needed in the Regional Office to further improve processing of pipeline activities in various concerned units. A suggestion was made that the WRs be given more authority for local purchase. It was clarified that "local purchase" was mainly intended for procurement of goods produced within the country. For procurement of goods that were produced outside the country but supplied through a local agent, it was usually more economical to procure these through the WHO Regional Office and Headquarters. The WHO Representative had specified authority to ' make local purchases in the event of unforeseen emergency needs. The CCPDM was informed that delegation of increased financial authority had already been made by Headquarters to the Regional Office for expenditure on local purchases within the region. A view was expressed that the level of delegation of authority to the Regional Office for procurement should be increased. . The CCPDM felt that there was a need now to start processing components yet to enter the pipeline. For example, against 2 200 fellowships budgeted for 1990-1991, only 360 FAFs had been received. In this context, the CCPDM reiterated the need for the countries and the Regional Office to adhere to its earlier recommendations of 1986 relating to actions at country and regional levels for implementation of various components, including fellowships. SEA/PDM/Meet.l8/8 Page 4 The CCPDM made the following observations: - For the fellowships component, the countries might consider providing WHO with a list of principal candidates in order of priority, as well as additional list of alternative candidates. The Regional Office would process them with the understanding that if the principal candidates were not accepted, the alternatives could be processed without reference to the country. Should the funds in the on-going biennium not be sufficient, such fellowships/other components would be financed from the next biennial budget. - In order to overcome some chronic difficulties in obtaining placement of candidates from some countries, especially Bhutan and Nepal, receiving countries may be requested to reserve a fixed number of places for WHO fellows, especially those for degree/diploma courses. Some countries had indeed allotted slots for overseas candidates, but not necessarily for WHO fellows. It was however also realized that, in view of high internal demand, it might be difficult for countries to increase the number of places offered. - WHO should look into alternative or new ways of giving some inducement to host institutions for providing more places for WHO fellows. The financial implications were, however, not discussed. The Regional Office should make' more concerted efforts in securing placements for fellows within the Region and at the same time should identify alternate institutions for placement by actively negotiating with the Member countries. - The Regional Office should be more active in advising on the selection of primary institutions for placement and in suggesting alternative placements if the primary institutions could not allot places. The Regional Office could also negotiate with host countries/institutions, specially in regard to short-term courses. - A related issue was the recognition o f degrees/diplomas/institutions of some countries by the receiving institutions. This had wide implications and might entail reciprocal recognition or inspection visits by the national authorities concerned. WHO needed to look into how this could be helped. .+ The CCPDM made the following recommendations: 1. The Regional Committee be requested to urge the Member countries to consider the question of allotting a fixed number of places in some of their training institutions for candidates from other countries of the Region. 2. Member countries can provide WHO with a list of candidates for fellowships, with alternatives, in order of priority, exceeding the provision made under the fellowship component in the country budget. SEA/PDM/Meet.l8/8 Page 5 Should the funds in the on-going biennium be not sufficient, such fellowships/other components would be financed from the next biennial budget. 3. WHO should enhance its efforts to help secure placement for WHO fellows, especially through provision of advice to Member countries on alternative institutions for placement, and through negotiation with training institutions for providing placement. WHO should consider ways and means of strengthening institutions in order to increase their capabilities to accept more WHO fellows. 4. While submitting lists of supplies and equipment, the Member countries should provide full and complete details of the items required, with a view to facilitating their speedy procurement. 5. There is a need to devise a mechanism to streamline the planning and implementation processes of activities, utilizing the LCS component. 6. Member countries and the Regional Office should follow the recommendations of the 10th CCPDM on actions at country and regional levels for expediting delivery of activities under various components (see Annex 2). SEA/PDM/Meet.l8/8 Page 7 The CCPDM noted its earlier observation at its 17th meeting in April 1990 on the preparation of an annual detailed document for programme implementation, in the context of discontinuation of the detailed programme budget, starting with 1992-1993 biennium. It had recommended that an annual detailed plan of action be prepared based on the biennial programme budget endorsed by the Regional Committee. This annual detailed plan of action would constitute the agreement between Member States and WHO for implementation of WHO country programmes commencing from 1992. These plans of action, agreed between the country and WHO, would be placed before the CCPDM at its meetings in April. The CCPDM reviewed the proposed frame and content of annual detailed plans of action as described in the working paper (SEA/PDM/Meet.l8/5). The CCPDM agreed that such a detailed plan of action be prepared very Q close to the implementation year to ensure high relevance to the actual needs of the national programmes. The WHO/country agreement, to be concluded in December every year, could be in the form of an exchange of letters. The CCPDM was informed that the system pursued in WHO was unique and quite different from the one being followed in UNICEF and UNDP, which did not have regional governing bodies. Programme changes were inevitable in planned programme implementation as these occurred in response to the countries' requirements. It was expected that flexibility would be greater under annual detailed plans of action. Having discussed various aspects of programme planning, the CCPDM recommended that: 1. 2. 3. 4. 5. 6. Member countries should prepare annual plans of action giving details of activities, budgets, etc., as proposed in Annex 3. It will be meaningful if the annual plans are drawn up carefully to avoid the need for frequent programme changes during the implementation year. If in some countries the preparation of two-year plans is more appropriate, this can be done. The detailed plans of action will be the basis for programme implementation by governments and WHO. It is not necessary to bifurcate the biennial budget into two equal parts for preparing annual plans of action. Proposed format and contents may be followed for two years and then reviewed at a future date for possible revision, as may be required. Country Support Teams (CSTs) should continue to assist the WRs and national authorities in the comprehensive programme review and preparation of detailed plans of action, if needed. Since the annual detailed plans of action, as prepared by the Member countries, will be noted by the CCPDM at its meetings in April of even years, the duration of the CCPDM meetings may be increased. Activities relating to the preparation of the Programme Budget for 1994-1995 at country level should also be reflected along with those for the preparation of annual detailed plans of action for 1992 and 1993 (see Annex 4). SRA/PDM/Meet.l8/8 Page 9 The CCPDM noted that the working paper (SEA/PDM/Meet.l8/6) contained a summary of progress made by the Member States since 1984 in the joint evaluation of selected priority.national programmes. The CCPDM was informed that, in pursuance of the recommendation of the Thirty-fifth session of the Regional Committee, Member countries had . evaluated jointly with WHO ten selected priority health programmes during the period 1984-1986. The CCPDM, at its Tenth meeting held in September 1986, considered this joint evaluation exercise as a useful effort and . favoured its continuation in the future. Accordingly, some Member countries continued to undertake joint evaluation of certain priority programmes during the period 1987-1989, details of which were given in the working Q paper. The CCPDM appreciated the efforts made by countries to undertake periodic evaluation of priority programmes, which was essential in the context of realigning the resources available to the health sector to the changing requirements of the country. It felt that such an exercise would also identify the constraints encountered in the implementation of various activities so that possible remedial measures could be applied. In the ensuing discussions, the following points emerged: - Any joint evaluation has to ensure that different population groups, such as rural and urban, are adequately covered. - The evaluation should cover economic aspects of health programmes. - Selection of programmes for joint evaluation should be made from the utility and cost-effectiveness angle. - Intersectoral impact on health should also be taken into consideration as a part of health policy evaluation. - Countries should be assisted with the methodology for programme evaluation. The results of evaluation should be utilized fully, including in programme formulation exercises. An important objective of this joint evaluation exercise is to improve the national programme. - The same programme can be identified by more than one country and this will afford them an opportunity to exchange information. The CCPDM reviewed the framework used during the earlier joint evaluation exercise. It suggested that under item 1, mention should be made of evaluation capacity available at the regional and global levels so that the Member countries could take advantage of it. Under item 4, the evaluation element should also include the beneficiaries of the programme, besides relevance, adequacy, etc. The CCPDM noted different programmes identified for joint evaluation by some countries, viz., Tuberculosis Control (Bangladesh and India); Primary SEA/PDM/Meet.l8/8 Page 10 Health Care (Mongolia); EPI (Myanmar); Environmental Health (Nepal); Health Education (Sri Lanka); and Prevention and Control of AIDS (Thailand). The remaining countries would communicate their choices after consultation with their respective governments. After further discussion, the CCPDM recommended the following: 1. The framework for joint evaluation, already agreed by the CCPDM, be applied, with the modifications suggested above. 2. The selection of a particular programme for joint evaluation be left to the, Member countries, so that the evaluation exercise can commence preferably by January 1991 and be completed during 1992-1993. 3. The Regional Office should provide technical support in at the request of a Member country. the biennium this exercise, SEA/PDM/Meet.l8/8 Page 11 The CCPDM noted that the resolution A&S/44/211, adopted by the United Nations General Assembly in December 1989, on the operational activities of the UN system at the country level, reiterated the primacy of governments of sovereign states in bringing about coordination, coherence and complementarity of cooperation and assistance by the UN and other agencies through national mechanisms. This resolution was the culmination of several reviews and studies made earlier by the UN to bring about greater cooperation and coordination in the operational activities of the UN system at the country level. In view of the importance of the subject and its far-reaching implications on the structure, functions and country level operations of WHO, the regional committees of WHO had been requested to review the various provisions of the resolution and express their views, so that the WHO Executive Board and the World Health Assembly could consider this matter at their respective sessions in January and May 1991. The CCPDM was informed that a consultation meeting of some senior health officials of the Region had been held in August 1990 to deliberate on the issues in the UNGA resolution and study their implications on operations of WHO at the country level. The CCPDM members lauded the objectives and aims of the resolution, but felt that the solutfons offered required close scrutiny in the light of present operational roles and procedures of the specialized agencies of the UN system, such as WHO. One member expressed his inability to offer his country's views on the resolution in view of inadequate time and other considerations at the present time. However, there was unanimity among the members on the need to maintain the individual identity of WHO. The members appreciated the directing and coordinating role of WHO in international health and the significant role it played in enhancing the capabilities of national governments and health personnel in programme development and management. The flexibility and responsiveness of WHO in its collaborative programmes was also recognized, and its scarce resources were utilized in important areas of consultancy, training, critical equipment, etc. WHO had a strong national focus and close collaboration with the Ministry of Health. Though other agencies also contributed to health and health-related sectors, it was felt that the nodal role in collaborative activities in the health sector should continue with WHO, which was guided by the health policies of its Member States and had the technical competence required for its directing and coordinating function. The joint government/WHO coordination mechanisms had proved efficient and effective. No advantages were seen in entrusting the nodal role function to another UN entity. Over-centralization of the UN system at the country level would be contrary to the idea of decentralization, which was being advocated. There was a need, however, to establish a mechanism to enhance exchange of information and coordinate inputs of UN agencies, as well as to promote regular consultation among them. This latter function could be assumed by the UN Resident Coordinator. The CCPDM questioned the cost effectiveness of securing multi-disciplinary advice through larger contingents of technical advisers in country offices rather than securing the same from the regional and global levels in support of country offices. It strongly felt that WHO's mandate required the Organization to have its own regular budget derived from assessed contributions of Member States, and to mobilize extrabudgetary funds for the implementation of its programme of work. SRA/PDM/Meet.l8/8 Page 12 The CCPDM took note of the issues raised in the specific operative paragraphs of the resolution and their implications on the operation of activities at country level, as well as the possible response arrived at by the Consultation Meeting, as comprehensively presented in the working paper (SRA/PDM/Meet.l8/7 Add.1). The conclusions drawn by the CCPDM members after thorough deliberations may be summarized in the following recommendations: 1. WHO collaboration with countries is not restricted to provision of technical advice, but comprises substantive involvement in the formulation, implementation and evaluation of national programmes and provision of critical inputs. The concept of central funding, to be operative only through the UNDP, as envisaged in the resolution, is likely to contradict the constitutional mandate of WHO, under which the WHO Regular Budget for its technical collaboration and cooperation is provided by the Member States through assessed contributions. It is also likely to impede the management of its collaborative programmes with Member countries. 2. The cost effectiveness of providing country level multi-disciplinary technical advice through centralized UN operations under the UNDP is doubtful, as it is likely to generate delays and to bureaucratize the process. WHO's close linkage and technical collaboration with the Member Countries has proved effective, as WHO draws upon its resources from the regional and global levels. 3. In regard to team-leadership, the role of the Resident Coordinator is more appropriate to bringing about coordination and complementarity through a mechanism for mutual consultation and information exchange. Integrated responses by the UN system of agencies to countries' needs will reduce the flexibility enjoyed by countries in their close collaboration with WHO. Technical leadership roles should remain with the specialized agencies. . * / . . \ 4. If UN staff work closely with their counterparts in respective ministries it will have distinct advantages, such as easy access to national officials, close partnership, frank discussions, etc. The physical location of the WHO office in the Ministry of Health has proved to be advantageous. Housing of all UN agencies in a common premise, per se, will not necessarily improve coordination and collaboration. 5. Harmonization of programming cycles of the UN agencies with those of the countries is a complex matter, as Member countries have different planning cycles from those of the UN agencies. An experimental exercise in Nepal had failed on account of differences in the programming cycles and modalities of the various UN agencies. WHO's biennial programming cycle is closely adapted to the countries' medium-term health plans and programmes. 6. An integrated "national programme framework" will impinge on the national prerogative to determine national collaborative needs from the various UN agencies, and will do away with the current flexibility and sector specificity. It is also likely to reduce the allocation to the health sector. On the other hand, the formulation of a national health programme framework could serve the purpose of coordinating and mobilizing resources from multilateral and bilateral development agencies. SRA/PDM/Meet.l8/8 Page 13 7. WHO has given the lead among the UN agencies in the application of the programme approach in the development and implementation of its collaborative programmes in the Member countries. WHO's substantive role in the formulation and implementation of specific health programmes under its Regular Budget and extrabudgetary resources has achieved notable successes. A restricted supportive role of WHO could erode international support to countries' health sectors. 8. The flexibility allowed under the current WHO'S collaborative programming process for budgetary revision during programme implementation is greatly appreciated. 9. Regarding utilization of national capacities in the programming process, WHO's collaborative activities form an integral part of national efforts for implementing national health programmes by national health officials. National authorities also identify and implement the programme activities with WHO support. WHO has made many efforts to improve national capacities for health planning and programme formulation, and should continue these efforts. Detailed comments of the CCPDM on the specific operative paragraphs are given in Annex 5. SEA/PDM/Meet.l8/8 Page 15 LIST OF PARTICIPANTS . BANGLADESH 1. Mr M. Abdul Mannan Chowdhury Joint Secretary (Medical Education, Health Manpower and Training) Ministry of Health and Family Welfare People's Republic of Bangladesh Dhaka BHUTAN 2. Dr J. Norbhu Director of Health Services Ministry of Social Services Thimphu 3. Dr Jigmi Singhe Joint Director, Department of Health Services Ministry of Social Services Thimphu DPR KOREA 4. 5. INDIA 6. 7. H.E. Dr Kim Yong Ik Vice-Minister of Public Health Democratic People's Republic of Korea Pyongyang Dr Chong Bong Ju Tutor Pyongyang Medical University Democratic People's Republic of Korea Pyongyang Mr J. Vasudevan Joint Secretary (International Health) Ministry of Health and Family Welfare Government of India New Delhi Dr A.K. Mukherjee Additional Director-General of Health Services Directorate-General of Health Services Government of India New Delhi SEA/PDM/Meet.l8/8 Page 16 INDIA (cont'd) 8. Dr G.R. Khatri * Assistant Director-General (International Health) Ministry of Health and Family Welfare Government of India New Delhi INDONESIA 9. Dr Deddy Ruswendi Chief, General & Foreign Aid Planning Division Bureau of Planning Ministry of Health Republic of Indonesia Jakarta MALDIVES 10. Mr Mohamed Rasheed Deputy Director of Planning and Coordination Ministry of Health and Welfare Republic of Maldives Male MONGOLIA 11. 12. MYAUMAR 13. 14. H.E. Dr G. Dashzeveg First Deputy Minister Ministry of Health and Social Services Government of the Mongolian People's Republic Ulaanbaatar Dr R. Arslan Senior Medical Officer Directorate of Science and Manpower Development Ministry of Health and Social Services Government of the Mongolian People's Republic Ulaanbaatar Dr U Tin U Director-General Department of Health Ministry of Health The Union of Myanmar Yangon Dr U Kan Tun Deputy Director International Health Division Ministry of Health The Union of Myanmar Yangon * attended as observer SEA/PDM/Meet.l8/8 Page 17 NEPAL 15. Dr S.P. Bhattarai Chief Manpower Development and Training Division Ministry of Health His Majesty's Government of Nepal Kathmandu SRI LANKA 16. Dr George Fernando Director-General of Health Services Ministry of Health and Women's Affairs Democratic Socialist Republic of Sri Lanka Colombo THAILAND 17. Dr Somsak Chunharas Chief, Office for Technical Cooperation and Health Manpower Development Ministry of Public Health Government of Thailand Bangkok WHO SECRETARIAT Dr D.B. Bisht, Director, Programme Management Dr M.Z. Husain, Director, Planning, Coordination and Information Mr N.P.H. Milner, Director, Support Programme Dr Samlee Plianbangchang, Planning Officer Mr C.R. Krishnamurthi, Health-for-All Officer Dr N.T. Cooray, Programme Development Officer Dr O.T. Christiansen, External Relations Officer Mr J. Mittar, Budget and Finance Officer Mr R.V. Narasimhan, Special Assistant to Director, Programme Management Mr S. Vedanarayanan, Senior Administrative Assistant Mr M.A. Harpalani, Administrative Assistant Mr P.P. Singh, Clerical Assistant RESOURCE PERSONS Dr Uton Muchtar Rafei, Director, Health System Infrastructure Dr N.K. Shah, Director, Prevention and Control of Diseases Dr Aung Than Batu, Director, Research and Human Resources Mr M.L. Gupta, Chief, Promotion of Environmental Health Annex 2 SEA/PDM/Meet.38/8 Page 19 - ACTIONS TO BE TAKEN BY THE GOVERNMENT AND THE ORGANIZATIbN FOR TIMELY IMPLEMENTATION OF VARIOUS COMPONENTS OF THE COLLABORATIVE PR0GRhiJ-l~ ---------------^-------------------------------------------------------------- Action by Government Action by WHO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Long-term staff cl.earance of candidate wherever clearance involves several ministries/departments. Ministry of Health to clear the candldate within a stipulated time if no response is received from other ministries/ departments. 2. Fellowships Terms of reference of individual To prepare study programmes fellowships, with clear objectives within 30 days of the receipt of to be submitted at the same time the FAFs and initiate negotiations as the detailed programme budget with the receiving countries/ is finalized. institutions. Nomtnation of suitable candidates, and submission of fellowship application forms to SEAR0 by September of the year preceding the biennium in respect of the fellowships scheduled for the first year, and by June of the first year of the biennium in respect of fellowships for the second year. (Wherever possible, nominations and FAFs to be submitted by September of the year preceding the biennium in respect of all fellowships). To prepare fellowship awards, and make travel arrangements for the fellows within 15 dsys of the acceptance by the institution. ____________________-----------------------------------------I_-- -------- * From the report of the meeting of the Working Croup of the CCPDH, held on 2 6 3 September 1986 Maintenance of a register of potential candidates available in different disciplines. Arrangements for medical clearance to be made, pending receipt of clearance from the host government. Arrangements for medical clearance to be made, pending receipt of clearance from the host government. Travel arrangements to be made within 2 weeks of the Government’s clearance or 2 weeks prior to the joining period. I f a f t e r G o v e r n m e n t c l e a r a n c e ; -. those candidates who fail to report within stipulated time, the offer of appointment may be withdrawn or he may be debarred from future recruitment in extreme cases, depending on the circumstances. , SEA/PDM/Meet.lB/B Page 20 --------------------___________________^-------------------------------------- Action by Government Action by WHO -_____-____________-____________________-------------------------------------- To ensure that candidates meet the host institutions’ require- ments, and have the language proficiency certificate, wherever needed. To identify the institutions most suitable for the placement of fellows, wherever possible. To avoid cancellation of fellowships already awarded. To ensure that the returning fellows are posted in the same discipline as they are trained. To carry out the evaluation of the fellowships periodically with the technical support of the Organization. To expedite release of candidates, against those fellowships for which fellowship final estimates, have been raised during the biennium, before the expiry of the first six months of the following biennium. 3. Supplies and equipment To submit details of supplies and equipment with specifications at least six months before the time that they are expected at the project site. Designation of Government representatives to receive the supplies and equipment. To raise purchase authorization, and purchase orders, and to maintain a register for improved follow-up in order to ensure the supplies and equipment on-order are shipped in time by the suppliers. 4 To initiate local purchase of supplies and equipment, wherever they are competitively priced, are of requisite quality, and could be delivered in time. To establish simplified procedures with the help of the Health Ministry for prompt clearance by the customs. SEA/PDM/Meet.l8/8 Page 21 -----_--------------------------------------------------------------- m --- s Action by Government Action by WHO ---__-_----~_~~~--~~~~--~~~-~~~-~---------~~--~~~~---~~~--~~~~~~~~~-----~~~~~~ 4. Local cost subsidies To formulate detailed plans of a c t i o n f o r a l l t h e n a t i o n a l GEAs a n d o t h e r a c t i v i t i e s , e a r l y i n the biennium in order to facilitate WHO to advance funds promptly, as per WHO Manual IV.1.205, i.e., initially for the 3-month agreed expenditure on subsidy or $20,000, * whichever is less. T o i n i t i a t e a c t i v i t i e s f o r w h i c h local cost subsidy has been provided during the operational biennium, and complete them within the first year of the ensuing biennium. To report progress of follow-up o f a c t i v i t i e s u n d e r a l l TSAs a n d complete them within the stipulated period. To provide statement of accounts f o r t h e u t i l i z a t i o n o f f u n d s required for the completion of a c t i v i t i e s a l r e a d y i n i t i a t e d . . To ensure that activities financed under LCS do commence in the biennium. 5. Others-7 To draw up plans of action for all major projects, before the commencement of the biennium. * Enhanced to $ 30,000 since 1989. ANNEX 3 SEA/PDN/Meet.l8/8 Page 23 i- ” ILLUSTRATIVE EXAMPLE OF A DETAILED PLAN OF ACTION FOR THE YEAR 1986 (IN BIENNIAL BUDCET FOR 1986-1987) (FINALIZED AND AGREED BY DECEMBER 1985) . . . . PHC 004 - Repair and Maintenance of Electra-Medical Equipment- - - - Objective To assist in further development and strengthening of repair and maintenance facilities and services for electro-medical equipment through institutional support and trajning of staff. Project Review A long-term WHO Electra-Medical Engineer had been In position. The establishment of National Electra-Medical Equipment Maintenance Workshop and Training Centre, . . . is at an advanced stage. All the class III and IV personnel and most of the Senior Officers and Engineers h a v e been recruited. Assistance from the Asian Development Bank was received. The orientation training programme for the personnel recruited is in progress and repair services for the basic equipment is being extended to the .local and outside hospitals. Establishment of repair units in each Medical College, specialized institutes and 19 district hospitals has been approved and implementation started from 8 January 1985. In the first phase, the units at . . . will be established. Part of the Repair Unit attached to the Central Medical Stores is being shifted. Survey of equipment in the hospitals has commenced on an organized basis. Proposed Activities The WHO Electra-Medical Engineer will continue to assist in further development of National Training Centre and establishment of repair units in the District Hospitals and Medical. Institutions ,&id conduct teach-in-workshops and seminars. Support will be extended through provision of further supplies and equipment to the repair centres; and machineries to the site; transportation 5 of test equipment instafl?tion of equipment at‘ the National Electra-Medical Equipment and Maintenance Workshop and Training Centre; establishment of repair units at . . . district hospitals; and commencement of repair of sophisticated equipment in the hospitals through mobile teams. Six fellowships for repair of advanced and specialized equipment w i l l b e p r o v i d e d . Training of personnel for the above centres will be carried out. Four teach-in-workshops in the repa’ir and maintenance of specialized equipment, a seminar on organization and management of repair workshops, and commencing the first 2-year training course in repair technology for Electra-Medical Equipment will be undertaken. FORMAT FOR PREPARATION OF DfTSfLED PLAN OF ACTION (for year 1986 in biennium 1986-i987) Proiect Objective To assist in further development and strengthening of repair and maintenance facilities and services for electro-medical equipment through institutional establishment and training of staff. Project No. . . . PHC 004 Project Title: Repair and Maintenance of Electra-tiedical Equipment Activity (1) Budget Allocation Component (3) Time frame iDates) Start of End of Activity Activity (4) (5) ?rimary Responsibility (6) Expected outcome (when completed) (7) Specific objectives and activities 1. To provide coctinued technical support to institution. Specific activity a) Provision of a LTS- Electra-Medical Engineer 114,700 24 mm LTS 2. To provide support to staff development Specific activities _ b) Training abroad on repair of diagnostic equipment 12,000 Z/6 Fell.(R) 12,000 Z/6 Fell. (R) c) Training abroad on repair of x-ray equipment 10,300 l/3 Fell.(ER) d) Training-in-Workshop on Repair of Equipment 4,000 40180 w Lcs 3. To support the strengthening of training facilities e) Provision of tools and test equipment and spare parts. 46,700 S&E 1.1.86 31.12.87 DGHS Six-monthly tech. reports. 1.6.86 31.8.86 Director Stores and Supplies. Termination reports 1.5.&6 31.7.86 Ditto Ditto 1.8.86 31.10.86 mtto mtto 1.7.86 14.7.86 Ditto Workshop reports To be processed within 1986. Mtto S&E as requested. Annex 4 SEA/PDM/Meet.l8/8 Page.25 s( --- Year/Mont m-w- 1990 September November 1991 January April June-Sept Sept.-Ott November December 1992 January April June-Oct. November December 1993 January April T I M E - T A B L E FOR P ANNUAL DETAILED PLAN OF ACTION FOR THE BIENNIUM 1992-1993 Activity Discussion on the format and content for annual detailed plan of action by 18th CCPDM and Sub-committee on Programme Budget Review and noting of the Single PB for 1992-1993 by RC43 Discussions on the steps for the prepara- tion of annual detailed plan of action for 1992-1993 PB at WRs' Meeting. Initiation of preliminary steps by WRs to pre- pare annual detailed plan of actton for 1992 Discussion on preparation of annual detailed plan of action for 1992 by RPC with WRs (during 19th CCPDM) Preparatory action to implement certain components of 1992-1993 programme budget, viz. LTS, fellowships, etc. which require a longer period for processing Preparation of annual detailed plans of action for 1992 by WRs In collaboration with the national authorittes concerned Finalization of annual detailed plan of action for 1992 (at WRs' Meeting) WHO/Country agreement on annual detailed plan of action for 1992, ready for implementation 1992 Commencement of implementation of programme January- activities for 1992 March Initiation of preliminary steps by WRs to pre- pare annual detailed plan of action for 1993 Submission of the annual detailed plan of action for 1992 to 21st CCPDM for information April Discussion on preparation of annual detailed plan of action for 1993 by RPC with WRa Preparation of annual detailed plans of action for 1993 by WRa in collaboration with the national authorltles concerned. Finalization of annual detailed plan of action for 1993 (at WRs' Meeting) WHO/Country agreement on annual detailed plan of action for 1993, ready for implementation Commencement of implementation of programme activities for 1993 Submission of the annual detailed plan of action for 1993 to 23rd CCPDM for information E P A R A T I O N O F SINGLE PROGRAMME BUDGET FOR THE BIENNIUM 1994-1995 Year/Mont -----___-_ 1990 1991- - July August September. Preparation of tentative programme October budget by countries and WRs November May-June July September 1993 January &Y ----------- Activity DG indicates regional planning figu Notification by RD to countries ol the country planning figure Review of tentative programme budgel by RAs/PDa/RPC - with WRs ~eformu+~1otl_.nf prcrpramme budget ay cotinlrles/Wks .- _ "?. 1s./ Finalization of programme budget for biennium with national representatives/WRs (RPC) Preparation of PB document (within Regional Office) Despatch to Member countries Endorsement of PB by KC Executive Board endorses global programme budget dorld Health Assembly approves global programme budget -------------,--------------,-,-,. SRA/PDM/Meet.l8/8 Page 27 ANNEX5 . IMPLICATIONS OF SPECIFIC OPERATIVE PARAGRAPHS OF RESOLUTION A/RES/44/211, WITH POSSIBLE RESPONSES OF SEAR0 TO THEM Operative para 12: The concept of central funding of technical cooperation through UNDP is stressed and all governments are urged to channel the maximum possible share of resources available for multilateral technical cooperation through UNDP. WHO has a technical collaboration function with the Member countries. This partnership enhances the capacities of national institutions and personnel involved in the delivery of health services. WHO's collaborative role is not restricted to provision of technical advice, but calls for substantive involvement and critical input in national programmes. The cost effectiveness of keeping technical experts in the UNDP is doubtful. The linkages of WHO with the Ministry of Health should be retained since collaboration in certain matters, such as fellowship, local training, provision of consultancy services, etc. is more effective with WHO than with UNDP. If UNDP were to implement such activities, the procedures might be lengthy and time-consuming. . The implications of central funding need further study in relation to UN specialized agencies and their established roles and funding. The Regular Budget is derived from assessed contributions from Member States and is used for technical coordination and cooperation with Member States. WHO has been mobilizing extrabudgetary resources from the UNDP, voluntary and other sources in support of special priority health programmes. The capacity of WHO to generate these funds reflects on the credibility of its technical cooperation with Member States. More recently, the World Health, Assembly (WHA) and the Executive Board, by resolutions WHA42.3 and EB85.Rl5 respectively, have directed WHO to mobilize extrabudgetary resources to meet the increasing needs. Its constitutional mandate, therefore, demands Q that WHO continue to receive Regular Budget and mobilize extrabudgetaryresources to implement country, regional and global health programmes. The central funding concept through a single agency should not affect these resources. UNDP, as a funding agency for development cooperation with countries, should provide supplemental resources in support of health programmes as an integral component of socio-economic development of countries. Operative para 13: There is a need for full utilization of national capacities in all aspects of the programming processes and project cycles of operational activities. This reinforces WHO's approaches to collaborative programme development at the country level within the managerial framework for optimal use of WHO's resources in direct support of Member States.' WHO's collaborative activities form an integral part of national efforts for implementing national health development programmes. The priorities of the collaborative programmes are decided by national authorities who are also responsible for SEA/PDM/Meet.l8/8 Page 28 identification of activities for programme implementation. The WHO field staff as well as the Regional Office staff provide required support with full utilization of national capacities. Operative para 14: There is a need to improve the operational activities of the United Nations system,, in particular with respect to programming, simplification and harmonization of rules and procedures governing the programming processes and project cycles, decentralization of authority, role of country office structures and reorientation of execution modalities, in order to enable the recipient governments to exercise their management and coordination responsibilities and strengthen their national capacities. The concept of strengthening national capability for exercising management and coordinating responsibilities is in conformity with WHO's current practice. WHO has been strengthening joint Government-WHO management of country programmes to support national capacities. The South-East Asia Region's recent decision to submit to the Regional Committee a single biennial programme budget document, supported by an annual detailed plan of action, is an example of promoting flexibility in programme formulation and implementation. Harmonization of programming and project cycles of all UN agencies is a complex undertaking. Countries have different plan, programme and budget cycles. Harmonization at the UN level and maintaining conformity with the country cycles do not appear to be feasible. Within the framework of medium-term national plans, technical co-operation requirements can be identified and matched with the UN agencies' programming cycles. Harmonization will require a wider study in the total UN system involving the governing bodies. Operative para 15(a): The country offices and the Resident Coordinators should effectively provide ongoing multi-disciplinary technical advice and support to the governments in their programming and executing responsibilities. WHO country representatives (WRs), supported by Regional Office technical staff, are providing technical advice and support to the health sectors in national governments. WRs are cooperating with the UN Resident Coordinators in providing relevant technical advice and support to national governments. However, if the operative paragraph implies rendering of technical advice and support through the UNDP Resident Coordinator, there will be an additional echelon interposed. This will bureaucratize and centralize the operations of the UN agencies, which is against the principles of decentralization advocated in the resolution. There is a need, however, to bring about effective coordination in the UN system and, possibly, to establish a network for communication among the different UN agencies. WHO's link with the Ministry of Health, as its technical advisor, should be maintained. WHO is now involved both in providing technical expertise and in carrying out technical operations in the countries. A SRA/PDM/Meet.l8/8 Page 29 reduced role for WHO in technical operations will contradict the Organization's constitutional mandate for directing and co-ordinating international health. It should be the countries' prerogative to decide whether the response required is a sectoral response or a multi-sectoral response and to request support from the relevant UN agencies accordingly. The cost-effectiveness of securing multi-disciplinary advice through , larger contingents of technical advisors in country offices versus seeking it on-call from the regional and global levels needs to be studied. w . Operative para 15(b): The team-leadership capacity of the Resident Coordinator within the UN system at the country level should be reinforced for the integration of the sectoral inputs. of the system and for theeffective and coherent coordination of the response of the United Nations System to the national programme framework. 0 Committee 'B' of the 41st WHA agreed to the need to strengthen the role of the Resident Coordinator to promote complementarity of support by the UN system at country level. However, WHO's technical leadership role in health is mandated by its Constitution and the governing bodies. In integration of sectoral inputs of the UN system under the leadership of the Resident Coordinator, WHO's operational support to national health programme framework should not be reduced but complemented by support from other UN funding agencies. The team leadership of the Resident Coordinator should improve coordination and complementarity. WHO has been cooperating in inter-agency forums, but it is important to maintain its present channels of communication as well as its direct access to the Ministry of Health. . Operative para 15(d): All organs, organizations and bodies of the United Nations system are requested to make, without delay, the necessaryt arrangements, in cooperation with host governments and without additional costs to developing countries, to establish common premises at the country level. Committee 'B' of the 41st WHA agreed to the principle of common premises for the UN system, while maintaining that WRs, as technical advisers to the Ministries of Health, should be located close to the ministries. In view of the cultural background of the countries in which the UN system operates, there are certain advantages in the UN staff working with their counterpart ministries and no attempt should be made to house all UN agencies in a common premise. WHO should not be another "desk" in the UN office. The physical location of WHO's country offices in the Ministries of Health has proved to be of practical advantage both to the countries as well as to WHO, particularly in view of the Organization's close working links being chiefly with the Ministries of Health. WHO country offices may be located in the common UN premises where accommodation is not available in the Ministry of Health or where it may be of significant advantage. Nevertheless, the question remains whether common premises are essential for solving coordination problems among organizations and bodies. Operative para 17(a): Governments should formulate, in accordance with their own development plans and priorities, integrated national programme frameworks setting out cooperation requirements from the UN system. SEA/PDM/Meet.l8/8 Page 30 Governments formulate medium-term socio-economic development plans within which individual sector plans and programmes are presented. WHO provides technical cooperation for the formulation of health sector plans and programmes as part of its country level collaboration with Member States. There may be a need to improve the definition of need for technical cooperation from UN agencies in national plan documents. Therefore, the question of a "national programme framework" may have to be carefully examined in the light of utility, use, and the demands on national staff that it will make. If such a programme framework document contains clearly spelt out requirements for cooperation from the UN system, how essential is it that a parallel framework be formulated by the UN system? ‘1 Besides, an integrated "national programme framework" will impinge on the national prerogat4ve to def'ermine collaborative needs from the various UN agencies, and will do away with the current flexibility and sector specificity. It is also likely to reduce the allocation to the health sector. On the other hand, the formulation of a national health programme framework could serve the purpose of coordinating and mobilizing resources from multilateral and bilateral development agencies. WHO has considerable experience in introducing a systematic and rational medium-term health programming approach - Country Health Programming &HP), comprehensive managerial process for health planning (MPNHD) - which has resulted in national health programme frameworks that provide a good basis for the governments to determine their needs for external technical cooperation. WHO is continuing with its efforts to improve national health planning methods and capabilities, and will be able to cooperate in the development of a strong health component within the contemplated "national programme framework". WHO would welcome the country level "appraisal" of programme frameworks under the leadership of national governments, and would advocate adequate representation of the Ministry of Health in such appraisal mechanisms to protect the health sector requirements. Operative paTa 17(b): The organizations of the UN system should adapt their programming processes to be based upon those of national programme frameworks. WHO's programme budgeting procedures comply with this requirement. WHO's collaborative programme is an integral part of the national health development programme and is formulated through a joint Government/WHO coordination mechanism, and through intensive consultations with national health administrators and officials of other sectors as required. Operative para 17(c): The programme cycles of all funding agencies of the UN system should be harmonized with and adapted to the planning period of national governments, and further consideration should be given to the introduction of budgetary cycles on a rolling cycle basis. The joint programming exercise has remained an attractive idea. But, an experimental exercise in Nepal in 1970 failed on account of differences in SEA/PDM/Meet.l8/8 Page 31 programming modalities of participating agencies. The subject of joint programming, though desirable technically, is not feasible practically and this should be guided by decisions of the agencies' governing bodies. Alignment of contents of technical cooperation is definitely more important than alignment of cycles. Those who advocate harmonising planning cycles of UN agencies should realize that the planning cycles or developmental plan periods of individual countries vary widely - from two-year periods to seven-year periods in South-East Asia. Adoption of a rolling budget in WHO's programming process will require changes in the Organization's current. programme .budgeting procedures.However, the possibility of preparing WHO's medium-term programme on a rolling basis may be examined.The General Programme of Work of WHO - a 0 six-year programme document - provides a sound basis for its programme budget formulation, and adapts itself to different programme cycles of countries. Operative para 17(d): The need for a shift from project to programme approach implies that all relevant governing bodies, in particular the Governing Council of UNDP, should develop more programme-oriented mechanisms for the provision of technical cooperation. Since the WHA approved programme budget presentation is based on a programme-oriented approach, WHO has taken the lead in the application of the programme approach in the development of its collaborative programmes. WHO welcomes the shift from diverse projects to a broader and sustained programme approach by all UN agencies. . Operative Para 17(f): Organizations participating in programming (of the UN system cooperation) should be invited to increase their efforts directed towards integrated programming under the leadership of governments. . From the country point of view, it is important to secure adequate participation of the relevant development sectors of the government in such an exercise. Greater importance should be given to the holistic complementarity of programme contents than to mere integration of programmes. r . WHO strongly believes in integrated programming for the health sector under government leadership, with close involvement of the Ministries of Health, which will bring adequate resources to health development programes. Para 18(a): The present rules and procedures for government/ national execution should be adapted, as appropriate, to promote and maximize the utilization and strengthening of national capabilities while enabling governments to make effective use of the expertise available within the UN system. Developing national capacities for programme execution has been an objective of WHO. However. the scone of national execution would vary from SEA/PDM/Meet.l8/8 Page 32 country to country, depending on infrastructural and managerial resources of individual countries. The required expertise and infrastructure are not uniformly present in all countries. Support from the agencies may be necessary to implement specific components. Direct financial cooperation, in which WHO has provided financial inputs to well-defined national programme objectives, requires that governments set up appropriate managerial mechanisms and processes ensuring full accountability. WHO should explore ways and means to further strengthen national capacities in existing mechanisms such as joint Government/ WHO coordination committees. Operative Para 18(c): Governing bodies should review existing budget, audit and other relevant practices with a view to taking specific decisions on measures designed to promote and maximise the utilization of national capacities through government/national execution. WHO has periodically reviewed its budget, audit and other practices and will continue to do so keeping in view the changing needs and in accordance with the wishes of its governing bodies. Operative para 19: In the context of government/national execution of programmes and projects, the participation of specialized agencies and technical entities of the UN system in operational activities should be re-defined towards, in particular, the provision of technical support to governments on a multi-sectoral and sectoral basis, as well as towards a supportive technical role in the project cycle, as required by governments. The project concept contradicts the advocacy of the programme approach. Redefinition of agencies' functions may imply that WHO's role as an executing agency will get restricted to only a "supportive technical" role; its operational role will be eroded. Experience confirms that WHO has a substantive role in formulating and implementing specific health programmes funded by Regular Budget and extrabudgetary resources. Notable examples are smallpox eradication, immunization, malaria control, and now AIDS. WHO cannot restrict itself to a "supportive technical" role, to be seen as merely giving advice to the RR/UNDP. WHO does not heavily depend on the UNDP or other funding agencies. Its Regular Budget allows WHO to provide substantive programme support. Mechanisms exist in all governments to coordinate the UN system's cooperation for development activities. But it is essential that the government undertakes the responsibility of coordinating multi-sectoral inputs from all UN agencies. Operative para 20 requests organizations of the UN system to improve their abilities to provide governments with information on the capacities and needs of other developing countries to enable greater integration in programme and project formulation, the components of technical cooperation among developing countries (TCDC). TCDC remains a valid concept, whose practice has not yet measured up to expectations. WHO has endeavoured to promote and catalyse TCDC in health in several ways, including the promotion of national focal points, inviting the Ministries of Health to extend political and policy support, publishing SEA/PDM/Meet.l8/8 Page 33 and disseminating information on needs and capacities, and catalytic financial inputs. WHO believes that the initiative and commitment must come from the cooperating partners voluntarily. WHO will continue to support TCDC in accordance with this principle. b Operative para 23(a): Within the broad multi-year programmes and projects approved by governing bodies, approval authority for specific programmes and projects should, to the maximum extent possible, be delegated to the country level, in support of improvement of programme and project appraisal capacity. _ This provision applies directly to the DNDP. WHO has been conscious of the necessity to decentralize its operations. WHO has progressively moved towards decentralization and delegated authority to the WRs. WHO will continue to periodically examine further delegation to improve efficiency and effectiveness. Decentralization and delegation are also linked with strengthening of the WRs' offices. The role played by the joint Government/WHO coordination mechanisms will also be strengthened. Operative para 23(b): Country offices should have the flexibility for budgetary revision of projects during implementation. At present, WHO's collaborative programmes have more flexibility, in comparison to UNDP-funded projects. WHO has made significant efforts to introduce flexibility in its programming and implementation procedures. Production of a single programme budget document for the biennium, delegation of authority to the WRs to effect programme changes, etc., are examples. The joint Government/WHO coordination mechanism is active in the management review and reprogramming of WHO country budgets as needed. Country Support Teams have assisted the WE& in programme review and replanning of programmes mid-point in the budget cycle. Certain financial and managerial authority has been delegated to the WRs for efficient implementation of WHO collaborative programmes. This delegation includes authority for programme changes as required during the implementation phase, release of funds for specific country level activities within the approved budget, etc. The real need is the simplification of the process of collaboration in the context of a particular situation, and the needs of individual countries. WHO may, however, periodically review the need to further simplify the process. Operative para 26: The executive heads of the UN funding and technical agencies should re-examine their organizational structures and staff development in support of the requirements of decentralization. This issue needs to be examined in its totality in the light of mandates of governing bodies, current organizational structures and programmes. WHO/SEAR has 70% of its regional budget programmed in the countries. WHO has periodically reviewed and strengthened its organizational structure and functions with a view to providing the most relevant and effective support to Member States through decentralization of SEA/PDM/Meet.l8/8 Page 34 responsibility and delegation of authority. This concept of the resolution is also reflected in WHO's efforts in the new managerial framework for optimal use of WHO's resources in direct support of the Member States and the regional programme budget policy. A strong country office is a condition for effective implementation of the decentralization process. Nearly two-thirds of WHO staff are assigned outside its headquarters. WHO country offices can be strengthened with additional staff using the country budget. It is the country's prerogative to decide what technical expertise it wants to be provided with by WHO in support of its programmes. WHO's technical expertise could either be in the form of country-based long-term staff or short-term consultants financed from the country budget, or in the form of technical expertise provided to the countries from the regional or the global level, costs of which are met from regional or global budgets of WHO. Maintenance of a full multi-disciplinary staff team on a regular basis in each country as a substitute for needs-oriented back-stopping from the regional and the global levels would have to be carefully examined.