WHO in the Western Pacific Region Highlights 2009–2013
© World Health Organization 2013 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications—whether for sale or for noncommercial distribution —should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, (fax: +632 521 1036, e-mail: publications@wpro.who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. ISBN–13 978 92 9061 633 7
WHO Western Pacific Region: Highlights 2009–2013
WHO in the Western Pacific Region Highlights 2009–2013
Contents 1 4 9 16 24 36 48 Introduction Consultation Reforms New divisions Innovations Results Future
WHO Western Pacific Region: Highlights 2009–2013
WHO
Introduction hen the World Health Organization was founded in 1948, there was an urgent need to restore basic health services in a world ravaged by war. Malaria, tuberculosis, sexually transmitted infections, and maternal and child health were the chief concerns of the first World Health Assembly. For much of the 20th century, in fact, disease control dominated WHO work. Global public health challenges have evolved. Trade, travel and migration link nations as never before. Emerging and reemerging diseases require new strategies. Noncommunicable diseases that once threatened only the richest nations now haunt all countries, including the remotest Pacific islands. Health systems in some countries, particularly in least-developed countries, either have not been established or are not
W
functioning properly. In other countries, health systems are strained to breaking point, with health-care costs overwhelming ordinary people and their governments. WHO has had to grow to meet these burgeoning challenges. Budgets have risen, and staff numbers have increased. In the wake of the 2008 global recession, Member States demanded greater efficiency in the use of hundreds of millions of dollars spent on public health. And they wanted solutions that more directly addressed their needs. That simple set of circumstances—a global agenda moving beyond disease control, tough economic times, a demand for greater efficiency and a desire by Member States for support that focused on needs at the country level—set the stage for a new era in the WHO Western Pacific Region. “The times demand that the Organization gets back to fundamentals, back to serving its clients,” said Dr Shin Young-soo, who in
in February 2009 began his tenure as WHO Regional Director for the Western Pacific. “And of course our clients are our Member States.”
In September 2008 Member States broke with tradition and chose Dr Shin, the first-ever outsider, as the sixth Regional Director for the Western Pacific. In his first address to staff, Dr Shin shared plans for internal and external assessments to examine the way WHO worked in the Region. It was the first step in a process that would eventually lead to significant reforms and restructuring. Changes instituted in the Western Pacific Region eventually would have implications for the way the Organization works globally.
1
AFP
WHO Director-General Dr Margaret Chan (seated centre) joins officials at the opening on the fifty-ninth session of the WHO Regional Committee for the Western Pacific.
2
WHO Western Pacific Region: Highlights 2009–2013
AFP
AFP
Left: Dr Shin Young-soo speaks to the press after his election as WHO Regional Director for the Western Pacific on 22 September 2008. Right: WHO Director-General Dr Margaret Chan (right), Dr Moon Chang-jin (centre), previous chairperson of the Regional Committee, and then-outgoing Regional Director Dr Shigeru Omi applaud the election of Dr Shin.
3
Consultation T he effort to reengineer WHO in the Western Pacific Region began with Fit for the Future, an internal consultation that included all staff at the Regional Office and in country offices. Much of what was revealed in the consultations was apparent as Dr Shin visited Member States. During his first year in office, he visited 14 of the 37 countries and areas of the Western Pacific Region. In July 2009, following a meeting of the ministers of health for Pacific island countries, Dr Shin took a 10-hour overland trip to visit a remote village in the mountains of Papua New Guinea that lacked many of the basic necessities of life. Dr Eksavang Vongvichit, Health Minister of the Lao People’s Democratic Republic, said WHO is making a difference in the Region, particularly on child mortality and maternal health, the focus of Millennium Development Goals 4 and 5. “WHO has become more country focused,” said Dr Eksavang. “When Dr Shin visited, he recommended ways of piloting a joint initiative on maternal, neonatal and child health. It was practical advice for the implementing of our national strategy.” Dr Cherian Varghese, senior medical officer for noncommunicable diseases (NCDs) in the Regional Office, said it is not unusual for Dr Shin to take on the role of a technical officer in the field. “It’s encouraging for the rest of us to see the Regional Director getting involved at the country level,” said Dr Varghese.
Over six months, a task force conducted lunchtime seminars, town hall meetings and retreats with professional staff and locally recruited support staff, from administrative assistants to drivers and janitors. Through this process, four priorities were identified: 1) strengthening leadership and partnership; 2) sustaining and building on resource mobilization and communications capacity; 3) improved human resources management— ensuring the best staff to deliver results; and 4) finding new ways of working.
“When I was there I asked myself, ‘How can we make a difference in places like this?’ ” Dr Shin recalled. “It’s a question that’s always on my mind whether I’m visiting highland dwellers in Papua New Guinea, ethnic communities in the Mekong, the urban poor in Manila or those living on remote atolls in the Pacific.”
4
WHO Western Pacific Region: Highlights 2009–2013
AFP
AFP AFP
Highland dwellers at Mount Kerawa in Papua New Guinea.
5
WHO
WHO
Above: Dr Shin in the Lao People’s Democratic Republic with WHO staff in 2009. Left: Dr Shin meets with Lao Deputy Prime Minister Dr Thongloun Sisoulith. WHO Western Pacific Region: Highlights 2009–2013
6
AFP
Above: Dr Shin visits children at a flood evacuation centre in 2009 in Muntinlupa, south of Manila, Philippines. Right: Dr Shin (left) and Philippine Secretary of Health Francisco Duque comfort a child displaced by the October 2009 floods.
AFP
7
WHO
AFP
AFP
Above: Dr Shin in a field visit in Fiji in 2010. Far left: A young girl prepares handmade rice cakes in Can Tho Province in the Mekong Delta in Viet Nam. Left: Traditional flat-bottomed boats on the Mekong River in the Lao People’s Democratic Republic, where malaria threatens ethnic communities. WHO Western Pacific Region: Highlights 2009–2013
8
Reforms estructuring and reforms in the Western Pacific Region have focused on transforming WHO at the regional level into an organization that can more effectively and efficiently support Member States in achieving their public health goals. Initial reforms focused on the Organization developing a more cross-cutting approach. Thirty-one technical units, some working in isolation from colleagues in related areas, were streamlined into just 17 teams—a move that broke down walls between units and encouraged collaboration. “We now work with more of a systems perspective that forces us to consider how one issue or one programme affects another,” said Dr Susan Mercado, Director of the Division of Building Healthy Communities and Populations at the Regional Office. “Most
R
health ministers have to think in those broad terms, and it’s essential that WHO be able to respond to that need.” Anjana Bhushan, technical officer for equity, human rights and gender at the Regional Office, said the emphasis on breaking down “silos”—a reference to the type of organizational behaviour in which little information is shared outside of specific offices or units— has made an important difference. “As I work on cross-cutting issues, I’ve often had to first build relationships and look for windows of opportunity to collaborate with other colleagues and programmes,” said Mrs Bhushan, who has worked in large organizations for 30 years. “But when the mandate comes from the top to break down silos, it pushes people to talk. There’s now more openness and a greater willingness to work across areas.”
Establishing better ways of working in technical units in the Regional Office was only part of the equation. In August 2009, the Country Support Unit (CSU) was created, tasked with implementing the Country Focus Policy and with strengthening crosscutting public health approaches throughout the Region. Information from the Regional Office for the Western Pacific began to flow to coun try offices through CSU, ensuring the country offices were well informed and aware of the latest developments within the Region. Updates from country offices, including significant political events, key public health events, and interactions with host governments and primary stakeholders, began to be compiled at the Regional Office in
9
bimonthly reports for middle and senior management. The early internal consultations and the streamlining of operations, such as the reduction of technical teams and the creation of CSU, were steps in the right direction. They were only a start. What WHO was hearing from staff members and Member States was echoed in reports by external agencies, beginning with a 2010 report from the Multilateral Organisation Performance Assessment Network and followed by the United Kingdom Department for International Development Multilateral Aid Review and the Australian Multilateral Assessment. Everyone agreed that WHO is respected as an essential and unique part of the health arena, with a strong reputation for developing robust and objective norms, standards and guidelines.
The Organization’s valuable convening capacity, especially its ability to bring together diverse partners and governments, was greatly appreciated. But they also raised concerns about the effectiveness and efficiency of WHO’s contribution to health development at the country level. They saw a gap between the support WHO provided and what countries actually needed and had the capacity to utilize. “Country focus is critically important,” said Dr Shin. “We need to customize our support to the political, social and economic context of every country. Some Member States are more concerned about disease control, while others are more concerned about emergency preparedness and disaster response. And the solutions for one country may be different than the solutions needed for the next country.” Dr William Adu-Krow, WHO Representative for Papua New Guinea, says innovations
such as the Country Strategic Frameworks and the Technical Strategic Frameworks have made the Regional Office more aware of what is needed at the country level.
“In the past, the Regional Office might invite us to participate in discussions on an ad hoc basis,” said Dr Adu-Krow, a 13-year WHO veteran. “Now there’s far better coordination.” “Morale is higher in the Country Office than ever before. And in all my years of work with WHO, the capacity of general staff has never been higher, and that’s because of investments in training,” Dr Adu-Krow added. “We’ve had four general staff members travel to the Regional Office for training. For Papua New Guinea that’s deeply motivating.”
10
WHO Western Pacific Region: Highlights 2009–2013
WHO
Dr Shin in Vanuatu in April 2010.
11
WHO
WHO
WHO
Above: Dr Shin and Dr Boris Pavlin at the opening of the new WHO Country Liaison Office in Pohnpei, Federated State of Micronesia, August 2010. Top left: Dr Shin in Samoa with WHO staff. Left: Dr Shin visits health facilities in Vanuatu in 2010. WHO Western Pacific Region: Highlights 2009–2013
12
WHO
WHO
Above and top right: In Cambodia in 2012, Dr Shin meets with health partners as part of his push to promote cross-cutting public health approaches. Right: Dr Shin in Viet Nam in 2010.
WHO
13
WHO
Dr Shin, seen here on a field visit to Pailin Province, Cambodia, in July 2012, has focused on meeting needs at the country level.
14
WHO Western Pacific Region: Highlights 2009–2013
WHO
Dr Shin (centre) in Samoa in 2010 at the Health Symposium on Primary Health Care.
15
New divisions T he creation in August 2010 of the Division of Pacific Technical Support (DPS)—which is based in Suva, Fiji, and directly serves 21 of the 37 countries and areas that make up the Western Pacific Region—was a giant step towards improving WHO performance at the country level. Many Pacific island countries and areas are small and isolated, with unique demographics and cultures. “Global and regional guidelines often are not applicable,” said Dr Ahn. “By providing Pacific-specific guidance, we can be much more helpful.” Samoa’s Minister for Health, Dr Talalelei Tuitama, said he appreciates WHO’s efforts to deliver more tightly tailored support that matches the needs of Pacific island countries and areas. “The new Division of Pacific Technical Support has allowed WHO to collaborate more closely with all of us in the Pacific,” he said. “Those of us in the Pacific very much want this kind of close collaboration to continue.” DPS is organized into three programmatic teams: Combatting Communicable Diseases and Health Security and Emergencies; Health Sector Development; and Building Healthy Communities and Populations. The new structure has enhanced communication and improved responsiveness to country needs. This enhanced responsiveness was demonstrated in the development of the Multi-Country Cooperation Strategy for the Pacific, which is the overarching framework for WHO’s strategic approaches in the Pacific. The strategy contains specific strategies for each of the 21 countries and areas in the Pacific, with a synopsis of country health plans and WHO’s role in those plans. DPS has offices in Fiji, Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu. A new WHO Country Liaison Office was opened in Pohnpei in the Federated States of Micronesia in August 2010 to serve the Federated States of Micronesia, the Marshall Islands WHO Western Pacific Region: Highlights 2009–2013
“Our efforts in the Pacific were very fragmented and scattered,” said Dr Dong-il Ahn, the division’s director. “In fact, we were not very well coordinated. But the creation of DPS put integrated technical support right here in the Pacific. If countries have requests for services, 80% of those requests can be dealt with in the Pacific, rather than at the Regional Office.”
16
and Palau, further increasing WHO presence in the Pacific. In addition, the Country Liaison Office in Solomon Islands was upgraded in 2012 to a full WHO Representative Office. The increased presence in the Pacific has allowed WHO step up its attack on neglected tropical diseases such as leprosy, lymphatic filariasis and yaws. These diseases have taken a particularly harsh toll on Pacific island countries and areas. Another important organizational change at the Regional Office for the Western Pacific was the merger of the units responsible for food safety and for humanitarian action and emergency response with the Communicable Disease Surveillance and Response unit, which had led the Region’s highly successful responses to SARS, avian influenza A(H5N1) and pandemic influenza A(H1N1) in April 2009.
The new Division of Health Security and Emergencies (DSE) was formed in July 2010. “In creating this new division, we emphasized the strengths and the common platform for emergency response operations we already had, and we enhanced cooperation among related programmes,” said Dr Ailan Li, who arrived at the Regional Office as a medical officer in 2004 and now serves as the director of DSE. “In the areas of emerging diseases, health security and emergency response, the effort to streamline technical programmes really has made a big difference,” said Dr Li. “Those reforms provided a common technical platform for programmes to work together when responding to an outbreak or an emergency. And it has served as a model for Member States in tackling these issues.” While the creation of DPS and DSE fostered more efficient country-focused technical support to Member States, an important administrative change at the Regional Office was directed at external relations and partner engagement—an increasingly important
task in light of the recent proliferation of vocal stakeholders and new players in the public health arena. In July 2010, External Cooperation and Partnerships (ECP) and Public Information were merged to form the new External Relations and Communications unit. Initially situated within the Division of Programme Management, the unit has been under the direct authority of the Regional Director since 2012. ERC was established to facilitate engagement and communication with donors and partners and to strengthen the visibility of the Organization and its capacity to mobilize resources through more effective outreach. Member States and donors demand greater efficiency, accountability and transparency. The need to demonstrate that money provided for public health is being used wisely has never been greater. ERC has developed a number of initiatives, including the establishment of the Award Management Support Service and the Awards Oversight Group, the streamlining of reporting and communication with
17
donors and partners, and the development and implementation of the Partners Coordination and Engagement Strategy (2013– 2019) and the Communication Strategy for the Western Pacific Region (2013–2019). In 2012, the Western Pacific Region mobilized US$ 187 million in voluntary contributions. In all, the Regional Office for the Western Pacific works with and genuinely appreciates the collaboration and support of a variety of donor Member States and more than 75 other partners. “The leadership of the Regional Office for the Western Pacific is pioneering and advancing WHO reforms at a regional and country level,” said Benedict David, AusAID Principal Health Specialist. “Australia strongly supports these reforms. They are important to improving the efficiency and effectiveness of health systems and services on the ground. Australia looks forward to continuing to work with the Regional Office for the Western Pacific to improve the health of people in our Region.”
WHO
In August 2012, Dr Shin arrives in Solomon Islands, on one of his frequent visits to Pacific island countries and areas.
18
WHO Western Pacific Region: Highlights 2009–2013
WHO
Dr Shin pays a visit to health facilities in Cook Islands in 2012.
19
WHO
WHO
WHO
Above: Dr Shin in Fiji with Minister of Health Dr Neil Sharma in 2010. Top left: Solomon Islands Health Minister Charles Sigoto (right) welcomes Dr Shin in August 2012, when WHO upgraded its presence in the country to the WHO Representative Office in Solomon Islands. Left: Dr Shin mixes with staff at the opening of the WHO Representative Office in Solomon Islands. WHO Western Pacific Region: Highlights 2009–2013
20
WHO
WHO
Above: Dr Shin in Cook Islands in 2012. Top right: Dr Shin accompanies Minister of Health Dr Neil Sharma in 2012 in Fiji during the handing out of health kits. Right: A Healthy Islands recognition award goes to Papua New Guinea in 2013.
WHO
21
WHO
Dr Shin in Papua New Guinea in 2010.
22
WHO Western Pacific Region: Highlights 2009–2013
WHO
Dr Shin on a field visit to Solomon Islands: many Pacific island countries face a dual burden of communicable and noncommunicable diseases.
23
Innovations T wo important innovations promote greater efficiency and help ensure WHO is making a difference at the country level: Country Strategic Frameworks and Technical Strategic Frameworks. from the CSF and the TSF can be found in the Organization-wide outcomes and outputs for the Programme Budget 2014–2015. In May 2011 WHO Director-General Margaret Chan introduced Reforms for a Healthy Future. Several aspects of that programme had their origins in the Western Pacific Region. Reform continues to be a priority agenda item at meetings of the WHO Executive Board and the World Health Assembly. The task force developed a framework entitled The Overarching Roles and Functions of the Three Levels of the Organization. The framework was structured around 12 elements of reform, some of which were influenced by the reform experiences in the WHO Western Pacific Region. In the Western Pacific Region, the Fit for the Future reform initiative launched in 2009 was followed by a second wave of reforms called Moving Forward, Making a Difference, which began in June 2011. Australia, a longtime donor and development partner in the Region, provided generous support, with Japan, Macao (China) and the Republic of Korea also joining the effort. Moving Forward, Making a Difference is intended to strengthen WHO’s country-level support to help Member States achieve their health development goals, including universal access to quality health services and a WHO Western Pacific Region: Highlights 2009–2013
Country Strategic Framework (CSFs) were developed to ensure that the work WHO and Member States agree to undertake—in Country Cooperation Strategies—is on track. Technical Strategic Frameworks (TSFs), meanwhile, ensure alignment and harmonization of work between the Regional Office and the country offices. This results-oriented approach has been adopted by WHO headquarters—including terminology used in the CSF and the TSF—for the development of the Twelfth General Programme of Work and the Programme Budget 2014–2015. Several outcomes and outputs
Dr Shin was asked by Dr Chan and the Global Policy Group to co-chair the task force examining the functions of the three levels of the Organization— headquarters, regional offices and country offices—to help clarify the role of each level.
24
WHO
The Global Policy Group (GPG)—From left to right: Dr Shin Young-soo, WHO Regional Director for the Western Pacific, Ms Zsuzsanna Jakab, WHO Regional Director for Europe, Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean, Dr Margaret Chan, Director-General of WHO, Mirta Roses Periago, former WHO Regional Director for the Americas, Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia, Dr Anarfi Asamoa-Baah, Deputy Director-General, Dr Luis Sambo, WHO Regional Director for Africa.
25
health agenda that is reflected in all policies. A new model of WHO engagement at the subnational level is under way in China and the Philippines. Programmes focus effort where the need is greatest, which often means working directly at the provincial or local level. The Region’s first such foray was the Western Area Health Initiative (WAHI), launched in China in July 2012. Dr Shin, accompanied by Dr Michael O’Leary, then-WHO Representative for China, visited three target provinces to identify priority interventions for the most vulnerable populations. These field trips, followed by discussions with senior officials at the central and pro vincial level, shaped the 2013–2015 WAHI workplan. “WAHI was Dr Shin’s brainchild,” said Dr O’Leary. “It’s an innovative idea that makes a lot of sense. China is so big and diverse,
and there are regions that are underserved. It makes great sense to put our main effort where the biggest problems are.” The Regional Office for the Western Pacific is doing something similar in the Philippines, where it is sharpening its focus and working at a more local level to support the Government’s universal health care agenda. Dr Enrique Ona, the Philippine Secretary of Health, cited the Country Cooperation Strategy, jointly developed by the Government and WHO, as an important element of support for the country’s universal health care agenda. “It serves as the key document for planning policy and programme development for the attainment of our common health goals,” said Dr Ona. In the same way WHO has focused on subnational efforts, the Regional Office for the Western Pacific has also reached out to other regions with broader initiatives in order to better serve Member States. In the Greater Mekong Subregion, the problems of three countries in the Western
Pacific Region, Cambodia, the Lao People’s Democratic Republic and Viet Nam, as well as Yunnan Province in China, are similar to those in Myanmar and Thailand, countries of the WHO South-East Asia Region. The two WHO regions are working together to solve the problem of resistance to artemisinin, a drug widely used to treat malaria. Several important strategies and frameworks, such as the Asia Pacific Strategy for Emerging Diseases (APSED), were jointly developed through biregional collaboration, as was the establishment of the Asia Pacific Observatory on Health Systems and Policies. In fact, Dr Shin and Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia, are the only regional directors to hold annual biregional retreats. Nonetheless, Dr Shin’s efforts to enhance cooperation and collaboration extend well beyond the Organization.
26
WHO Western Pacific Region: Highlights 2009–2013
WHO
WHO
Above: WHO Director-General Dr Margaret Chan (second from right) and Dr Shin (far right) join Chinese officials in signing the WAHI agreement to provide support to three provinces. Left: Dr Shin speaks at the July 2012 launch of the Western Area Health Initiative (WAHI) in China, a project he spearheaded to provide technical support where it is most needed.
27
WHO
Dr Shin in the Lao People’s Democratic Republic in 2011.
28
WHO Western Pacific Region: Highlights 2009–2013
WHO
WHO
Above: Dr Shin during a field visit in Mongolia in 2010. Top right: In Zhan’an County, Shangluo City of Shaanxi Province, China, Dr Shin treks to San-tiao-gou Village Clinic. Right: Dr Shin visits Yun-gai-si Township Hospital in Shaanxi Province, China, in December 2012.
WHO
29
WHO
Dr Shin (left) accompanies United Nations Secretary-General Ban Ki-moon to Australia, Solomon Islands, Kiribati and New Zealand in September 2011 to see how the United Nations family can better serve the Pacific.
30
WHO Western Pacific Region: Highlights 2009–2013
In September 2011, Dr Shin accompanied United Nations Secretary-General Ban Ki-moon to Australia, Solomon Islands, Kiribati and New Zealand to gain insight into challenges in the Pacific and how the United Nations family can better serve the people there. To better focus WHO’s service, the Country Support Unit led all WHO country offices in conducting self-assessments against four key attributes: focus on country needs, offering value for money, convening and coordinating more effectively, and communicating more effectively. The assessments pointed to the need for better coordination between the Regional Office and country offices in advocacy, planning and technical support; improved communications, including communications training and raising awareness of WHO and its achievements; and strengthening the management of offices, including recruitment and staff retention.
Objective assessments with external experts of WHO country offices in the Western Pacific were carried out in Cambodia, Papua New Guinea and Solomon Islands. The assessments identified several areas for improving the performance of the Organization’s core functions, including placing the best people in the most demanding jobs, making health systems the main focus in all country offices and being more strategic—in other words making tough choices to achieve real impact. Dr Adu-Krow, the WHO Representative for Papua New Guinea, said the external assessment conducted in his office in 2012 was an “eye-opener”. “We do our work and think we’re doing what needs to be done with partners, ministries and civil society,” said Dr Adu-Krow. “But through our external assessment, we learned that we had a serious communications problem, both with the Department of Health and with an external partner, that neither felt comfortable bringing to our attention. Without an external review, we might never have caught and corrected that problem.”
External assessments of the Regional Office for the Western Pacific, the Division of Pacific Technical Support and the Office of the WHO Representative for the Philippines are planned in 2013. Among the many developments over the past five years, Member States and WHO experts consistently applaud the renewed focus on health systems. A comprehensive review examined the effectiveness of six recent Western Pacific regional strategies and action frameworks for health systems strengthening, focused on indicator trends, lessons learnt, and the need for future work on health systems, the health workforce and universal health coverage. “There’s been a refocus on certain areas over the last few years in the Western Pacific Region, with new issues coming to the fore,” said Dr O’Leary, the WHO Representative for China. “Health systems have certainly been at the top of the list. It’s different from what we were used to, and that’s a noticeable change at country level.”
31
Some seemingly less dramatic reforms in areas such as duty travel and the protocol for organizing meetings and workshops have led to substantial savings in the Region. Mobility for internationally recruited staff has long been a difficult issue for WHO at all levels. But Dr Shin firmly believed that a more mobile professional staff—one that served not only in the Regional Office, but also in the country offices and in other regions—would improve the Organization as a whole and staff members personally. He also wanted locally recruited support staff to have an opportunity to rotate through different divisions and units.
The Western Pacific Region has had a 95% success rate on professional staff mobility, with all but two of 38 staff members from the original mobility roster having moved to new assignments. “Mobility benefits the person and benefits the Organization,” said Dr Marianna Trias, who
spent 17 years working in child, adolescent and maternal health in the Regional Office before becoming the senior programme management officer in the China Country Office. “I’m the only person in the Country Office who has worked in the Regional Office,” said Dr Trias, pleased to be working where her expertise is most needed. “I’ve been able to apply that broad experience at the country level.” Dr Nasir Hassan, who worked in environmental health and NCDs at the Country Office in Cambodia for six years, made the move to the Regional Office in 2010. “After so many years working at the country level, it was a bit of a shock to move,” said Dr Hassan, who is now team leader for environmental health. “It’s worked out well. I now have a better perspective of the broader issues facing the Region, but I’m also able to approach issues with a very keen understanding of how our initiatives can be carried out at the country level.” The benefits of mobility are not limited to internationally recruited professional staff.
Lisa Lim has worked at the Regional Office for 14 years. “I stayed in the same administrative unit for 10 years while my children were growing up,” she said. “But as they got older I wanted to focus more on my career.” Transferring to a new unit turned out to be easy and more fulfilling. “Now I’m putting my economics and accounting background to work. The rotation policy has been very good for my career.”
WHO headquarters agrees. “The Western Pacific Regional Office policy on mobility represents best practice in WHO,” according to a 2012 WHO management report. “It should be taken into consideration for a global mobility scheme.” In addition, recruitment procedures have been enhanced, with the eventual goal of bringing recruitment times down from the 250-day norm five years ago to just 120 days, while still ensuring that WHO has “the right people in the right place at the right time”.
32
WHO Western Pacific Region: Highlights 2009–2013
Staff training and development has been a priority, as witnessed in programmes ranging from work–life balance training for drivers to executive coaching for senior managers. Phonepraseuth Phonseya and Saykham Siharath, drivers in the WHO Country Office in the Lao People’s Democratic Republic, attended a workshop on work–life balance in Phnom Penh, Cambodia, as part of the Western Pacific Region Staff Development and Learning (SDL) programme. “We really appreciated that WHO provided this great training to Lao drivers,” said Mr Saykham. “We both feel it really improved our work style and our lifestyle. It also let us exchange opinions and lessons with staff from other countries. It made us feel close to another WHO office. We look forward to other training courses.” Anthony Catalig, an informatics assistant on the Regional Service Desk in Manila who was elected to the WHO Western Pacific Region Staff Association in 2011, said management has supported the association, in particular through the SDL.
“Every biennium we’re getting more funds for work–life balance activities, sports, creative activities and brown bag seminars,” he said. “Senior management is open to suggestions. There’s been an open-door policy.” Staff as well as visitors to the Regional Office for the Western Pacific have given high marks to the WHO compound’s transformation since 2010. The Regional Office has been transformed into a modern, environmentallyand visitor-friendly facility.
Major improvements include new drainage and sanitation systems, a complete renovation of the conference hall and reception and lounge areas, a new air ventilation system, enhanced tropical gardens and ponds, a new two-storey car park, the construction of a modern library and a state-of-the-art communications studio, a renovated cafeteria and the modernization of the Emergency Operations Centre.
WHO
The newly renovated Regional Office cafeteria — one more example of creating a healthier work environment.
33
WHO
WHO
WHO
Above: Murals by Philippine National Artist Arturo Luz have been carefully restored. Far left: The Regional Office Conference Hall, renovated after extensive damage caused by Typhoon Ondoy in 2009, is now an inviting venue for meetings. Left: The Conference Hall after floodwaters recede in September 2009. WHO Western Pacific Region: Highlights 2009–2013
34
WHO
WHO
Above: The Regional Office for the Western Pacific, Manila, Philippines, after renovations were completed. Top right: The modern public health library, inaugurated in March 2013. Left: Typhoon Ondoy leaves the Regional Office in need of a facelift in September 2009.
WHO
WHO
35
Results very year, the Regional Director presents a report to the Regional Committee for the Western Pacific, the Organization’s governing body in the Western Pacific, highlighting the accomplishments of the previous year. However, the full scope of the achievements of WHO and Member States can be seen more clearly when they are viewed over a longer time frame. WHO in the Western Pacific Region is now a more effective and efficient organization than it was just five years ago. Seventeen technical teams—down from 31 units in 2009—work in closer collaboration than ever before. Cooperation among programmes in the Regional Office and in the Region’s 15 country offices is now the norm.
E
Transparency and accountability—both to Member States and to the generous donors who support public health—have become the Region’s hallmarks. Positive health outcomes abound in the Region. Successes in combating vaccine-preventable and vectorborne diseases, malaria, HIV, tuberculosis and neglected tropical diseases are but a few examples. Significant progress also has been made in improving maternal health and reducing child mortality, although some countries still face stubborn challenges.
Member States in the Western Pacific are taking proactive steps to tackle the growing NCD epidemic, with efforts to control tobacco use and promote healthy lifestyles including initiatives such as Healthy Cities and Healthy Islands.
The Western Pacific Region has maintained its polio-free status, and projections show that endemic measles virus transmission has likely been interrupted in 31 countries and areas in the Region. Measles incidence in the Region has dropped from 27 per million people in 2010 to 12 per million in 2011. Measles mortality fell from 80 deaths in 2010 to only 11 in 2012. Some 30 countries and areas are likely to have reduced hepatitis B seroprevalence to less than 2% among five-year-old children, with eight countries having been certified as having achieved the goal of reducing infection rates in five-year-old children to less than 1%. Nine of the 10 malaria-endemic countries in the Region have changed their programme goals from control to elimination. Between 2009 and 2011, the number of new malaria cases dropped by 10% and the number of deaths by 38%. WHO Western Pacific Region: Highlights 2009–2013
36
Cambodia, the Lao People’s Democratic Republic, the Philippines and Viet Nam have achieved a 75% decrease in malaria mortality as compared to 2000, a target set for 2015 by the World Health Assembly. China, the Republic of Korea and Viet Nam have achieved similar decreases in malaria morbidity. The Western Pacific Region is also on track to meet the Millennium Development Goal (MDG) targets for tuberculosis, with TB prevalence having been cut in half over the last 10 years. The Regional Office for the Western Pacific has delivered technical assistance to Member States for the surveillance of multidrug-resistant TB (MDR-TB), laboratory strengthening, the introduction of new tools and strategies for vulnerable groups, and to combat TB/HIV coinfection. AFP
Princess Astrid of Belgium (right), Special Representative of the Roll Back Malaria Partnership, Cambodia Health Minister Mam Bun Heng (centre) and Dr Shin Young-soo launched an initiative combat drug-resistant malaria in the Mekong Subregion in April 2013.
37
The Western Pacific Region has made significant progress over the past five years on MDG 4 (child mortality) and MDG 5 (maternal health). Malaysia and Mongolia have achieved the targets for MDG 5, while Cambodia, China, the Lao People’s Democratic Republic, the Philippines and Viet Nam are likely to reach the targets by 2015. Most Member States in the Region have registered major reductions in maternal mortality and the under-five mortality rate. In Cambodia, for example, the maternal death rate fell from 830 deaths per 100 000 live births in 1990 to 206 deaths per 100 000 live births in 2010. But progress among and within countries has been uneven. Noncommunicable diseases continue to be the leading cause of death and disability in the Region. In November 2012, WHO and Member States set voluntary global targets
to turn back the tide of the NCD epidemic and created a global monitoring framework to measure progress. Two people die every minute from tobaccorelated disease in the Western Pacific Region, where one third of the world’s smokers reside. Raising taxes and the price of tobacco products is one of the most cost-effective policy interventions to reduce smoking prevalence. WHO has placed a high priority on advocacy and capacity-building for raising tobacco taxes and using the resulting revenue for the establishment of health promotion foundations and tobacco control funds or boards. In Pacific island countries and areas, where the highest rates of tobacco use are found, WHO, with the support of AusAID, launched the Pacific Tobacco Taxation Project to work with ministries of finance to strengthen tax regimes. As a result of these efforts, three new health promotion foundations have been established in the Lao People’s Democratic Republic, the Republic of Korea and Viet Nam. Samoa is expected to establish a similar foundation. Taxes on tobacco prod-
ucts have increased in Brunei Darussalam, China, the Federated States of Micronesia, Palau, Malaysia, Mongolia, New Zealand, the Philippines and the Republic of Korea. Cook Islands, Fiji, Papua New Guinea and Tonga have also announced their decision to raise tobacco taxes in the immediate future. WHO and Member States have also stressed the importance of cost-effective interventions for controlling alcohol, reducing salt intake, reducing and replacing transfats, and providing essential drugs, medicines and services to manage NCDs. As part of its focus on country-level results, WHO helped Pacific island countries and areas to develop a crisis-response package for their national NCD strategies. WHO also continues to work with Member States to improve health financing systems, especially those aimed at providing universal health coverage—one of the top priorities in the Western Pacific Region. In the Lao People’s Democratic Republic, WHO has been working with the Government and development partners on national health
38
WHO Western Pacific Region: Highlights 2009–2013
AFP
A young family in Mongolia: the country has already achieved Millennium Development Goal 5—improving maternal health. Malaysia also has met the target. Cambodia, China, the Lao People’s Democratic Republic, the Philippines and Viet Nam are likely to reach the target by 2015.
39
WHO
WHO
WHO
WHO
Top left: Dr Shin and Mongolian Prime Minister Sukhbaataryn Batbold in 2010. Others: Dr Shin during a field visit in Mongolia in 2010.
40
WHO Western Pacific Region: Highlights 2009–2013
WHO
WHO
Above: Dr Shin meets with staff at the WHO Representative Office in the Lao People’s Democratic Republic in March 2013. Top right: Lao Vice-Minister of Health Dr Bounkong Syhavong and Dr Shin visit the Medical Education Development Centre of the Lao University of Health Science. Right: Dr Shin and Lao Health Minister Dr Eksavang Vongvichit at a ceremony celebrating 50 years of cooperation.
WHO
41
system reform strategies for universal health coverage.
At the celebration of the 50th anniversary of cooperation between WHO and the Lao People’s Democratic Republic, Dr Shin met with the Lao Vice Premier and advocated for more public funding for health. WHO provided technical support to help Viet Nam improve its health financing system. The process of revising its health insurance law has provided Viet Nam with a great opportunity to review and analyse challenges and opportunities. WHO facilitated the Government to bring in international experts for a series of policy dialogues to address the challenges and explore solutions. The Minister of Health and Dr Shin led two high-level policy dialogues and brought together various ministries to discuss health and raise the priority of health on the national development agenda.
WHO also supported the implementation and monitoring and evaluation framework of Kalusugan Pangkalahatan, or universal health care, in the Philippines. The goal of the initiative is to ensure that everyone has access to essential services at an affordable price. In Mongolia, WHO has successfully advocated the vision of universal health coverage and continues to support the country in moving towards that goal. In the past five years, WHO has facilitated the development of Mongolia’s overall health financing architecture, as well as its long-term national health insurance strategy. Six regional health systems strategies developed in the Western Pacific Region in recent years have been reviewed, and WHO and Member States have discussed lessons learnt. In addition, WHO assisted five Member States in developing human resources for health plans and strategies, as well as strategies and plans for medicines and laboratories. Ten Member States now have national health accounts, and per capita health expenditures are on the rise throughout the Region.
Every year in the Western Pacific Region, between 250 and 300 public health events are detected, assessed and monitored, including disease outbreaks, disasters and food safety concerns. An upgraded Emergency Operations Centre located at the Regional Office for the Western Pacific now serves as the technical, information and management hub for coordinating response operations. But experience in the Region, includ ing SARS, avian influenza and the consistently high number of natural disasters and food safety events, has prompted WHO and Member States in recent years to shift their emphasis towards preparedness. Forty-eight percent of Member States in the Region— significantly higher than the global average of 21%—have met the core capacity requirements of the International Health Regulations, or IHR (2005), with the other Member States working under a two-year extension to meet the requirements.
42
WHO Western Pacific Region: Highlights 2009–2013
The Asia Pacific Strategy for Emerging Diseases, a biregional plan that was updated in 2010, serves as a framework to assist Member States in meeting the IHR core requirements and thus strengthen their capacity to prepare and respond to emergencies and public health events. Nearly all countries in the Region now have designated units for surveillance, with data on epidemic-prone and priority diseases analysed at least weekly. Three quarters of the Member States in the Region have conducted national risk assessments to identify potential public health events. Health emergency communications plans are in place in most countries and areas, and public health laboratory capacities have been enhanced. WHO
The Regional Office’s upgraded Emergency Operations Centre serves as the technical, information and management hub for coordinating response operations.
43
WHO
WHO
WHO
Top, left and right: The sixtieth session of Regional Committee for the Western Pacific in 2009 in China, Hong Kong SAR. Bottom: The sixty-first session of Regional Committee for the Western Pacific in 2010 in Putrajaya, Malaysia.
44
WHO Western Pacific Region: Highlights 2009–2013
WHO
WHO
Top: Opening of the new Conference Hall during the sixty-second session of the Regional Committee for the Western Pacific in 2011 in Manila, Philippines. Bottom, left and right: The sixty-third session of the Regional Committee for the Western Pacific in 2012, in Hanoi, Viet Nam.
WHO
45
MOHW, Republic of Korea
MOHW, Republic of Korea
MOHW, Republic of Korea
MOHW, Republic of Korea
Fourth Tripartite Health Ministers Meeting, Jeju Island, Republic of Korea, November 2010. Top left (from left to right): Dr Shin Young-soo, WHO Regional Director for the Western Pacific, Dr Chen Zhu, Minister of Health (China), Chin Soo-hee, Minister of Health and Welfare (Republic of Korea) and Ritsuo Hosokawa, Minister of Health, Labor and Welfare (Japan). Top right: Dr Shin and Chin Soo-hee, Minister of Health and Welfare (Republic of Korea). Far left: Dr Shin and Dr Chen Zhu, Minister of Health (China). Left: Ritsuo Hosokawa, Minister of Health, Labor and Welfare (Japan) and Dr Shin.
46
WHO Western Pacific Region: Highlights 2009–2013
WHO
WHO
Above: Ninth Pacific Health Ministers Meeting, Solomon Islands, July 2011. Top: Eighth Pacific Health Ministers Meeting, Papua New Guinea, July 2009. Right: Tenth Pacific Health Ministers Meeting, Samoa, July 2013.
WHO
47
Future hen Member States elected Dr Shin Young-soo as Regional Director in September 2008, they chose a leader with broad experience in international public health, as well as policy development and implementation. As Dr Shin himself readily acknowledges, however, he was an outsider. “I knew coming in that WHO was 65 years old, with established ways of working,” said Dr Shin, recalling his first days in office. “I knew we couldn’t implement everything we had in mind immediately. My goal was to push us in a new direction without disrupting that which the Organization was doing well.” Now after five years in office, Dr Shin continues to offer the fresh perspective of an outsider, tempered with a deep understanding of the complexities of the Organization and
W
of how WHO at the regional level can best support Member States in meeting their health challenges. The next five years will mark a new era in public health, as the 2015 target date to meet the Millennium Development Goals passes and the international community begins to shape the post-2015 development agenda. WHO in the Western Pacific Region will play a key role in that process, especially with transformational issues such as universal health coverage, healthy ageing and emerging infectious diseases. These issues will play out in a Region undergoing dramatic change, where rapid socioeconomic development will make “leastdeveloped country” status a thing of the past. Ageing societies and rapid industrialization and urbanization will demand that investments in health be more efficiently and effectively managed.
While aligning itself with global public health priorities and policies, the Regional Office for the Western Pacific fully expects to remain in the vanguard of reform within WHO. Above all else, WHO in the Western Pacific Region will strive to better understand each Member State and tailor its support to their specific needs.
Five principles will guide WHO work in the Western Pacific Region over the next five years.
48
WHO Western Pacific Region: Highlights 2009–2013
BEING PEOPLE CENTRED AND COUNTRY ORIENTED Understanding the needs of Member States and tailoring WHO’s support in a manner that can be of practical use to Member States. Using evidence-based approaches and adhering to WHO’s overarching principles, WHO in the Western Pacific Region will package its technical support so that it is easily absorbable and adaptable to countries facing similar challenges.
BEING ADAPTABLE TO CHANGE Reinventing WHO in the Western Pacific Region to find the best ways to be more effectively engaged—both externally with partners and internally across regions and at the subregional level (Pacific island countries and areas, the Mekong Subregion and the Association of Southeast Asian Nations) and at the subnational level (China’s Western Area Health Initiative and similar efforts).
These guiding principles, along with mandates from the Regional Committee for the Western Pacific and the expressed needs of Member States, will set the course over the next five years as WHO in the Western Pacific Region works towards the goal of good health and well-being for all of the Western Pacific Region’s 1.8 billion people.
BUILDING ON SUCCESSES WHILE RECOGNIZING UNFINISHED AGENDA AND CHALLENGES Recognizing both successes and unfinished business in an effort to achieve the best possible results. WHO will address unfinished business, especially in communicable disease control (malaria and TB) and will continue to work on priority programmes, such as the Expanded Programme on Immunization and neglected tropical diseases, while also strengthening preparedness for emergencies, addressing lifestyle and environmental issues, and tackling health systems issues.
ENGAGING WITH ALL ACTORS IN HEALTH AND BEYOND Communicating, developing and sustaining dialogue internally and externally as WHO continues to work with partners and align ourselves with shared development and public health goals.
BEING BETTER MANAGERS Improving productivity, increasing the quality of staff members, increasing staff mobility, saving money and promoting transparency.
49
WHO
50
WHO Western Pacific Region: Highlights 2009–2013
WHO
Dr Shin and Executive Officer Dr Corinne Capuano in Solomon Islands: Field visits to Member States have been a priority for the Regional Director.
51