Polio: transition: report by the Director-General

EXECUTIVE BOARD EB144/10 144th session 21 December 2018 Provisional agenda item 5.3 Polio Transition Report by the Director-General 1. Pursuant to decision WHA70(9) (2017) on poliomyelitis: polio transition planning, the Secretariat drafted a strategic action plan on polio transition which it submitted to the Seventy-first World Health Assembly in May 2018.1 The Health Assembly noted the strategic action plan2, which included identification of the capacities and assets, especially at country level, that are required to sustain progress in other polio-funded programmatic areas and to maintain a polio-free world after eradication. Since then the Secretariat has worked with the 16 countries that are global priorities for transition and 4 additional vulnerable countries to review, and where appropriate, support development, of their national plans for polio transition. This report provides an update on progress since May 2018 in implementing the key activities and reaching the milestones laid out in the strategic action plan and outlines the approach to be taken and milestones for 2019. PROGRESS ON TRANSITION ACTIVITIES AND TOWARDS MILESTONES SINCE MAY 2018 2. The Secretariat has accelerated its support for transition activities since the Health Assembly in May 2018. A team dedicated to polio transition that reports to the Assistant Director-General, Strategic Initiatives, has been established while experts from polio eradication, immunization, emergencies, containment, surveillance and laboratories and the three WHO regional offices impacted by transition, as well as partners and donors, are now actively supporting the ongoing programme of work. A road map and detailed workplan to implement the strategic action plan is now also available. Four country transition support visits were undertaken in 2018, to Bangladesh, Ethiopia, India and Myanmar. Outcomes of these country visits have been instrumental in informing discussions on global ownership and governance. 3. Work has continued on building a WHO-wide fleet management system, with polio-funded vehicles being a large part of the pilot programme. This system is expected to reduce costs and bring greater transparency and accountability to the use of WHOs’ vehicles, and is one example of the transition of polio assets into other programmes for broader purposes. 4. In accordance with its commitments under the strategic action plan, WHO convened a high-level meeting of key stakeholders in November 2018 to secure agreement on the implementation and discuss 1 Document A71/9. 2 See the summary records of the Seventy-first World Health Assembly, Committee A, sixth and eighth meetings. EB144/10 2 options for governance of the Polio Post-Certification Strategy. Representatives of the Global Polio Eradication Initiative and other stakeholders debated the challenges of achieving a smooth polio transition and sustaining essential functions to keep the world polio-free. Stakeholders concluded that an effective polio transition will contribute significantly towards attainment of the Sustainable Development Goals, the global health security agenda and universal health coverage, besides its contribution to sustaining the gains of polio eradication. 5. A recommendation of the high-level meeting is that a differentiated approach to polio transition is required that recognizes the circumstances of individual countries. In countries where polio continues to be endemic, minimal transition planning will be possible, as the focus will remain firmly on eradication. In fragile or conflict-affected countries, where some progress with transition planning is possible, continued provision by WHO of technical and financial support will be required in the medium to long term. In “low-risk”, less-vulnerable countries, faster implementation of the strategic action plan is possible, with capacity-building support, to enhance routine immunization and emergency capabilities. In countries with stronger health systems, a sufficiently large and trained workforce and stronger economies, governments are expected to fund the polio assets and capacities needed to meet their health priorities and fully integrate them into their national health plans. 6. Following the decision of WHO to consider transition under its base budget and the later decision of the Global Polio Eradication Initiative to extend its programme for another five years, stakeholders at the high-level meeting raised concerns about potential duplication between the Initiative’s budget and the proposed WHO base budget increase in 2020–2021 of US$ 227 million for transition. The Initiative has informed the Secretariat that it is committed to raise resources for the costs of sustaining essential polio-funded functions in lower-risk, non-endemic countries, that will move onto WHO’s base budget for 2020–2021. Beyond 2021, the Secretariat will work with Member States and donors to secure long term, sustainable funding to maintain essential functions and build upon foundations in place for polio eradication for other health sector priorities such as expanding immunization, outbreak emergencies and integrating surveillance systems. 7. In July 2018, the establishment of a high-level Steering Committee for Polio Transition by the Secretariat provided another vital step to monitor and evaluate progress in the implementation of the strategic action plan on polio transition. PLANNED TRANSITION ACTIVITIES IN 2019 8. Country support visits will continue, in addition to intensified consultations with representatives of the Global Polio Eradication Initiative, Gavi, the Vaccine Alliance and other donors, in order to inform decision-making by key transition stakeholders as detailed in the following paragraphs. 9. The stakeholders’ meeting described in paragraph 4 identified four thematic transition priorities: integrated vaccine-preventable disease surveillance, strengthening essential immunization, outbreak emergency response, and containment. Prior to the Seventy-second World Health Assembly, the Secretariat will take the lead in organizing consultations to make pragmatic proposals on how polio transition across these priorities will be determined and relevant budgetary allocations made. 10. Visits to priority transition countries, namely Angola, Bangladesh, Cameron, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Iraq, Libya, Myanmar, Nepal, Nigeria, Somalia, EB144/10 3 South Sudan and Sudan,1 will continue to take place up to May 2019. These visits will be undertaken by a group of WHO experts from across the range of priority functions. The objective is to review, and where appropriate, update and facilitate finalization and implementation of national transition plans. The visiting teams will provide support to governments and WHO country offices in the development of country-level resource mobilization plans and high-level advocacy strategies to mainstream polio- essential functions into national health plans, where government capacity exists. Where government capacity does not yet exist, these functions will be integrated into other WHO programme areas. 11. Although the current focus remains firmly on eradication in the countries in which polio is still endemic, the Secretariat will provide support to Afghanistan and Pakistan through country visits to further the development of their national transition plans in the first half of 2019. 12. As agreed at the November 2018 meeting, the Secretariat will convene a follow-up high-level stakeholder meeting during the first half of 2019 with representatives of the Global Polio Eradication Initiative, Gavi, donors and other partners to accelerate decisions on the pragmatic implications of polio transition. 13. Options for the future governance of polio transition are a key issue for discussion, with a range of models put forward for consideration. The major concern of governance is the sustainability of progress made in eradication after the Global Polio Eradication Initiative reaches the end of its current extension. Further consultations will be organized to ensure optimal contributions towards achieving the Sustainable Development Goals and universal health coverage, while sustaining a polio-free world. 14. A set of communication and advocacy materials will be produced to support Member States in the first half of 2019. 15. The Secretariat will elaborate a results-based monitoring and evaluation framework to measure progress towards the objectives and expected outcomes of the strategic action plan on polio transition. 16. The Secretariat will also propose an independent monitoring mechanism for transition. A potential role for Executive Board members in transition country support visits will also be explored. 17. The Secretariat will continue to report annually on polio transition progress to the Health Assembly, through the Regional Committees and the Executive Board as necessary. ACTION BY THE EXECUTIVE BOARD 18. The Board is invited to note the report. = = = 1 At the time of writing, the joint country support visits to Bangladesh, Ethiopia, India and Myanmar have been completed.