Fifty-fifth Meeting of the Regional Director with the WHO Representatives WHO/SEARO, New Delhi, 8-12 November 2004

SEA-WRM-55 Distribution: Restricted Fifty-fifth Meeting of the Regional Director with the WHO Representatives WHO/SEARO, New Delhi, 8-12 November 2004 Report WHO Project No.: ICP SCC 001 World Health Organization Regional Office for South-East Asia New Delhi January 2005 © World Health Organization 2005 The contents of this restricted document may not be divulged to persons other than those to whom it has been originally addressed. It may not be further distributed nor reproduced in any manner and should not be referenced in bibliographical matter or cited. Page iii CONTENTS Page 1. PREFACE.......................................................................................................... 1 2. BUSINESS SESSION.......................................................................................... 1 2.1 Regional Director’s Opening Remarks ..........................................................1 2.2 Review of Recommendations from WRs’ Retreat in March 2004 (agenda item 2 ) ...........................................................................................4 2.3 Key Policy Directions in Decentralization (agenda item 3) ..............................4 2.4 Government-WHO Coordination Mechanisms (agenda item 4) ......................6 2.5 Monitoring, Evaluation and Technical Assessment (agenda item 5)....................8 2.6 Eleventh General Programme of Work (agenda item 6) ................................ 10 2.7 Concept and Practice of New Way of Working with Countries (results of SEARO retreat) (agenda item 7) ................................................... 12 2.8 Programme Budget and Planning for 2006-2007 (agenda item 8)................. 14 2.9 Concept for Future Planning in WHO (agenda item 9)................................. 16 2.10 Discussion with Departments: CDS and FCH Departments – Department Priorities and Subjects for Horizontal Collaboration (agenda item 10)........................................................................................ 18 2.11 Administrative Aspects of Delegation of Authority – Finance, Recruitment, Inventories, Training, etc. (agenda item 11)............................. 21 2.12 Resource Mobilization and Partnerships in Countries (agenda item 12)........................................................................................ 26 2.13 Horizontal Collaboration (agenda item 13).................................................. 29 2.14 Recommendations from the WRs’ Internal Meeting/Retreat (agenda item 16)........................................................................................ 31 3. CLOSING SESSION........................................................................................ 32 Page iv Annexes 1. Agenda........................................................................................................... 35 2. Programme..................................................................................................... 36 3. List of Participants........................................................................................... 39 4. Results of Group Discussions on Horizontal Collaboration .............................. 41 5. RD’s Opening Remarks................................................................................... 43 Page 1 1. PREFACE The Fifty-fifth Meeting of the Regional Director with the South -East Asia Region (SEAR) WHO Representatives (WRs) was held in the Regional Office, New Delhi, India from 8 to 12 November 2004. On the last day of the meeting, the WRs held an internal meeting to review the recommendations of the meeting. This report presents the key highlights of discussions under each agenda item along with the recommendations of the WRs. It documents the important issues discussed at the meeting, and shall be the basis for follo w-up efforts in countries, the Regional Office and headquarters. This meeting represented a significant change in the way that WRs meetings were conducted. First, all WRs were involved in the preparations of the agenda in order to identify their needs. Second, there was active participation of the Regional Office Directors and Coordinators, both in preparing for the meeting and participating in all agenda sessions. Third, we noted that all sessions were open to Regional Office staff and there was strong attendance in many sessions throughout the meeting. All three of these innovations will ensure a more consultative and transparent approach to management in the Region. On behalf of the WRs, I would like to express our special thanks to the Regional Director, Dr Samlee Plianbangchang, who guided in the preparations for this meeting and participated fully in all sessions. In addition, I would like to thank the Director for Programme Management, Dr Bjorn Melgaard, the Planning Officer, Dr R Mark Brooks and the entire staff of the Programme, Planning and Coordination Unit who worked tirelessly to organize and conduct the meeting, as well as to assist in the preparation of this final report. I would also like to acknowledge the participation and valuable contributions of headquarters staff who attended the meeting. Report of the Meeting Page 2 Finally, as this was the last WRs’ meeting for Dr Suniti Acharya and myself, we were pleased to have the opportunity to bid farewell to all our colleagues in the Regional Office. It has been a memorable experience for both of us, and we wish all the best for future meetings, based on our results during the last week. Dr Klaus Wagner Dean, SEAR WRs Page 1 2. BUSINESS SESSION 2.1 Regional Director’s Opening Remarks The Regional Director welcomed the WHO Representatives (WRs) to the meeting. He stated that this meeting occurred at an important time for WHO when decentralization was a major policy change not only for the Region but also for the Organization globally. Besides being the head of respective WHO offices in Member States of the Region, WRs had a number of key roles they must fulfil: technical adviser to the government in the area of health, representative of the WHO Director- General and the Regional Director, diplomat for WHO in the country, manager of WHO’s programme in the country, coordinator of WHO’s global and regional activities in the country, provider of technical and scientific information about health to the country and a key member of health development partners, both within and outside the UN system, working to improve health in the country. Thus, a WR needed to be a technical expert, a good manager, an effective communicator, a diplomat and even a skilful politician. All the while, he or she must follow the code of conduct for international civil servants and, most importantly, be honest and loyal to the Organization, and politically neutral. One of the new challenges for WRs was to deal with sensitive international or local issues between conflicting groups or opinions. The WR must be open to all parties, including the media, and approach the issue in a technically sound manner, closely coordinating positions with all levels of the Organization. In these situations, the Regional Director will support WRs as will headquarters, with the ultimate responsibility in the Region resting with the Regional Director. This meeting will cover a number of important agenda items related to decentralization and programme management. Those related to decentralization include: implementation of Country Cooperation Strategies (CCS), operationalizing WHO country focus, horizontal collaboration, decentralization of regional and intercountry functions to the country level and maintaining budgetary resources in countries. These are all implemented through increased delegation of authority to WRs. At the same time, the Regional Office will implement initiatives to strengthen country offices. Report of the Meeting Page 2 The WHO Director-General had stated that 75% of the Organization’s resources will be decentralized to regions and countries, in order to strengthen WHO work in countries. This included at least three main categories of WHO work: direct support to countries; normative work, and intercountry cooperation. The objective here was to ensure that country offices implemented WHO work and provided direct support to countries. At the same time, country offices must coordinate WHO activities, contribute to normative work, support intercountry cooperation and horizontal collaboration, promote partnerships and mobilize resources. WHO’s work at the Regional Office should become more strategic and more effective in supporting country offices. This will emphasize coordination of regional policies and strategies within the WHO global framework, normative work with headquarters and countries, facilitatio n of intercountry cooperation, monitoring and evaluation of WHO biennial budget implementation, technical and administrate support to country offices, strengthened capacity of country offices, interagency cooperation and resource mobilization. In the area of programme management, this meeting will focus on the 2006-2007 biennial budget. The work on the budget in the South-East Asia Region involved three main issues: ensuring support of Member States for the global 12.8% budget increase, determining how these additional funds were to be distributed to Member States and deciding how ICP-II funds will be used to protect intercountry and normative work when ICP-II ends next year. The Regional Working Group on Budget Development was now working on these three issues. This group, consisting of high -level representatives of Member States, was recommended by the 41 st Meeting of the CCPDM and the 57th session of the Regional Committee. Regional policies in decentralization required joint planning between countries and the Regional Office starting with the 2006-2007 programme budget. Emphasis on strengthening country programmes and more effective Regional Office support required that country expected results were developed in a collaborative process between regional advisers and country office staff. At the same time, staff must consult closely with government counterparts to develop expected results and work plans. Countries played a major role in determining what will be done in their countries and WHO should determine how results can be achieved. In order to do this, there needed to be clear and simple planning guidelines for both the Regional Office and countries. 55th Meeting of the Regional Director with the WHO Representatives Page 3 While strengthening joint planning, consideration must be given to future global trends in WHO planning and budgeting, also a major agenda item during the meeting. Furthermore, collaboration with Member States required strengthened Government-WHO coordination mechanisms, which must be efficient and require minimal resources and time in proportion to the activities that WHO supported. Effective coordination mechanisms will promote collaborative efficiency and goodwill, and prevent conflicts and constraints in work with Member States. Liberal decentralization also required monitoring, evaluation and oversight as management tools to protect WRs, their staff and the Organization as a whole. These will also ensure transparency and accountability, essential to high-quality performance and the reputation of the Organization. The work of the Programme Planning and Coordination Unit in monitoring and evaluating the programme budget, reports of internal and external auditors and assessments of specific programme areas by various technical units will be maximally utilized by the senior and executive management in the decision-making process. In addition, an Internal Review and Technical Assessment Unit was now being established in the Regional Office to provide necessary information for executive decision-making. Care will be taken to ensure that the work of this unit will not duplicate or conflict with the work of the other concerned units but, instead, supplement their work. During the meeting there will also be discussions on administrative and finance issues, especially related to decentralization and delegation of autho rity. In this meeting between the Regional Director and the WRs, the WRs were playing a key role in the conduct of the meeting. At the same time, the Regional Office staff was encouraged to participate. This meeting should be open, promote the exchange of views and encourage all to learn from the experiences at different levels of the Organization. During deliberations, positive and constructive comments should be emphasized and sustained for daily interactions. All were working for the same goal – the health and well- being of people in the Region and, no less important, for the reputation and credibility of WHO. [The full text of the Regional Director’s Opening Remarks is contained in Annex 5.] Report of the Meeting Page 4 2.2 Review of Recommendations from WRs’ Retreat in March 2004 (agenda item 2) The meeting reviewed the recommendations from WRs’ Retreat held in March 2004. 2.3 Key Policy Directions in Decentralization (agenda item 3) Highlights of the presentation Strengthening country cooperation was one of the main strategies announced by the Regional Director at the start of his present term. Within this strategy itself, decentralization was a key element for improved cooperation with countries. At the same time, the WHO global policies had emphasized country work and decentralization to this level of the Organization. There were four organization-wide pillars of decentralization: results at the country level, mobilizing resource for these results, management and administration to deliver the results and accountability for results. These formed the basis for regional work to strengthen country operations. The identification of results required focused Country Cooperation Strategies that had been fully discussed with the government and health partners. These should then be implemented through workplans developed jointly with the Regional Office in order to ensure that the entire Organization puts its attention on country work. Joint planning was the key to improving country workplans and focusing Regional Office work on countries. Th e Regional Office was moving ahead with several innovations, beyond joint planning, to support decentralization. These included horizontal collaboration and assignment of Regional Office staff to work in countries for extended periods. It was important to monitor the implementation of decentralization innovations and ensure that Member States were informed about these changes affecting WHO country work. Discussion points A Code of Conduct for WHO staff visiting countries had been drafted and should be finalized before the end of the year. This issue was not new, but 55th Meeting of the Regional Director with the WHO Representatives Page 5 compliance had been a problem in the past. It was expected that the “One country plan and budget” will help increase compliance. Resource mobilization varied from country to country depending on needs and donor interest. While Voluntary Contributions needed to be raised for WHO operations, most donor resources directly supported government programmes. WHO might assist in raising these funds. Administrative issues, including negotiations with potential donors, were often a constraint in implementing donor funds and required close cooperation between countries and the Regional Office. WHO’s active involvement in technical issues and support for country programmes often required adequate staff with a good mix of national and international personnel. In addition, adequate administrative staff were needed to implement country programmes. The size and composition of staff in countries should be determined during the formulation of Country Cooperation Strategies. As much as possible, core staff should be funded by funds from Assessed Contributions to ensure continuity. However, small countries faced difficulties when a high proportion of the county budget was used for staff costs. In addition, changes in the way WHO operates in countries should be discussed at the Regional Committee and CCPDM meetings. Special missions to countries might also be effective in communicating these issues to Member States. Comments by the Regional Director WHO is not a funding agency like UNICEF or UNDP. Therefore, work should emphasize technical assistance and knowledge management. However, this did not mean that our staff needed to be experts in all areas. WHO can mobilize technical support much better than any other organization. In addition, our staff must have expertise in management and experiment with management innovations. Member States must have a good understanding of the roles of WHO and the importance of adequate country presence. This can be enhanced by appropriate Government-WHO coordination mechanisms. Report of the Meeting Page 6 Countries were the hub of WHO’s work. Therefore, the Organization at all levels should support country work. Regional Office staff may be stationed (for long or short-term duration) in countries to provide more support to countries. At the same time they will continue to perform Regional Office work as necessary. Recommendations (1) WHO should take special initiatives to communicate to governments about the major changes related to strengthened country presence. If necessary, special missions to selected countries should be considered in addition to RC sessions and CCPDM meetings. (2) The Country Cooperation Strategies should analyse staff needs of the country office and discuss these needs with the government during CCS preparation. (3) Countries may request support from WHO not only in technical areas but also in issues involving health systems development. Therefore, WHO must strengthen its capacities to assist governments and emphasize technical innovations in this area. 2.4 Government-WHO Coordination Mechanisms (agenda item 4) Highlights of presentations The experience in Indonesia and Maldives showed great variation in Government – WHO coordination mechanisms. Coordination was needed between the Ministry of Health and WHO, but WHO also might involve other ministries and agencies depending on the country work. Furthermore, there were a variety of tasks involved in coordination, ranging from planning to implementation to issues such as the number of WHO staff. Some coordination mechanisms, especially in Maldives, were formalized through the establishment of special committees with specific terms of reference. Other mechanisms were more informal and depended on periodic meetings with high -level officials. Formal mechanisms were often weakened by changes in the membership of key groups or reorganization of ministries, while informal mechanisms often were not able to coordinate all issues and groups involved. 55th Meeting of the Regional Director with the WHO Representatives Page 7 Discussion points Should coordination mechanisms involve policies or implementation of WHO programmes? It was agreed that countries might need different mechanisms for each type of coordination. The key subjects requiring coordination were the formulation of CCS, the development of workplans and programme implementation. Each of these points might require separate mechanisms. Other issues discussed included coordination with local governments, location of the WHO country office (does proximity improve coordination?), how does WHO coordinate work with other ministries beyond the Ministry of Health, and coordination and relationships with NGOs. Further work was needed to develop better coordination mechanisms. Though some countries had developed their coordination mechanisms, there was a need to further assess the mechanisms throughout the Region. The Regional Office was planning to undertake special efforts to facilitate their development. The importance of coordination mechanisms might be discussed at meetings of Governing Bodies. Comments by the Regional Director The Government-WHO Coordination Mechanisms varied from country to country and often depended on the personality of key officials. However, mechanisms were needed in all countries. WHO had had 50 years of experience working with countries and our initiatives in decentralization made it even more important to specify mechanisms for each country. It was crucial that coordination mechanisms be used to obtain a consensus on key issues prior to the Regional Committee meeting. The consensus of Member States in regions should be achieved before attending global meetings such as the Executive Board (EB) and the World Health Assembly (WHA). Recommendation Each country should have coordination mechanisms as the interface between WHO and the government. These mechanisms will vary substantially from Report of the Meeting Page 8 country to country but should be formalized as soon as feasible. The experience to date should be reviewed. 2.5 Monitoring, Evaluation and Technical Assessment (agenda item 5) Highlights of presentations The Internal Review and Technical Assessment Unit (IRTA) had been established by the Regional Director to oversee the performance of country offices and departments. It will work closely with the Director of Administration and Finance (DAF) Unit as well as the Planning and Programme Coordination (PPC) Unit. The IRTA will form review teams mostly from the Regional Office and from country offices to review workplan implementation, management and administrative processes, ad hoc issues triggered by monitoring reports and thematic reviews. Reviews will use the criteria of relevance, adequacy, effectiveness and efficiency. The results of these reviews would be internal and will be reported directly to the Regional Director. Technical and financial monitoring at the country level was presented for the Myanmar country office. Technical monitoring, usually undertaken every six months, concentrated on the implementation of CCS and the biennial workplans. Financial monitoring, done quarterly, also focused on the CCS and workplans with attention to both RB and EB funding sources. Financial monitoring mainly used the AMS although this system was still overly complicated and not user-friendly. Furthermore, the mix of RB and EB funding made this monitoring more difficult. Technical monitoring was less well-developed compared to financial, and was limited by the lack of tools and human resources. Efforts need to be taken to strengthen technical monitoring, especially to evaluate the implementation of the CCS. There was a brief presentation on the implementation of the 2004-2005 budget, as well as that of unliquidated obligations carried over from the previous biennium. It was stressed that the quality of implementation was important. Poor-performing obligations should be terminated before the end of the biennium to be used for other purposes. Otherwise, funds would have to be surrendered to headquarters. 55th Meeting of the Regional Director with the WHO Representatives Page 9 Discussion points Monitoring, evaluation and technical assessment should use the CCS to measure performance at the country level since these set out the major directions of country work. Relevance, adequacy, effectiveness and efficiency were often difficult to measure. It may be better to monitor, evaluate and assess results shown in workplans where work could be undertaken to see if results had been achieved. In many cases, the quality and usefulness of these results could also be assessed. However, this required workplans with clearly defined results. In some cases it was useful to have external reviews to provide an independent assessment of the work achieved. The AMS had improved somewhat and facilitated financial monitoring during implementation. However, there were still some constraints in its use largely involving connectivity. In addition, some of the report formats needed to be modified to make them easier to interpret and use. It was also noted that the Global Management System (GSM) would eventually replace the AMS, although probably not during the next few years. Comments by the Regional Director Monitoring, evaluation and technical assessment were needed to select the accountability and transparency of our work at all levels of the Organization. Therefore, it was essential that we provided regular and clear reports to our Governing Bodies. Ideally, our evaluation and assessment reports should cover bo th Voluntary and Assessed contributions and be in a single format. However, this was not always possible because of the different funding cycles of donors and frequent requests for special formats for reports required by them. Monitoring, evaluation and technical assessments were essential tools for management, especially in the context of increased decentralization. This included the accountability of both WRs and directors in delegation of authority. These should be seen as tools for protecting managers by detecting problems before they are pointed out by the auditors. These tools did not Report of the Meeting Page 10 necessarily mean more work for WRs and directors but did require analytic skills to detect issues in the large number of documents related to implementation. Recommendations (1) The quality of implementation should be given equal status to financial implementation. Efforts should be increased to ensure that quality of implementation is measured through various monitoring and evaluation mechanisms. (2) Tools for monitoring, evaluation and assessments are being developed. Progress on this matter should be reported at the next WRs meeting. 2.6 Eleventh General Programme of Work (agenda item 6) Highlights of the presentation The 11th General Programme of Work (GPW) would cover a period of 10 years starting 2006. It would be different from the previous GPW in that it would cover a longer period and be a more visionary document setting out the possible future roles of WHO. The GPW will be largely based on futures methodology using scenarios of health outlined during this period. Four different scenarios were outlined covering possible developments in health. The purpose of scenario development was to think about the possible ranges of work for WHO and Member States in the GPW period. WHO’s roles will be discussed fully in the final GPW although the scenarios themselves may not be presented at all. Work on the 11th GPW was proceeding rapidly and a draft report was expected around March 2005 to be discussed at the Regional Committee meetings in 2005, presented to the EB in January 2006 and endorsed by the WHA in May 2006. The WRs were encouraged to provide comments and suggestions for the GPW and to involve Member States as much as possible. Discussion points There were extensive discussions about using scenarios for developing the GPW. This was felt to be a useful methodology for thinking about the future 55th Meeting of the Regional Director with the WHO Representatives Page 11 and how WHO could develop strategies to face a wide range of situations in the next ten years. The private sector had made good use of scen arios in planning. Even WHO’s own experience in West Africa had found that scenario planning was useful. It was also noted that scenarios were merely tools to develop WHO strategies for the coming ten years. In addition, WHO was also commissioning other background papers to be used for developing the GPW. Some participants felt that there were advantages to a more specific description of WHO’S work, such as was described in the Ninth GPW. In addition, there were questions about the possibility of mid-course revisions to the 11th GPW. Several participants raised the issue of how WHO would adjust its strategies (as reflected in the GPW) to the changing roles of the United Nations. There seemed to be a stronger push towards UN synchronization and harmonization, including joint budgeting. Questions were asked about the policies of WHO at headquarters and at the Regional Office concerning WHO’s position with the UN. The next draft of the GPW was planned for early next year, but no specific process had been initiated to obtain inputs from the Region and countries. Comments by the Regional Director In general it was felt that WHO, as a specialized agency, must limit its participation in many of these initiatives. WHO had its own constitution and Governing Bodies that guided the policies and operations of the Organization. Long-term planning was generally risky because of the unpredictability of the future leading to major changes affecting the plans. Recommendation The scenario approach is useful and may provide a way of making long-term plans. The Regional Office and HQ should keep WRs informed of the latest progress on the developments of the 11 th GPW on a regular basis so that additional comments can be provided. Report of the Meeting Page 12 2.7 Concept and Practice of New Way of Working with Countries (results of SEARO retreat) (agenda item 7) Highlights of the presentation Staff from the Regional Office held a “retreat” from 4-6 November 2004. One of the major topics at the “retreat” was “decentralization” and how this would affect the work in the Region. Horizontal collaboration was also a major topic at the “retreat”. This collaboration was felt by some to change the way the Regional Office (RO) and countries work together. Although countries could work together directly, it was felt that the RO had a critical role to play in coordinating and facilitating the work between countries. Some RO staff may be posted in country offices but the number would be small as this innovation is still being evaluated. Though there were concerns about the ph asing out of ICP-II, it was made clear that these funds could be used to strengthen technical support to countries through a variety of new mechanisms. Discussion points There was a discussion on the changing roles of the Regional Office. With decentralization, more emphasis was being put on the work in countries. Would this reduce the size of the Regional Office and change its functions? It was agreed that any changes in the Regional Office would be gradual and be carefully evaluated. However, the role of the Regional Office would be more strategic. There was now a much greater emphasis on support to countries and this would continue after ICP-II ends. Some regional functions (such as EHA) were so large that they will never be completely decentralized. In the context of horizontal collaboration, did this include countries working across regional boundaries? Epidemiology did not follow regional borders, as was seen with SARS and avian flu. Country-to-country work had already started in some countries, such as between DPR Korea and China, and between Thailand and the Mekong countries. In the past year, some bi- regional reports covering health issues in both the Western Pacific and the South-East Asia Regions were also produced. 55th Meeting of the Regional Director with the WHO Representatives Page 13 The difficulties of small and weak countries in horizontal collaboration were discussed. For example, the Bhutan-India cross-border issues are of great concern to Bhutan, but are only a minor issue with India. Small and weak offices had little to offer to other countries but stood to receive benefits. It was felt that “sister country” arrangements might be appropriate in these situations. Many felt that the Project Support Costs (PSC) should be channelled to countries where the projects were being implemented. It was noted that the Regional Office had only recently received these funds from headquarters. Efforts would be taken to move more PSC funds to the country level, as had already been tried in WPRO. Comments by the Regional Director WHO must adapt its ways of working to the many glob al changes taking place in order to be competitive, and to provide the most useful services to its Member States. Many of the ideas proposed are not new, but are now being proposed in a more systematic fashion. Our countries needed to be strengthened and more resources should be mobilized to do this. However, we could also improve our efficiency and effectiveness in using existing resources. We needed to have new ways of working and to learn by doing. Joint planning was essential to support this process and it must involve new ways in which the country and Regional Office staff could work together. We must also convince our Member States that these initiatives will benefit them. Transparency and accountability were essential to support these initiatives. Recommendations (1) The WRs agreed with the revisited role of the Regional Office in supporting activities at the country level. Progress on this should be reported at the next WRs Meeting. (2) Horizontal collaboration should be increased within the Region, but we should move cautiously when such collaboration involves other regions, with the exception of initiatives between DPR Korea and China, and between the Mekong and ASEAN countries. Report of the Meeting Page 14 2.8 Programme Budget and Planning for 2006-2007 (agenda item 8) Highlights of the presentation New policies in the Region would affect the development of budgets and workplans for the next biennium (2006-2007). Most important was the increased support for work in countries. This demanded improved joint planning between the Regional Office and country offices so that the full capacity of the Organization could be mobilized to support country work. In doing this, there needed to be greater emphasis on clear results in country workplans to distinguish the work of WHO from that of government and partners. Specific results would facilitate support from the Regional Office and ensure improved accountability for workplan implementation. The Regional Office had initiated innovations to promote joint planning. These included Country Days, department planning meetings and special visits to country offices. The current emphasis was on developing expected results and products agreeable to all parties before preparing workplans and activities. The Regional Expected Results (RER) were a framework to group similar Country Expected Results (CER) to facilitate country support and horizontal collaboration. Discussion points It was agreed that results-based planning was a key step in clarifying the work of WHO at the country level and in increasing accountability for our work. However, there was concern that if results were too specific, this would confine the work in countries to only results that could be clearly measured. There was agreement to include results, such as partnerships, that reflected work of country offices that was not necessarily quantitative. Some creativity was needed to reflect clearly the work of WHO at the country level. The Country Cooperation Strategy (CCS) was a key instrument to guide the work in countries. If the CCS was too bro ad, it would be difficult to determine priorities for country plans. Some noted that the CCS often started with a clear focus but this focus was lost during the review process where 55th Meeting of the Regional Director with the WHO Representatives Page 15 additional priorities were added. In other cases, the CCS was specific but there were no clear strategies for its implementation, leading to slow achievement of CCS goals. Overall, it was agreed that work should continue to improve CCS and make them more useful for planning and implementing changes at the country office. There was approval of new approaches to improve joint planning between the Regional Office and countries. These should continue and be strengthened with the objective of producing better workplans for countries and increasing the support from the Regional Office for country work. Comments by the Regional Director During all steps of the budget process there should be close cooperation with governments. Negotiations should start during the CCS process, be continued in determining Expected Results and completed in the preparations of the final workplans. Governments should also play a key role in determining what WHO should do in the country, while WHO should emphasize how this work would be implemented. In the end, WHO is accountable to its Governing Bodies for results in the workplans. During the next three to four months, there should be agreement about the methods and processes for developing workplans for the 2006-2007 programme budget. Recommendations (1) Efforts for Joint Planning should be intensified during the coming months. The Regional Office will support initiatives to facilitate this process. (2) At the country level, WRs will continue to coordinate the process of negotiations with governments concerning the development of the PB 2006 -2007 workplans striving for increased transparency while making it clear that WHO is responsible for its budget. (3) Joint Planning should be linked to the Country Cooperation Strategy. Report of the Meeting Page 16 2.9 Concept for Future Planning in WHO (agenda item 9) Highlights of the presentation Headquarters were currently looking at planning and budgeting within the Organization to see how these might be improved. One of the issues was strategic planning now carried out every two years before determining the budget of the Organization. It relied on Areas of Work that often forced vertical results on the work of the Organization and were often rearranged every two years. The proposal for revising the strategic budgeting process was to undertake strategic planning once every six years. The Organization’s strategic plan would rely on Strategic Objectives instead of Areas of Work. Every two years there would be a process to develop the budget, but this would be simpler than the current two-year strategic budgeting process. It was expected that this new budgeting process would start covering the 2008-2009 Programme Budget. Preliminary work on the Strategic Objectives for 2008 -2013 would start around March 2005. Discussion points Potentially, the new procedures proposed by headquarters may add a new layer in the planning process between the GPW and the two -year Organization-wide Expected Results. Creating a proposed additional layer starting from PB 2008-2009 by way of Strategic Objectives could create additional work at all levels of the Organization. There were discussions about the need to simplify planning as much as possible and to avoid too many changes in planning procedures. A lack of continuity in planning procedures often created confusion for planning in country offices. Any improvements in planning procedures may be offset by the disruption caused by introducing these changes. Therefore, any proposed changes should clearly show significant improvements and simplifications to offset disruptions caused during the implementation of changes. 55th Meeting of the Regional Director with the WHO Representatives Page 17 During the 2004 -2005 biennium, workplan budgets were not fully funded mainly because Voluntary Contributions (VC) were not yet available. The Regional Office was currently negotiating with headquarters to ensure that unspecified funds from VC were used to cover workplan shortfalls. In addition, country and regional efforts in resource mobilization needed to be intensified to fill these gaps. Comments by the Regional Director The issue of top-down and bottom-up planning had been discussed many times. Over the last 20 years, there had been a great variation in the proportion of each to develop plans at all levels of the Organization. In the PB 2006-2007 process, there had been renewed attempts to ensure that inputs were received from all levels of the Organization. Even with these efforts, the Regional Office needed to increase emphasis on joint planning between the Regional Office and countries, especially in the development of workplans. The budgeting of VC was a major issue in the Region. Workplans should reflect the overall fundin g needs, although this is not yet consistently done. At the same time, shortfalls in funding workplans should drive resource mobilization efforts. Recommendations (1) Headquarters should provide more information about the two-year planning process to ensure that the “light” planning part of the cycle has substantial savings and simplifications over the previous system. More information is needed on how this planning will be based on ERs without AoWs. (2) Further information is needed about the proposed strategic directions and how this will replace the AoW procedure now. In addition, information is needed as to how these Strategic Directions conform to organizational structures at various levels of the organization. (3) Headquarters should take further action in the realization of VC now shown in the budget. This is required to motivate countries and the Regional Office to prepare realistic, integrated budgets. Report of the Meeting Page 18 2.10 Discussion with Departments: CDS and FCH Departments – Department Priorities and Subjects for Horizontal Collaboration (agenda item 10) Communicable Diseases (CDS) Department Highlights of the presentation The CDS Department presented its three areas of focus: (1) Surveillance and response for communicable diseases; (2) Eradication and elimination of leprosy, lymphatic filarias is, kala-azar and Yaws; and (3) HIV/AIDS, tuberculosis and malaria. The outbreak response activities were divided into: (1) Surveillance and preparedness, and (2) Outbreak response. The main diseases of concern varied from country to country but in recent years the major diseases had been avian influenza, dengue, diarrhoea and cholera. Integrated disease surveillance work has started in several countries and will continue to be scaled up in the coming years. Related to these are efforts to revise the International Health Regulations (IHR). Special emphasis has now been put on Zoonoses including recent outbreaks in SARS, avian influenza, the Nipah virus and rabies. Capacity-building and surveillance system development, including laboratory services, are the major areas of focus for this work. HIV/AIDS, tuberculosis and malaria have been grouped together because of the Global Fund. Much of WHO’s work on these three diseases involve close support for Global Fund proposals and implementation. The exception is the 3 by 5 initiative where ART is being targeted in India, Indonesia, Myanmar and Thailand. Activities here are being intensified and additional personnel are being recruited to support the new work. Work on malaria and tuberculosis are more closely tied to the Global Fund and WHO staff are supporting Member States for these two diseases. Efforts to eradicate and eliminate other communicable diseases emphasize cross-border collaboration, increasing commitment of governments to undertake these programmes and capacity-building to ensure that appropriate interventions are implemented. Special efforts are being planned to eliminate kala-azar, an important disease for three Member States of the SEA Region. 55th Meeting of the Regional Director with the WHO Representatives Page 19 Discussion points With regard to disease surveillance, there were comments that many countries were weak and urgently needed support. There was great variation between countries; each should, therefore, be assessed to identify specific weaknesses and interventions planned accordingly. SARS and avian influenza showed the risks of these weaknesses. It was pointed out that the International Health Regulations (IHR) also provided resources to strengthen surveillance systems in countries. In addition, allocations in this area of work for 2006/2007 have almost tripled over the previous levels. There was a call for more planning to deal with possible outbreaks in the Region. This should include both the use of limited drugs and vaccines. Some suggested that a scenario type approach might be useful for this work. It was also noted that WHO had recently issued guidelines for developing Pandemic Preparedness Plans, and that work should start in countries using these guidelines. Several WRs discussed the importance of communication skills, especially with the media. In times of outbreaks such as avian influenza, WHO was under pressure to communicate with the media. WRs must be prepared for these situations. The importance of working with other regions, especially WPRO, was noted by several speakers. Efforts to coordinate technical work in the CDS area between the two regions had improved substantially and there were frequent communications between WPRO and SEARO leading to bi-regional meetings and workplans. The importance of CDS working with other departments for outbreak response was noted. This includes infection control and emergency and humanitarian assistance. An interdepartmental team had already been established in the Regional Office. Discussions related to HIV/AIDS, TB and malaria concentrated on working with both the public and private sectors in implementing interventions. Furthermore, the importance of strong health systems was emphasized as these were needed for all the three programmes. In addition, it was made clear that WHO would have to continue involvement in Global Fund activities to support Member States. This required a considerable investment of the Organization’s resources. Various mechanisms were being tried to cover some of the costs of this support. Report of the Meeting Page 20 Comments by the Regional Director More efforts must be taken to implement plans for improving surveillance systems in countries. It was important to go to the field to see the situation. Resources were adequate but joint planning was needed to identify how the Regional Office could assist country offices in these efforts. Team work between countries was essential. It was expected that significant progress would be made by next April. It was important to recognize that the Global Fund was not a technical agency but an important funding mechanism. Presently, political circumstances had led to major resources being channelled through the Global Fund. Therefore, WHO must work with Members States to utilize these funds for these three important programmes. Family and Child Health (FCH) Department Highlights of the presentation The Vision of the Family and Community Health Department (FCH) was to work with Member States and development partners to achieve the MDGs and agreement from other key international commitments. The FCH Department covered six sections: (1) Reproductive health and research covered maternal and newborn health, family planning and various research efforts to support policies and interventions for these areas; (2) Child health and development had worked to scale up implementation of IMCI initiatives and had recently started integrating additional programmes such as malaria and environmental health; (3) Adolescent health and development had emphasized advocacy to promote more attention to health problems of adolescents and had integrated its work into other programme areas such as HIV/AIDS; (4) Nutrition and health development emphasized improving the nutritional status of mothers and children with special attention on micronutrient deficiencies; (5) Gender and women’s health had worked to increase the use of gender in analysis and planning interventions mainstreaming gender into key programme areas, and (6) Nursing and midwifery had worked to improve the skills of nurses and midwives as well as skilled birth attendants not only for pregnant women and newborns, but also in providing nursing care during epidemics and to improve the quality of health services in general. 55th Meeting of the Regional Director with the WHO Representatives Page 21 The achievement of these goals required the integration of these six areas as well as coordination into programmes in other departments. In addition, the department was committed to provide technical support for countries in the Region. Countries now needed to expand their efforts in FCH programme areas in line with the priorities of the Organization. In preparing new country results and workplans, priorities should be set to determine which activities should be supported by existing funds and where additional funds need to be mobilized. Discussion points The group discussed the importance of interventions aimed at decreasing neonatal mortality in Member States. Progress was needed here to reduce IMR further. This required several key programmes (child health, maternal health and nutrition) all working together to have an impact on newborn health. Many felt that efforts such as IMCI were not having a significant impact on child health. Was this because the approach was not being scaled up quickly enough or was another strategy needed? Several speakers noted that weaknesses in the health systems were often the major constraint in countries and that breakthroughs were needed in health systems for further improvements in maternal and child health. Poverty and poor access to health services were also issues that constrained the progress in health improvements. Finally, health promotion and generating demand for health services must also be considered, in order to improve the health of these vulnerable groups. Recommendation (related to both CDS and FCH) Interaction with selected departments should continue, but with the focus on pre-selected priority topics. 2.11 Administrative Aspects of Delegation of Authority – Finance, Recruitment, Inventories, Training, etc. (agenda item 11) Highlights of the presentations The delegation of authority intended to facilitate work at the country level. This delegation also demanded increased capacity for administrative functions Report of the Meeting Page 22 and accountability for country performance. In March 2004, the Regional Director delegated additional authority to WHO Representatives. This included the recruitment of long- and short-term staff in countries. There were still a number of difficulties arising from this delegation in relation to staff issues, ranging from identification of candidates for positions, to travel authorizations and medical clearances. The delegation of authority for APWs had been increased to $50000, but this had also increased the responsibility of country offices to ensure that standard procedures were being followed in developing and implementing these contracts. The use of the LCS mechanism was also being revised, involving increased emphasis on achievement of results and simplification of financial reporting and payment mechanisms. A new manual was being developed for procurement procedures for supplies and equipment, although the WR’s authority was limited to $10000. In topics not related to delegation of authority, the WRs were told about new policies and initiatives related to human resource development. There was increasing attention on competency and a model had been developed to measure and improve the competencies of personnel. Funds were now available for training and several initiatives, such as the Global Leadership Training programme had started. Other initiatives included a new web-based system for imprest accounts, work to develop the Global Management System to integrate various computerized management systems, continued efforts to develop the Global Private Network (GPN) in all country offices, expanded use of the Geographical Information System (GIS) and country websites. Discussion points Delegation of authority The delegation of authority to country offices was higher in the SEA Region than in all other regions. In fact the Regional Director had delegated the maximum amount of authority to WRs. This should provide experience for other WHO regions in their efforts to promote decentralization. Increased authority may increase the workload of country offices, especially in administrative tasks. However, some representatives commented that although there was more to do, it was easier to do because the country office was in direct control of processes. At the same time, increased delegation did 55th Meeting of the Regional Director with the WHO Representatives Page 23 involve increased responsibilities and some WRs acknowledged the greater risks to them associated with their increased authority. Health insurance claims was one area where WRs felt that it was better to keep functions at the regional level. The confidentiality of medical records could be preserved in this way. WR offices were willing to help the Regional Office if there was a need to question unusual medical costs incurred in any country. The selection of personnel was a continuing concern in countries. It was sometimes difficult to identify the best candidates for short-term positions. There was a need to increase the use of the roster system of candidates. It was noted that the report system would be linked to the roster so that potential candidates could be evaluated on the basis of their previous reports. In some countries where it was difficult to have nationals assigned as long-term WHO staff, there was a request to extend short-term contracts. It was however stated that our policies did not support this and that posts should be established for long-term positions. There was a request for using P1 and P2 positions in countries, but it was clarified that NPOs were commonly used for these types of posts in our Region. Medical clearance was often the major cause of delay in recruitment. All efforts would be taken to speed up medical approvals for long-term staff. However, short-term employment required simpler physical examinations. The process of medical evacuations should also be simplified, especially for emergency situations. There was a discussion on APW contract processes. Detailed expenditure reports were only required if the contract payment schedule to the APW holder was based on actual expenditures. Otherwise, payment was based on completion of work. Standard selection procedures must be followed for issuing APWs even under the delegation of authority. Other administrative issues The GPN system was essential for communications and management innovations in the Region. Therefore, it was urgent to obtain necessary GPN licences from governments. In some countries it was noted that many UN agencies already had satellite dishes and the location of the WHO office was critical to the establishment of satellite communication systems. Report of the Meeting Page 24 Countries were urged to make better use of their websites and to ensure that they contained up-to-date information. Several countries had difficulties in obtaining digital maps for GIS. Even government agencies were charging high amounts for these data. In some cases it may be possible to exchange health information for digital maps to lower costs. There was also a question about digital maps from neighbouring countries. Were these standardized between regions? It was explained that efforts were being taken for standardization with WPRO and globally. It was asked if the Regional Office could employ a lawyer to assist with security and accident cases. The Regional Office had already hired a part-time lawyer and it would evaluate if a full-time person was needed. There were several questions related to the staff-learning fund. There was a request to include seconded staff in training courses and to have additional places in the first round to train secretaries. Some asked if funds would be available at the country level. In response, it was clarified that staff learning funds were available but most training could be done more efficiently at the regional level or with groups of countries. It was important to evaluate the effectiveness of new training courses before expanding to include country office staff. The staff learning committee was responsible for determining training policies and evaluating implementation. Consideration would be given to the inclusion of country office staff on this committee. Recommendations General administration and finance It was strongly recommended that the Regional Office organize a meeting for all administrative officers for updating on personnel and administrative issues. Delegation of authority (1) The meeting recommended that the example of SEARO’s delegation of authority should be shared with other regions. (2) Staffing situation at the country office level would be kept under review in light of increased functions and responsibilities associated with the delegation of authority. 55th Meeting of the Regional Director with the WHO Representatives Page 25 Human resources development (1) Staff working on secondment from the government in some countries should be extended the same benefits in respect of staff development and training as regular WHO staff. (2) The Staff Development and Learning (SDL) function should be reviewed and representation from country offices included. (3) Training of country staff on issues of common interest should be grouped for efficiency. (4) Proposals for in-country staff development and training of WRO staff should be handled by WRs within the programmed budget and the extra funds available. (5) Regional Advisers need to continue developing and updating rosters for STPs/STCs, which can be on-line and shared with countries. (6) Guidelines for recruitment of STPs need to be reviewed in the light of the authority delegated to country offices. (7) The Regional Office should provide guidelines to WRs concerning selection panels. Financial matters AMS should be revised promptly to reflect EB programme changes in order to avoid delays. Procurement The e-procurement system should be extended to country offices as early as possible. Medical evacuation The Regional Office should prepare updated guidelines for medical evacuation procedures. Report of the Meeting Page 26 IT matters (1) Countries should provide briefing on VSAT licence status and expected timeline for clearance. WRs should try to resolve licensing issues. (2) Once the final site survey reports are received from HQ, site preparation work should be undertaken promptly. (3) The importance of having high-quality websites was recognized. 2.12 Resource Mobilization and Partnerships in Countries (agenda item 12) Highlights of the presentations The Regional Office’s External Relations Officer outlined the new regional policy on resource mobilization and partnerships as well as the major work undertaken on resource mobilization this year. At present, the Region had mobilized about $112 million in donor funds although this was still below the $191.5 million budget set by headquarters. The future work of the Regional Office will concentrate on expanding relations with key partners and with sub -regional groupings such as ASEAN and SAARC. The Regional Office will also support country offices in partnerships, working with partners in areas such as donor coordination and MDGs and expand the database on information about donors and resource mobilization efforts. WR India discussed resource mobilization and partnerships. At the regional level, Voluntary Contributions (VC) now exceeded funds from Assessed Contributions (AC) and were concentrated in a limited number of areas: HIV/AIDS, EHA, TB and polio. WHO staff was increasingly involved in donor-funded projects and often were required to monitor and report on projects in formats specific to each donor. It was important to limit our acceptance of donor funds to our priority areas and to ensure that we had the capacity to implement these projects. Effective contacts needed to be maintained with donors and there should be adequate administrative support from the Regional Office in developing donor agreements and reports. Special efforts were also needed to mobilize funds from donors in noncommunicable diseases area, normally not supported by VC. 55th Meeting of the Regional Director with the WHO Representatives Page 27 Sri Lanka discussed various types of partnerships within the health sector including government (central and sub -national, health and other ministries), the private sector, bilateral and international agencies, NGOs and the community. WHO could develop forums for partners, provide technical assistance and promote collaboration with partners. It must also be proactive with partners and be an honest broker in dealing with them. There were often constraints dealing with partners because of competition among partners, unclear policies for dealing with non-health ministries and sub-national government agencies, and lack of clear guidance on how to implement MoUs with partners. Discussion points It was agreed that partnerships were key to our relations with donors who liked to be perceived as development partners rather than funding agencies. Partnerships must provide value-added benefits in order to be successful; the WRs should play a key role in interacting with partners. Some partners were overly aggressive in pushing their own technical agenda and this often lead to conflicts at the country level. NGOs were increasingly being seen as key partners, and they appreciated WHO’s attention towards them in areas of technical coordination. Many felt that our core presence or capacity was the key to the development of strong partnerships. Some felt that communication skills and staff were needed to promote partnerships while others emphasized the need for administrative support to ensure smooth implementation of partner - funded work. It was also stated th at partners looked to WHO to provide analysis of key health conditions in the country. This required strong analytical skill as part of the core presence. There was agreement that core presence should be funded through the Regular Budget in order to provid e continuous support. There was a discussion of whether we should raise funds for the government or for WHO. As a technical agency, our major focus should be on technical support rather than on implementation – a role for the government. Furthermore, our success in raising large amounts of funds put additional strain on us and required good counterparts in the government for smooth implementation. It was sometimes easier for WHO to raise funds for others by making recommendations to donors, who trusted our neutrality and technical ability. Report of the Meeting Page 28 WHO’s constitution did not foresee our role in raising funds, either for the Organization or for Member States. Also, the expectations of Member States for us to raise funds had changed. In the last five bienniums, our Voluntary Contributions had increased about 13-14% per biennium. This showed how successful we had been. However, it was now time to be more strategic in our use of Voluntary Contributions. A working group in headquarters was currently looking into this issue. Furthermore, there was a drive to integrate Voluntary and Assessed Contributions into integrated workplans emphasizing the Organization’s priorities. It should be remembered that our major donors are also members of our Executive Board and there should be more consistency between the decisions of the EB and the financial support of donors. At the same time, more must be done to ensure that funds raised at headquarters were equitably distributed throughout the Organization. The use of Voluntary Contributions was also discussed. In most cases, funds were raised for communicable diseases and emergency assistance. Some discussed ways of using these funds to support longer -term development efforts. It was felt that WHO needed to strengthen its support for the development process. In addition, areas of work such as noncommunicable diseases and accidents needed greater emphasis. The Resource Mobilization Strategy for the Region should cover all three levels of the Organization and describe clear roles for each. There had been considerable progress in developing this strategy for our Region. This and our experience should be shared with other regions. There was a discussion of the European Commission (EC). The EC saw itself as a development partner and not as a donor. Therefore, it was reluctant to consider direct appeals for funding. It was noted that EC’s priorities included education, health, social solidarity and poverty alleviation. In addition, the management of the EC was being decentralized to regions and countries. This provided the Regional Office and countries with opportunities to have direct contacts with EC offices. We should use these opportunities to provide the EC with good health situation analysis and good practices at the country level. This would be the basis for a strong partnership between WHO and the EC. Some felt that working with the UN was becoming more difficult. There were some problems with the UNDAF process and the specialized agencies must make more efforts to balance their work and th at of the UN. 55th Meeting of the Regional Director with the WHO Representatives Page 29 The sub -regional groups, such as SAARC and ASEAN were seen as important partners for WHO. More must be done to raise the profile of health in these associations. For example, cross-border health issues were often constrained by political issues that might be resolved in these forums. The Memorandums of Understanding between WHO and these groupings were often too vague, and required action plans to be developed. Finally, it was emphasized that the image of WHO was important as experience in one country was often transferred to others. It was important that we spoke more about our position and record, and were not seen to be passive. In the end, our performance would speak for itself. Recommendations (1) There is a need for clear roles of the country office, the Regional Office and headquarters, concerning resource mobilization. In a competitive environment, it is important to emphasize to the donors the credibility of WHO as a technical agency in public health by providing them with evidence-based health information and situation. Relationship -building with donors should be done on a continuous basis. In fact, donors should be treated as partners. (2) Other sources (OS) funds are largely available for communicable diseases, yet the disease burden is higher and growing for noncommunicable diseases and injuries. WHO may need to emphasize to donors and partners that NCD are equally important. (3) The Regional Office should play a more proactive role in resource mobilization and should continue to provide support to country offices, and should eliminate delays in the release of donor funds to countries. (4) Expanded partnerships should be developed with sub-regional groupings like SAARC and ASEAN, and partnerships forged beyond the ministry of health. 2.13 Horizontal Collaboration (agenda item 13) Comments by the Regional Director Horizontal collaboration was collaboration among and between WHO country offices. It responded to the requests of WRs to have the freedom to Report of the Meeting Page 30 work together within the rules of the Organization. In practice, this meant changes in the channels of communication for WRs and the Regional Office, making them flexible in allowing direct communication between countries. At this stage horizontal collaboration should concentrate on work within the Region. The exception to this was the collaboration between DPR Korea and China, as well as between the SEA Region and the Mekong Basin countries. At a later time, this mechanism might also be used between countries in other regions. Horizontal collaboration should be performed in a systematic fashion and in a planned manner. Except in emergency situations, the activities should be included in workplans and agreed to by all the countries involved. Technical units in the Ministries of Health should be informed of these collaborative activities and they should provide some form of concurrence, as there may be sensitivities in some countries. Horizontal collaboration and intercountry collaboration were not the same, although horizontal work could help facilitate inter country collaboration. Discussion points Horizontal collaboration should not be limited to technical areas. There was also the need to share administrative skills and experience between and among country offices in the Region. There was a discussion on financing of horizontal collaboration. It was felt that WHO staff costs should not be an issue since the Organization was supporting all countries. In most cases, travel costs should be borne by the country receiving the support. Small countries would likely be at the receiving end of most collaborations. However, these countries might be able to use pooled funds in the spirit of regional solidarity. This issue would be discussed at the Health Ministers’ Meeting to ensure regional solidarity support. The results of the two discussion groups are presented in Annex 4. Recommendation The concept of horizontal collaboration is well accepted and is evolving. The WRs will continue to seek further guidance from the Regional Office based on experiences, and these should be presented in future WR meetings. 55th Meeting of the Regional Director with the WHO Representatives Page 31 2.14 Recommendations from the WRs’ Internal Meeting/Retreat (agenda item 16) (1) The WRs recommended that the Fourth Global WRs meeting be held as planned in 2005. (2) The Programme Support Costs (PSC) should be shared to the countries should be a topic for discussion as part of the next WRs meeting on the principle that certain amount of PSC should go to the country office. (3) Selection of Dean: Dr Georg Petersen, WR Indonesia. (4) Selection of Deputy Dean: Dr Kan Tun, WR Sri Lanka. (5) Next WRs meetings: � It was proposed that one WRs meeting be held in the Regional Office (November) and one in a Member country (April). � The tentatively proposed venues for the next meeting (18-22 April 2005) and the technical areas proposed as part of the field visit were: • Myanmar (topic TB programme) or • Chiang Mai, Thailand (topic: 3x5 home-based care) or • Timor-Leste (topic: clinical nurse training process). Page 32 3. CLOSING SESSION Concluding Remarks by WHO Representatives Representing all WRs on their behalf, Dr Klaus Wagner, highlighted that this meeting was a departure to the previous meetings in terms of the increased consultative approach and transparency. It was evident from the way all WRs were involved in the agenda in order to meet their needs, and by the greater participation of the Regional Office Directors, Coordinators and other Regional Office Staff, and also by the representation from HQ and other WHO offices. The new vision of the Regional Director, most notably the new planning processes, decentralization, horizontal collaboration and monitoring, was made explicit during the different sessions of this meeting. With the recently increased delegation by the Regional Director, it was, clear that WRs were much more accountable now. They would make all efforts to fulfil their new expectations and would like to continually receive the valued support from the Regional Director and from their colleagues at the Regional Office. Concluding Remarks by the Regional Director In his concluding remarks, the Regional Director stated that it was a very productive meeting. Much useful information was generated from the meeting to improve the ways of working of the Regional Office. He assured the WRs that efficient and effective support will be provided to them and to the country offices. He hoped that timely action would be taken on the recommendations/action points of the meeting before the next meeting of WRs in April 2005, so that the progress could be seen and something new could be discussed. He felt that in future the WRs’ meeting could be more focused by way of a fewer number of agenda items. He also opined that there should be more social get-togethers in such types of meetings so as to enhance inter-personal relationships. He stressed the need for communication and dialogue through the internet. The Regional Office will closely monitor the decentralization process to ensure smooth implementation. For any clarifications on issues of decentralization, concerned technical units in the Regional Office or DRD, DPM, DAF or RD may be contacted. He wanted the Regional Office and country offices to work together as one team in the light of the new direction of work in the Organization. He said that he realized that the job of WRs was the most difficult job. 55th Meeting of the Regional Director with the WHO Representatives Page 33 About the retirement of WRs Bangladesh and Nepal, Dr Samlee thanked the respective WRs for their kind words. Referring to the nearly two decades of services of Dr Klaus Wagner, WR Nepal, who had probably the longest service as WR in the Region, Dr Samlee stated that Dr Wagner was a thoughtful and hardworking person. He appreciated Dr Wagner’s dealing with complicated/complex issues at the country level and his contribution to the work of WHO. He wished him a happy retired life and hoped that Dr Wagner would keep up his active role in the field of health. Speaking about Dr Suniti Acharya, WR Bangladesh, Dr Samlee stated that she had served WHO for 11 years. She had exceptional technical competence and strong leadership qualities. Therefore, she had been successful in her functioning as WR Bangladesh. He commended Dr Suniti Acharya’s prominent contribution to WHO’s work and wished her a wonderful retired life. Dr Samlee thanked the WRs for their active participation and also thanked the staff from headquarters for contributing many new ideas from the global perspective. He requested more support, at least morally, from HQs. He thanked Dr John Martin from the WHO Office in Brussels, Belgium, for his participation in the meeting, as well as all the Regional Office staff involved in the conduct of this meeting. Finally, he assured the WRs that the Regional Office was committed to support and help them and their offices in every possible way. Valedictory Remarks Dr Suniti Acharya, WR Bangladesh in her valedictory message, thanked Dr Samlee for his valued support, guidance and advice to her throughout her tenure, even when she was new to WHO. Dr Acharya had worked in the government, as a national, and subsequently with WHO - both at the Regional Office and at the country office. Her assignments had provided her with a good opportunity to understand most facets of health development in the field. She also thanked her colleagues in headquarters, in the Regional Office and in country offices for their continued guidance. In his valedictory remarks, Dr Klaus Wagner, WR Nepal, narrated his wonderful experiences with WHO during his long tenure in the Organization, spreading across three countries in the Region. The understanding of the Report of the Meeting Page 34 diverse cultures, traditions and socio -political problems faced by these different countries was not only a learning experience for him but was most useful while interacting with the nationals. He thanked the counterparts in the respective Member States, other partners, the WHO staff in country offices, and in the Regional Office, for all their support. He particularly thanked Dr Samlee and the previous Regional Directors for their continued guidance to fulfil his expected duties and hoped that with the new vision, the Region would indeed become a model for other regions. Page 35 Annex 1 AGENDA (1) Opening (2) Review of Recommendations from WRs’ Retreat in March 2004 (3) Key Policy Directions in Decentralization (4) Government-WHO Coordination Mechanisms (5) Monitoring, Evaluation and Technical Assessment (6) 11 th General Programme o f Work (GPW) (7) Concept and Practice of New Way of Working with Countries (results of SEARO retreat) (8) Programme Budget and Planning for 2006 -2007 (9) Concept for Future Planning in WHO (10) Discussions with Departments: CDS and FCH Departments – department priorities and subjects for horizontal collaboration (11) Administrative Aspects of Delegation of Authority – Finance, Recruitment, Inventories, Training, etc. (12) Resource Mobilization and Partnerships in Countries (13) Horizontal Collaboration – Sessions of Common Interests (14) Closing (15) Session with RD (16) WRs’ Retreat (WRs only) Page 36 Annex 2 PROGRAMME Monday, 8 November 2004 0900-0930 Opening 0930-0945 Tea/Coffee 0945-1000 Review of Recommendations from WRs’ Retreat in March 2004 (agenda item 2) 1000-1115 Key Policy Directions in Decentralization (agenda item 3) • Presentation by DPM • Discussions 1115-1230 Government-WHO Coordination Mechanisms (agenda item 4) • Presentation by WR Indonesia and WR Maldives • Discussions 1230-1400 Lunch 1400-1545 Monitoring, Evaluation and Technical Assessment (agenda item 5) • Presentation by IRA • Presentation by WR Myanmar • Discussions 1545-1600 Tea/Coffee 1600-1700 11th General Programme of Work (agenda item 6) • Presentation by PLN • Discussions Tuesday, 9 November 2004 0900-1000 Concept and Practice of New Way of Working with Countries (results of SEARO retreat) (agenda item 7) • Presentation by Director, FCH • Discussions 1000-1015 Tea/Coffee 55th Meeting of the Regional Director with the WHO Representatives Page 37 1015-1145 Programme Budget and Planning for 2006-2007 (agenda item 8) • Presentation by PLN • Discussions 1145-1245 Concept for Future Planning in WHO (agenda item 9) • Presentation by PRP/HQ • Discussions 1245-1400 Lunch 1400-1700 Discussions with Departments – department priorities and subjects for horizontal collaboration (agenda item 10) • CDS Department Wednesday, 10 No vember 2004 0900-1100 Administrative Aspects of Delegation of Authority - Finance, Recruitment, Inventories, Training, etc. (agenda item 11) • Presentation by DAF on Delegation of Authority • Presentation by WR Bangladesh on Delegation of Authority • Discussion s • DAF Group Presentation and discussions on other administrative issues 1100-1115 Tea/Coffee 1115-1245 Resource Mobilization and Partnerships in Countries (agenda item 12) • Presentation by WR Sri Lanka on Partnerships • Presentation by WR India on Resource Mobilization • Discussions 1245-1400 Lunch 1400-1700 Discussions with Departments – department priorities and subjects for horizontal collaboration (agenda 10) • FCH Department Thursday, 11 November 2004 0900-1030 Horizontal Collaboration, Session 1 – tw o parallel groups discussing areas of Common Interests (agenda item 13) Report of the Meeting Page 38 1030-1100 Tea/Coffee 1100-1230 Horizontal Collaboration, Session 2 – two parallel groups discussing areas of Common Interests 1230-1400 Lunch 1400-1500 Closing 1500-1515 Tea/Coffee 1515-1645 Session with RD Friday, 12 November 2004 WRs’ Retreat (WRs only) 55th Meeting of the Regional Director with the WHO Representatives Page 39 Annex 3 LIST OF PARTICIPANTS WHO Representatives Dr Suniti Acharya Bangladesh Dr Ei Kubota Bhutan Dr Eigil Sorensen DPR Korea Dr Salim J. Habayeb India Dr Georg Petersen Indonesia Dr Jorge M. Luna Maldives Dr Agostino Borra Myanmar Dr Klaus Wagner Nepal Dr Kan Tun Sri Lanka Dr William L. Aldis Thailand Dr A.G. Andjaparidze Timor-Leste WHO/HQ & Other Regions Dr Marie-Andree Romisch-Diouf Director, CCO/HQ Dr Ian Smith Advisor to the Director-General, DGO/HQ Ms Namita Pradhan Director, PRP/HQ Dr John Martin Director, WHO Office at the European Union Brussels, Belgium Secretariat Dr Samlee Plianbangchang Regional Director Dr Poonam Khetrapal Singh Deputy Regional Director Dr Bjorn Melgaard Director, Programme Management Ms Ann T. Van Hulle-Colbert Director, Administration and Finance Dr Than Sein Director Department of Health Systems Development Dr N. Kumara Rai Director Department of Communicable Diseases Dr Abdul Sattar Yoosuf Director Department of Sustainable Development & Healthy Environments Dr Monir Islam Director Department of Family & Community Health Dr Sawat Ramaboot Director Department of Noncommunicable Diseases & Mental Health Report of the Meeting Page 40 Dr Myint Htwe Chief Internal Review & Technical Assessment Dr P.T. Jayawickramarajah Coordinator Strengthening of Health Systems Dr Jai P. Narain Coordinator HIV/AIDS & TB & Other Communicable Diseases Dr A.S. Abdullah Coordinator Communicable Diseases Control Dr Brent Burkholder RA-in charge Immunization & Vaccine Development Dr R.M. Brooks Planning Officer Dr Sarveshwar Puri Programme Development Officer Mr Salil Agrawal Programme Planning & Coordination Unit Mr R.K. Arora Programme Planning & Coordination Unit Mr Gulshan Malhotra Programme Planning & Coordination Unit 55th Meeting of the Regional Director with the WHO Representatives Page 41 Annex 4 RESULTS OF GROUP DISCUSSIONS ON HORIZONTAL COLLABORATION Group A: Outbreak Surveillance and Response Process � Regular exchange of information among WR offices, including with SEARO � Exchange of expertise/visiting experts (with copy of the same to SEARO) � Training of both WRO and national staff (with a copy of the same to SEARO) � Exchange/sharing of commodities directly and/or through SEARO during emergencies � Consideration to country sensitivity and national perspectives during the process of horizontal collaboration Modalities/Guiding Principles � Funding: • In general, recipient to bear cost involved; • Funds from existing programme budget or through a separate provision � Chan nel of communication: WR to WR while keeping SEARO informed when relevant � Work within technical standards/norms/guidelines of WHO � Sharing roster of experts on demand � WR may request critical review and feedback on technical and managerial matters � No horizon tal collaboration outside the Region without RD’s concurrence Report of the Meeting Page 42 Group B: Reduction of neonatal mortality Guiding Principles � WRO to WRO � To strengthen country presence � Linked to results in workplan � For important unplanned events (e.g. outbreaks, emergencies) � Financing based on solidarity (“One WHO”) � Should have genuine added value Mechanism � Clear and inclusive channels of communication � RO may facilitate • Map WHO expertise • Proactive in identifying opportunities for horizontal collaboration � Maximize potential of GPN and IT 55th Meeting of the Regional Director with the WHO Representatives Page 43 Annex 5 RD’S OPENING REMARKS Colleagues, Ladies and Gentlemen, At the beginning, let me welcome you all to the 55 th meeting of the Regional Director with WHO Representatives. This meeting is considered to be one of the very important meetings of the Regional Office. It is even more important in light of the overall policy on decentralization of WHO, and the decentralization strategy in our Region, in particular. We are moving along with the policy trend of the Organization. Countries are now becoming the main focus of WHO work, and our WHO country offices are assuming great importance in WHO collaboration with Member States. WHO representatives, as chief of the WHO mission in countries, have to shoulder a number of important responsibilities; this is to remind all of us that WRs: � Act as technical adviser to the government of the country of their assignment in the area of health; � Are representatives of the WHO Director-General and the Regional Director; � Play a diplomatic and political role as Chief of the WHO country mission; � Are responsible for WHO programme development and management in their respective countries; � Coordinate WHO global and regional activities at the country level; � Provid e the required technical and scientific information in all areas of health to the country; � Are responsible for resource mobilization for country health developments; and � Are involved in interagency coordination and cooperation, both within and outside the UN system. Report of the Meeting Page 44 In this perspective, therefore, WHO representatives need to possess the quality of a health professional/expert, administrator/ manager/ communicator/ coordinator, diplomat and even politician, as said by one of our former Directors-General. While functioning as WHO staff members anywhere we must always keep in mind that we are international civil servants who have our own specific code of conduct as such. Most importantly, we have to be honest and loyal to the Organization, and technically sound and neutral in our decisions and actions. One of the emerging important challenges for us at the country level now is to deal with issues involving conflict of interests among groups, locally and/or internationally. It is indispensable that we work together very closely between the three levels of the Organization in tackling the issues of such nature at all stages. At all costs, we have to try and stay neutral, approach the issue on a technically sound basis, and listen to all parties involved, including the media. It is a difficult task indeed, especially for WHO representatives when they are placed in between the conflicts. Whatever the situation, the Regional Office is always ready to provid e the required support and back-up to WRs in such a situation. I am sure headquarters is also ready to help in every possible way. In any situation when WHO in the Region is involved, it is the Regional Director who primarily has to bear the responsibility. Colleagues, for this meeting, there are several interesting items on the agenda. Most of these relate to our decentralization strategy and WHO programme development and management. I would just like to mention a few things as a background to help our consideration of the subjects. The Regional Office staff heard me say this a few days ago at the Retreat, so please bear with me. Concerning decentralization in our Region, the elements of this strategy may be listed as follows: � to pursue effective implementation of WHO Country Cooperation Strategy (CCS); � to further operationalize WHO country focus and WHO specific country app roach; 55th Meeting of the Regional Director with the WHO Representatives Page 45 � to implement the idea of horizontal collaboration among WHO country offices; � to pursue decentralization of certain regional and intercountry functions to the country level, and � to maintain the high proportion of budgetary resources in countries (75%). To provide critical support to the implementation of these decentralization elements, delegation of authority to WHO representatives is an important prerequisite. We have doubled such delegation since the beginning of this year. This delegation is not only in financial terms, but also in several other managerial aspects. At the same time, the Regional Office will have to pursue extensively the strengthening of WHO presence in countries, especially strengthening capability and capacity of WHO country offices. This is to ensure that these offices will be able to shoulder more burden due to this decentralization, in both quantitative and qualitative terms. As we know, it is also a policy of the Director-General to decentralize 75% of the WHO global resources to countries and regions. These resources will be mostly allocated for activities at the country level. In future, therefore, direct WHO support to countries will be mostly planned and implemented in countries. Colleagues, in the management of WHO collaboration with countries in the Region, I would like to remind us that there are at least three main categories of WHO work: � Direct support to individual countries; � Normative work, and � Intercountry coordination. Certainly, there are some other things also to be carried out by us as part of our duty. As far as our work at country level is concerned, we are now pursuing our tasks so that our WHO country offices become really implementing offices as far as direct support to countries is concerned. In addition to direct support to countries, WHO country offices are also responsible for: � Coordinating all WHO activities at the country level; � Contribution to normative work, especially in providing/supplying the required information; Report of the Meeting Page 46 � Promotion of intercountry cooperation through horizontal collaboration between or among WHO country offices; � Involvement in interagency coordination and cooperation at country level, and � Resource mobilization. In this connection, I should also mention that we will pursue our work in this direction so that the Regional Office becomes a strategic office, to be more effective in supporting WHO work at the country level. The strategic areas for Regional Office work will be: � Coordination of regional policy and strategy within the WHO global fram ework; � Performing normative work in coordination with headquarters and in collaboration with WHO country offices; � Promotion and coordination of intercountry cooperation activities; � Monitoring and evaluation of WHO regional biennial programme budget; � Pursuing oversight work to support executive management; � Providing support to WHO country work, as required; � Strengthening the capacity of WHO country offices, and � Involvement in interagency coordination and cooperation, and resource mobilization at the regional level. Colleagues, in the areas of programme development, during this meeting, we will focus our attention on the biennial programme budget for 2006-2007. As far as we in the SEA Region are concerned, there are three main issues relating to this programme budget: � There is a proposal for total global budgetary increase of 12.8%. We need all Member States to support this proposal. � If we could get the above increase, WHO/SEAR would obtain about US$ 9 million more in Regular Budget for countries. Now, we need to come up with objective criteria for distributing this increased amount among countries in the Region. � ‘ICP II’ will cease to exist from the next biennium. We will have to work out its successor in order to protect intercountry activities and normative work in the Region. 55th Meeting of the Regional Director with the WHO Representatives Page 47 However, in this connection, a Regional Working Group on Budget Development, consisting of high-level representatives from all countries, has been established. This is in pursuance of the recommendation of the 51st meeting of CCPDM, whic h was endorsed by the 57 th session of the Regional Committee. The Working Group is now working on the above three issues. It has met three times already and, we will keep all WRs informed of the progress. Colleagues, trends in decentralization, at both regional and global levels, necessitate unified programme planning and management in the Region, whereby the focus is on WHO activities at the country level. Joint planning between the WHO Regional Office and Country Office staff, with inputs from concerned national authorities in terms of needs and requirements, will be of paramount importance. In this process, in principle, the country will tell us “what” and we will tell them “how”. This joint planning exercise should start now on the plans of action for the biennial programme budget 2006 -2007. To pursue this exercise efficiently and effectively, there is a need for operational guidelines, which are clearly understood by all concerned staff members, at both country and regional levels. At the same time, we have to catch up and keep up to date with the new and future trends in the WHO global biennial programme budgeting process, of which we are a part and parcel. Furthermore, to ensure effective collaboration between WHO and individual Member States, we will have to review and strengthen the Government-WHO coordination mechanism. In this particular exercise, we have to keep in mind that such a mechanism has to be commensurate with the quantum of resources and activities to be coordinated, not too extensive or insufficient. I would like to underline the importance of this mechanism, which is to facilitate the management interface between the government and WHO. If it is appropriately developed, it will go a long way in promoting collaborative efficiency and goodwill; if not, it can contribute to conflicts and inefficiency in our work with Member States. Colleagues, with liberal decentralization as we are pursuing now, monitoring, evaluation and oversight have become very important management tools to protect the WHO Representative and his staff and Report of the Meeting Page 48 WHO in the Region as a whole through ensuring transparency and accountability. The work of the Programme Planning and Coordination Unit in monitoring and evaluation of the programme budget, report of internal and external auditors, and monitoring and evaluation of specific programme areas by various technical units, will be maximally utilized by the senior and executive management in the decision-making process. All in all, in our business, we have to ensure high-quality performance, transparency and accountability. All of us have absolute responsibility to help ensure these. In addition, an Internal Review and Technical Assessment Unit is now being established in the Regional Office to provide necessary information for executive decision-making. Care will be taken to ensure that the work of this unit will not duplicate or conflict with the work of the other concerned units, but, instead, supplement their work. For this meeting, WRs may have brought with them many issues in the areas of administration and finance for discussions and clarification with concerned units in Administration and Finance. Many of these issues may have arisen from the implementation of our decentralization strategy. I hope they will get satisfactory replies and responses on those issues. Colleagues, this is the Regional Director’s meeting with WRs, and the WRs will have to play a key role in the conduct of the meeting. However, I would like to see the Regional Office staff members participating as resource persons, at least. There are many things we can learn together, from each other. This is a learning process, it is the best way for us to learn while pursuing our duties. Therefore, this meeting should be kept open, as much as possible. I personally do not think that we have anything to hide from each other. We should be open and frank in our association and interaction. While saying so, I must underline the importance of being positive and constructive in the course of our deliberations during this meeting and in our day-to -day functioning. Adopting this approach will help us go a long way in maintaining our integrity, the quality of having high moral principles and of being united. 55th Meeting of the Regional Director with the WHO Representatives Page 49 All of us are working towards the same goal – the health and well-being of all people; and, no less important, for the reputation and credibility of WHO. Therefore, we should not let the differences among us constrain our course of action towards this goal. Finally, let me wish the meeting efficient and smooth proceedings; and successful conclusions. Furthermore, I wish all WRs and their spouses, if any, an enjoyable stay in Delhi. Thank you.