REGIONAL COMMITTEE
Provisional Agenda item 19.1
Sixty-third Session Bangkok, Thailand 7–10 September 2010
SEA/RC63/16 16 July 2010
Follow-up action on pending issues and selected Regional Committee resolutions/decisions of the last three years: Collaboration within the UN system and with other international agencies and partnerships The recognition of health as a key element for sustainable development and global security has resulted in a substantial increase in global resources for health in recent years. At the same time, the diversity and number of health actors have also increased significantly, with private and non-state actors contributing significant resources to development assistance for health. With this proliferation of actors in health, WHO, particularly at country level must coordinate its work, through effective partnerships, not only with government authorities but also with other United Nations (UN) agencies, donors, and civil society organizations, in order to ensure alignment of health strategies and goals and improve health development outcomes at country level. The paper provides an overview of WHO’s collaboration within the UN system and with other international agencies and partnerships over the last year. It reflects the Organization’s commitment to UN reform, as well as its efforts in collaborating with a diverse and complementary array of partners to enhance the effectiveness of the global health community in accelerating the achievement of the internationally-agreed health development goals, including the Millennium Development Goals (MDGs). The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 28 June to 1 July 2010 reviewed the working paper and made the following recommendations: Action by Member States •
To strengthen national coordination mechanisms for external assistance for health, based on the principles of national ownership and alignment with national health development goals and strategies.
Actions by WHO-SEARO
(1)
To continue to support Member States, as requested, during the United Nations Development Assistance Framework (UNDAF) development process in order to enrich the health dimension of the UNDAF through the country cooperation strategy (CCS). To support Member States and WHO country offices to build capacity in strategically integrating health into the Climate Change; Human Rights; Social Protection and Emergency Preparedness and Response components of UNDAFs.
(2)
The working paper and the HLP meeting recommendations based on it are submitted to the Sixty-third Session of the Regional Committee for its consideration.
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Introduction 1. The World Health Assembly resolution WHA58.25 on United Nations (UN) reform process and WHO’s role in harmonization of operational development activities at country level requested the Director-General to ensure that: WHO continues to implement country-level activities in accordance with Member States’ priorities; WHO staff and programmes at headquarters, and regional and country offices adhere to the international harmonization and alignment agenda; the triennial comprehensive policy review of operational activities for development of the UN system is taken into account, and that ways are examined and specific steps taken to further rationalize procedures and reduce transaction costs, as outlined in the United Nations General Assembly resolution 59/250. 2. At its Sixty-second Session in September 2009, the Regional Committee for South-East Asia requested WHO to support Member States as appropriate during the United Nations Development Assistance Framework (UNDAF) development process; to build capacity of Member States to take forward the harmonization and alignment agenda at country level; to support country offices to become key actors in national health partnerships; to provide Member States with an analysis of the impact of “Delivering as One” UN reform processes on health outcomes at country level from the eight pilot countries. 3. The present report provides an overview of WHO’s collaboration within the UN system and with other international agencies and partnerships over the last year in line with the World Health Assembly resolution WHA58.25, as well as with the recommendations of the Sixty-second Session of the Regional Committee.
Engagement in health partnerships 4. Global health has become a multi-stakeholder process. Alongside WHO, a complex array of actors play an increasingly significant role in global health governance, each accountable to a different constituency and with different mandates, guiding principles, expertise, resources, governance structures and authority. 5. A number of partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the Global Alliance for Vaccines and Immunization (GAVI) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), have entered the scene with large amounts of grant money and are playing an increasingly prominent role in the global health architecture. Global health partnerships have mobilized important new resources for health and brought political and technical focus to priority diseases or interventions. 6. In recognition of the fact that global health partnerships (GHPs) can play an important role in aligning and coordinating efforts at global and country levels, WHO’s involvement in GHPs has grown dramatically over the last decade. In order to help streamline its engagement with such a multiplicity of partners, WHO submitted a policy guideline for relations with partnerships, to the
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Sixty-third World Health Assembly. The policy, endorsed by the Health Assembly in May 2010, provides a framework for guiding WHO’s assessment of, and decisions concerning potential engagement in different types of health partnerships, as well as specific principles to be applied by the Organization in hosting formal partnerships. 7. The WHO Regional Office for South-East Asia does not host any partnerships, but is an active partner in a number of global health partnerships, including GAVI, GFATM, the Stop TB Partnership; The Partnership for Maternal, Newborn and Child Health and the Roll Back Malaria Partnership, and provides through its technical units and country offices, technical assistance and support to Member States to help maximize the benefits and minimize the challenges to countries of engagement with global health partnerships. 8. The International Health Partnership and Related Initiatives (IHP+) and its compacts, represent a commitment by world leaders, donors, agencies – and the countries receiving aid – to work together in a more effective way to provide support to a country’s costed and validated national health plan. The IHP is supported by donor governments and agencies representing half of the world’s aid spending on health. 9. Nepal is one of twelve developing countries participating in the International Health Partnership and Related Initiatives (IHP+). In February 2009, Nepal became the first Asian country to sign an International Health Partnership National “Compact” with emphasis on aid effectiveness; national ownership and leadership; equity and focus on vulnerable groups. 10. WHO was actively involved in co-facilitating the International Health Partnership process in Nepal with the World Bank and United Nations Children’s Fund (UNICEF) providing assistance in ensuring greater coherence, harmonization and alignment among multiple stakeholders. 11. Other partnerships in which WHO is an active participant include the IFRC1, with which the Regional Office enjoys a privileged relationship, particularly in the areas of disaster management; emergency preparedness and response; blood safety; and health information. In February 2009 the WHO Regional Director for South-East Asia and the Secretary-General of the IFRC met to review the collaboration between the two organizations, and discuss ways to continue to strengthen the existing partnership and increase the scope of collaboration to other areas such as community rehabilitation, mental health and road safety.
Comments 12. As a result of the increasing number of health initiatives, recipient countries have been overwhelmed among other things by inefficient aid: duplication, fragmentation, multiple reporting requirements, high transactions costs and fierce competition for scarce health staff, etc. 13. Some global health partnerships are often not aligned with government priorities, and can undermine and potentially even distort country’s public health priorities. WHO must play a 1
International Federation of Red Cross and Red Crescent Societies.
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leading role in ensuring that there is an agreed set of country-driven priorities for partners to align behind, in order to mitigate the effects on health outcomes of competing interests. 14. Global health partnerships often do not have a country-level presence and therefore rely on other agencies, such as WHO, for provision of technical support to countries. The increased workload and costs incurred by WHO in scaling up the provision of technical assistance to countries in response to increasing partnership financing, are not being matched by predictable core resources from GHPs or donors. 15. Lessons learnt from new and innovative partnerships such as the IHP+, will be important to guide Member States’ efforts to coordinate external health development assistance. IHP+ signatories pledged to evaluate and report their work in line with commitments in the IHP+ Global Compact, the Paris Declaration on Aid Effectiveness, and the Accra Agenda for Action. Despite pledges, only seven of the donor/funding signatories, mostly multilateral agencies, have self-reported sufficient information to generate an account of delivery at the country level. As such, there is as yet insufficient data to determine whether the IHP+ is a successful initiative. In addition, although there are some data that suggest that donors are increasingly aligning with national plans, most of the aid still reflects donor priorities. 16. The policy guideline on WHO’s involvement in partnerships, which was endorsed by the Sixty-third World Health Assembly will impact on the South-East Asia (SEA) Region’s work in this area. The Region may therefore consider developing its own guidelines for engaging in regional partnerships.
Coordination and collaboration within the United Nations system 17. With health issues forming part of the agenda of many UN organs and entities, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Economic and Social Council (ECOSOC), the World Bank, the United Nations Children’s Fund (UNICEF), the United Nations Environment Programme (UNEP), the United Nations High Commissioner for Refugees (UNHCR), and the United Nations High Commission for Human Rights, the UN system continues to be a privileged partner for WHO. 18. In line with the World Health Assembly resolution WHA58.25, WHO’s collaboration within the UN system, and in particular its involvement in UN reform efforts has a two-fold orientation: to promote health as a contributor to national development processes and to increase the coherence and effectiveness of the UN system’s contribution to those development processes, including adherence to international harmonization and alignment agendas and overall UN reform efforts2. 19. WHO is increasingly pursuing opportunities for collective action to enhance collaboration and efficiency within the UN system. It participates actively in the planning process for UN joint 2
The World Health Assembly resolution WHA58.25 on UN reform process and WHO’s role in harmonization of operational development activities at country level.
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action and reform, as well as in the Chief Executive’s Board (CEB), which addresses United Nations system-wide policy, programming, management and operational issues, and its subsidiary bodies. The CEB has recently reformed to bring the United Nations Development Group (UNDG) under its purview, as a third pillar focusing on country-level operations, along with the other two pillars: the High-level Committee on Programmes (HLCP) and the High-level Committee on Management (HLCM). WHO has been designated as the Vice-Chair of the United Nations Development Group for 2010. 20. WHO was actively involved in the development of the UNDG strategic priorities for 20102011, the essence of which is to maximize the UN development system’s impact at country level and support national partners to accelerate achievement of the MDGs and other internationallyagreed development goals. The principle of “no one size fits all’ is a central concept of the strategic priorities that highlights the importance of providing differentiated support to different types of countries, e.g. middle-income countries and least-developed countries. The aim is to shift from project implementation to greater policy-, sector- and programmatic-level interventions, in close alignment with national development strategies. The strategic priorities therefore envisage a focus on stronger upstream engagement with national partners; tighter internal discipline in priority-setting; more effective capacity development; and, stronger focus on harmonizing business practices. The strategic priorities further address the need to provide focused support to UNDAF roll-out countries; countries in crisis or transition; the “Delivering as One” pilot countries; and self-starter countries. 21. WHO, along with the International Labour Organization (ILO) has been designated as the lead agency for the UN initiative on Social Protection, one of nine Joint Crisis Initiatives endorsed by the CEB in April 2009, as part of a coherent and comprehensive UN strategic response to the challenges facing the international community in the wake of the financial crisis. The initiative is targeted at ensuring access to basic social services, shelter, and empowerment and protection of the poor and the vulnerable.
Regional coordination and collaboration 22. At the regional level, WHO is actively engaged in strengthening opportunities for improved synergies and alignment among UN agencies with regional mandates in Asia and the Pacific. Through its country office in Thailand, WHO has strengthened collaboration with the UN Regional Coordination Mechanism (UNRCM-AP) convened by the Executive-Secretary of UNESCAP3, where it co-chairs the health thematic working groups with the United Nations Population Fund (UNFPA) and participates in other working groups. 23. The Regional Office has been increasingly involved in the UN Regional Directors Team (UNDG-Asia Pacific)4 convened by the UNDG.
3 4
United Nations Economic and Social Commission for Asia and Pacific. United Nations Development Group for Asia and the Pacific.
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24. It participated in May 2010 in the first Consultations with the Resident Coordinators/UN Country Teams of UNDAF (2009) countries, to discuss the process of UNDAF and its substantive issues. From the SEA Region, this included Indonesia, Maldives and Myanmar (UNSF)5. 25. The UNDG Asia Pacific has designated regional Convening Agencies (CAs) from among its member agencies to be the focal point agencies for provision of the necessary organizational, reporting and monitoring support for each of the countries initiating CCA/UNDAF processes in the Region.
Convening Agencies for the 2010 SEA Region roll-out countries • • •
The Convening Agency for Bangladesh is the United Nations Development Programme (UNDP); The Convening Agency for Myanmar UN Strategic Framework is UNDP; and The Convening Agency for Thailand is the Food and Agriculture Organization (FAO).
26. A regional ministerial meeting on the theme "Financing Strategies for Health Care" was held in Colombo, Sri Lanka, in March 2009, as part of the preparatory process for the 2009 Annual Ministerial Review (AMR). 27. The report of the meeting encompassing the region’s top priorities, challenges and successes in this area was published and presented for consideration to the high-level segment of ECOSOC.
Country-level coordination and collaborative efforts 28. WHO is a committed partner in the UNs system’s "Delivering as One” (DaO) pilot initiatives launched in 2007 and currently under way in eight countries6, which voluntarily agreed to work with the UN system to capitalize on the strengths and comparative advantages of the different members of the UN family. The pilot countries are experimenting with ways to increase the UN system’s impact through more coherent programmes, reduced transaction costs for governments, and lower overhead costs for the UN system. The reforms are based on the principles of “One leader, One budget, One programme and One office.” 29. Although there are no countries in the SEA Region among the pilots, lessons learnt from the eight exercises will be important to achieve flexible, inclusive and effective UN team coordination mechanisms, and enhance coordination of development assistance to countries. 30. Country-led evaluations of the DaO pilot initiatives are being conducted in seven7 of the eight programme pilot countries. The lessons learnt from these evaluations will be shared among 5 6
United Nations Strategic Framework. Albania, Cape Verde, Mozambique, Pakistan, Rwanda, United Republic of Tanzania, Uruguay and Viet- Nam. 7 All except Pakistan.
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pilot countries, countries which have indicated voluntary adoption of the DaO approach, as well as with other countries. The objective of the evaluation is to assess the contribution of the DaO initiative to national development priorities. The evaluation will assess the four core evaluation criteria: relevance, effectiveness, efficiency and sustainability of the DaO approach; and will cover the time period since the DaO initiative was started in the country. Country-led evaluations will be completed by 1 July 2010, and will provide inputs to the inter-governmental meeting to be held in Hanoi, Viet Nam, to review the achievements and challenges related to the DaO initiatives. In addition to these evaluations, preparations for an independent evaluation of the DaO approach based on the principles of national ownership and leadership are currently under way, and are scheduled to be completed during the second half of 2011. Reports on these evaluations will be submitted to the Sixty-sixth session of the UN General Assembly in advance of the Quadrennial Comprehensive Policy Review (QCPR) planned for 2012. 31. Other efforts to improve the coordination of joint UN activities include the creation of Multidonor Trust Funds (MDTFs), which may be used by donors to channel and pool resources to support national development priorities and facilitate the work of UN country teams. WHO participates in activities of several of these funds, some of which are increasingly being used to fill the funding gaps in joint country team programmes. At the end of 2009, there were 32 MDTFs, which disbursed a total of US$ 4.5 billion to 23 Joint Programmes (JPs). The proliferation of MDTFs carries with it the risk of fragmentation, donor bias and increased transaction costs. It is hoped that these risks can be mitigated by the “One UN Coherence Fund” concept, which keeps the focus on filling the unfunded gap of the UNDAF in support of national development plans and priorities. 32. The Expanded DaO Funding Window (EFW) is based on the concept of the 'UN Coherence Fund', designed to fill funding gaps identified in the One UN Programme or UNDAF Action plan. To date, the EFW has committed US$ 259 386 488 to countries that are pursuing strategic and integrated programming in line with the DaO principles. At the end of 2009 there were 12 recipient countries, among which was Bhutan from the SEA Region. 33. In line with the Paris Declaration on Aid Effectiveness, WHO's work in and with countries is aligned with national development strategies and plans through the Country Cooperation Strategy (CCS), and harmonized with the UN system in the context of the UNDAF. Since its onset, WHO has been a continuous supporter of the UNDAF as the programming framework for effective and efficient coordination of operational activities for development of the UN system at country level. 34. Recently, WHO was actively involved in the elaboration of The “New UNDAF”, which draws its direction from UN General Assembly resolution 62/208 and the lessons learnt from the eight pilots. Over 90 countries are expected to go through the “New UNDAF” process from 2009 to 2011, including all countries in the SEA Region, with the exception of the Democratic People’s Republic of Korea and Myanmar, where a similar process known as “UN Strategic Framework” has been set up. 35. The Regional office has supported country office engagement in the CCA/UNDAF, including through active participation in the regional Peer Support Group (PSG), a standing group of the
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UNDG Asia-Pacific, developed to provide value-added support to UNCTs8 in preparation of highquality and timely CCA and UNDAF. 36. WHO country offices in Indonesia, Maldives and DPR Korea (UNSF) participated in the UNDAF development process during 2009, ensuring that the health section was aligned with priorities of the national health sector plan.
Comments 37. The division of labour between UN system agencies at country level needs to be better defined, with special emphasis on ways in which the UN system can collectively provide support to sectoral needs at country level, taking into consideration the respective mandates, roles, competencies and business models of all the UN funds, programmes and specialized agencies. 38. While the value of the UNDAF for the collective UN system is undisputed, it faces limitations in leveraging action in the health sector. The concept of “comparative advantage” implicit in the UNDAF has the potential to undermine the contribution which individual agencies such as WHO bring to development cooperation. WHO will continue to strive to enrich the health dimension of the UNDAF through the CCS, which provides a platform for the development community at country level to discuss cooperation for health, as well as the role of UN agencies, and the particular contribution of WHO. 39. At its July 2009 meeting, the UNDG Advisory Group (Principals from UN Agencies, Programmes and Specialized Agencies) agreed that all UNDAFs must offer strategic, relevant and focused support to countries towards achievement of MDGs. Embedding the MDGs in the UNDAF provides an opportunity for WHO to work with the Ministry of Health (MoH) and partners to ensure the alignment of UNDAF outcomes with national health priorities. WHO must capitalize on its comparative advantage in terms of the health-related MDGs. 40. WHO must be increasingly strategic in integrating health into the Climate Change, Human Rights, Social Protection/Resilience and Emergency Preparedness and Response components of UNDAFs. 41. Given the substantial implications of the UN reform agenda for health at global, regional and country levels, it is essential for Member States to lead and be fully engaged in this ongoing process. Health authorities need to increasingly collaborate with Foreign Affairs officials to enhance their understanding of the implications of UN reforms on health development activities at the country level. 42. Efforts by WHO and the United Nations system as a whole to exert effective and impartial leadership and improve performance on global development priorities must be supported by coherent and predictable financing by donor governments.
8
United Nations Country Teams.
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43. The “One Budgetary Frameworks/One Fund” has been important in promoting coherence and improved division of labour among UN system agencies at country level. However, the need remains for greater predictability and timeliness of funding at the country level, and nonearmarking of contributions within the “One Fund”.
Collaboration with regional intergovernmental organizations 44. The comparative advantage of collaboration for health development with Intergovernmental Organizations (IGOs) rests upon the country presence and technical expertise of WHO in the planning, implementation and evaluation of public health programmes, projects and activities, and the high-level political commitment, multisectoral support and advocacy that IGOs can rally behind such programmes, projects and activities. 45. Initiated in the 1980s, the Regional Office’s collaboration with ASEAN9, was strengthened by the renewal in 2009, of a joint Memorandum of Understanding (MoU) with the Regional Office for the Western Pacific, with focus on joint activities in areas including prevention and control of communicable and noncommunicable diseases, health systems strengthening, food safety, climate change, and emergency preparedness and response.
Follow-up plans 46. Considering the implications of UN reform for implementation by the UN system of national development and health priorities, it is important for Member States to be fully informed and engaged in driving the UN reform, coordinating external assistance, and ensuring alignment of UN interventions with national development goals and strategies. WHO will continue to pass on relevant information to Member States, and facilitate opportunities for them to interact and discuss in depth issues related to UN reform and health. 47. The Regional Office will continue to provide support to the UNDAF roll-out countries in the Region, including through active participation in the Peer Support Group of the UNDG AsiaPacific; Bangladesh, Myanmar (UN Strategic Framework) and Thailand have new UNDAF commencing in 2011, and are going through the UNDAF development process during 2010. 48. The Regional Office will provide training to WHO country teams on harmonization and alignment using the “WHO Alignment and Harmonization Learning Tool for Country Teams”, designed to enhance the capacity of country offices to support Member States to further the principles of the Paris Declaration. 49. Towards the end of 2010, the Regional Office will be organizing a Partners’ Conference on Health Development to promote regional collaboration for health and encourage effective and sustainable partnerships between the various stakeholders for health. The Partners’ Conference will provide a venue for high-level representatives of donor countries, multilateral and 9
Association of South-East Asian Nations.
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intergovernmental organizations, civil society, foundations, corporations, research/academic institutions and other global partner organizations from the 11 Member States to engage in an open and dynamic discussion on health priorities for the Region, and the challenges and opportunities facing governments, organizations and communities in partnering to advance these priorities.
Conclusion 50. Over the past decade, health has gained increasing recognition as a key component for sustainable development and global security, with a prominent role assigned to the health sector, through various mechanisms including the G8 and G20 agenda, International Health Regulations, the MDGs’ financing, the UN reform, the Paris Declaration, and the Accra Plan of Action. 51. Within this global context, it is essential for WHO, as the largest intergovernmental organization with an exclusive international health mandate, to strengthen its role as the leading and coordinating authority on international health, both within the UN system as well as beyond. WHO must increasingly engage in effective and innovative health partnerships and networks, in order to support countries in the achievement of the MDGs. 52. National governments have the primary responsibility for setting and monitoring their respective development priorities. As such, they must continue to play the lead role in coordinating external assistance for health, and assuring alignment with national health development goals and strategies.