The Ninth Meeting of the Country Support Unit Network The Harare Report 30 November - 2 December 2009
9 CSU Network Meeting - Harare, Zimbabwe 30 November - 2 December 2009
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Table of Contents List of Acronyms ........................................................................................................................ 4 Introduction, objectives and expected outcomes .................................................................... 5 1. Opening Session..................................................................................................................... 6 Review of key action points agreed in the 8th CSU Meeting ........................................................ 6 Presentation of the AFRO Country Analysis and Support (CAS) Unit: ......................................... 7 2. 5th Global Meeting of HWCOs with the Director-General and the Regional Directors ...... 8 Session1: Strengthening WHO's response to public health and humanitarian crises .................. 8 Session 2: Responding to the financial and economic crisis........................................................ 9 Session 3: Strengthening WHO performance at the country level ............................................... 9 3. United Nations Development Assistance Framework (UNDAF) ........................................ 11 4. Renewing Country Focus ..................................................................................................... 13 5. Selection, appointment, induction and development of HWCOs ...................................... 16 6. Improving WHO's performance in countries in a resource constrained environment..... 17 Implications of budget constraints ............................................................................................. 17 Resource mobilization ............................................................................................................... 18 7. AOB........................................................................................................................................ 20 Update on the Country Cooperation Strategy (CCS) ................................................................. 20 CSU Network Portal .................................................................................................................. 20 Next CSU Meeting .................................................................................................................... 20 Annex 1: List of Participants .................................................................................................... 21 Annex 2: Agenda of the 9th Country Support Unit (CSU) Network Meeting ......................... 23
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List of Acronyms ADG ARD AC CAS CCO CCR CCS CSU CVC DG DPM GMG GPG GRMST GSM HWCO ICST IHR MDG MoU MOSS MTSP NIC PRP
Assistant Director General Assistant Regional Director Assessed Contributions Country Analysis and Support Unit Department of Country Focus Country Cooperation Review Country Cooperation Strategy Country Support Unit Core Voluntary Contributions Director General Director of Programme Management General Management Cluster Global Policy Group Global Resource Mobilization Support Team Global Management System Head of WHO Country Office Inter-Country Support Teams International Health Regulations (2005) Millennium Development Goal Memorandum of Understanding Minimum Operating Security Standards Medium Term Strategic Plan Newly Industrialized Country Department of Planning, Resource Coordination and Performance Monitoring
PSG RD RM SIDS SO TCC UNDAF UNFPA UNCT UNDP UNRC WHA
Peer Support Group Regional Director Resource Mobilization Small Island Developing States Strategic Objective Technical Cooperation among Countries United National Development Assistance Framework United National Population Fund United Nations Country Team United Nations Development Programme United Nations Resident Coordinator World Health Assembly -4-
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Introduction, objectives and expected outcomes The ninth meeting of the Country Support Unit (CSU) Network was hosted by the Regional Office for Africa CSU, with support from the WHO Country Office, in Harare, Zimbabwe, from 30 November to 2 December, 2009. The meeting was attended by members from all regional CSUs; four Heads of WHO Country Offices (HWCOs) (Cuba, Mongolia, Somalia and Zimbabwe); representatives from the Department of Programme Planning, Coordination and Performance Monitoring (PRP) and the Department of Country Focus (CCO); and the Assistant Regional Director of AFRO. The list of participants is attached as Annex 1. Overall objective To effectively contribute to enhancing WHO's performance in countries through the strengthening of the CSU Network within the framework of the WHO renewed country focus that: i) supports the development, implementation, monitoring and assessment of National Health Strategies/Plans; ii) responds to emergencies situations; and iii) shapes the health dimension of existing partner platforms and maximize synergies with Global Health Initiatives. Specific objectives The specific objectives of the meeting are to: 1. Agree on the role of CSUs in the implementation and follow-up of key action points from the 5th Global Meeting of Heads of WHO Country Offices (HWCOs) with the DG and RDs. 2. Discuss and internalize a renewed country focus, and to identify the implications for CSUs in taking forward the renewed Country Focus Policy. 3. Update on the assessment of HWCOs as part of the selection, appointment and development process as well as the way forward. 4. Identify implications of simplified UNDAF guidelines and UNDAF Action Plan for WHO. 5. Discuss financing of WHO at country level: i) implications of budget constraints for the forthcoming 2010-2011 biennium; and ii) resource mobilization needs for countries and to support WHO's country work. Expected outcomes The expected outcomes of the meeting are as follows: 1. Agreement reached on the role of CSUs in the implementation and follow-up of the key action points from the 5th Global Meeting of HWCOs with the DG and RDs. 2. The renewed Country Focus Policy discussed and internalized; and implications for the CSUs identified. 3. Participants updated on the assessment of the first cohort of applicants to the position of HWCO; and steps for further improvement/way forward identified. 4. Implications of simplified UNDAF guidelines and the UNDAF Action Plan for WHO, identified. 5. Implications of budget constraints for the 2010-2011 biennium, and resource mobilization for countries and to support WHO's country work, identified.
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1. Opening Session The WHO Representative of Zimbabwe, Dr Custodia Mandlhate, welcomed participants to the 9th Country Support Unit (CSU) Network meeting and gave a brief overview of the health situation in the country, changes to the socio-political context and the recent Cholera epidemic. The Assistant Regional Director (ARD) of the Africa Region opened the meeting, referring to the renewed country focus, which underpinned the agenda of the recent 5th Global Meeting of Heads of WHO Country Offices (HWCOs) with the Director-General (DG) and Regional Directors (RDs). ARD explained that a number of important developments necessitate a renewed country focus, especially in a resource constrained environment and in the context of health system strengthening based on primary health care (PHC). Countries are requesting/need a way of working - with partners and with resources - that is less fragmented. Sound National Health Strategies/Plans (NHSPs) are critical to the achievement of Millennium Development Goals (MDGs) and other health development goals; and in the implementation of the Paris Declaration, through the International Health Partnership and Related Initiatives and the Accra Agenda for Action (AAA). The renewal of PHC and a focus on health systems strengthening provide provides important opportunities for making and sustaining health achievements in countries. The realization and implementation of a renewed country focus has thus become more urgent, and requires us to play a strong role in policy development and dialogue. ARD also highlighted the need for WHO to find ways to share, adapt and apply good practices, experiences and innovations that can help to inform strategic and policy guidance. WHO also needs to make the most of the current human resources within the Secretariat, especially in times of financial crisis, and to be strategic in its use of the Country Cooperation Strategy (CCS). It needs to enhance the role of Governments in health partnerships; and focus resource mobilization efforts for activities in support of the actions agreed at the 5th Global Meeting, such as making inter-country and cross-regional collaboration a reality. Review of key action points agreed in the 8th CSU Meeting For the follow-up on the actions agreed at the 8th CSU Network Meeting, a table of key action points and their implementation status, was discussed among the participants. The only action point that has not been fully implemented related to the cost of ensuring 'realistic' compliance with Minimum Operating Security Standards (MOSS). Discussions have focused primarily on implementation of the Guidelines for Working with WHO Country Offices, and the ongoing challenges related to MOSS-compliance. Guidelines for Working with Countries The application of WHO Guidelines for Working with Countries appears to have become more systematic, with only a few cases of 'parachuting' reported in 2009. Nonetheless there have been a few serious instances where activities not requested by the Country Office or articulated in the CCS, were proposed/carried out by the Regional Office or Headquarters. It was subsequently agreed that the CSU Network needs to further insist that all the contributions being made in a country, should be responding to the country's needs as articulated in the CCS and workplans. CSUs, with support from HWCOs, should continue to monitor compliance with these guidelines. Minimum Operating Security System (MOSS) - compliance The 2.5% taken from staff salaries to cover staff security and other costs remains insufficient for ensuring full MOSS-compliance. A resolution was presented to the 2009 World Health Assembly (WHA), however no significant progress towards MOSS-compliance has been registered.
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Participants agreed that WHO Country Teams need to find innovative ways to ensure MOSS compliance, seizing and building on opportunities as they arise, including extra-budgetary resources (e.g. humanitarian funds). The representative from PRP also highlighted the role of HWCOs in increasing funds for MOSS-compliance, by including security costs into funding requests. CCO commits to: Providing, based on the Country Presence Survey, a trend analysis of evolutions in the location of country office premises.
Presentation of the AFRO Country Analysis and Support (CAS) Unit: Coordinator the AFRO Country Analysis and Support (CAS) Unit presented the mission, functions, and organizational structure of the CAS, as well as areas that require improvement. Mission The mission of the CAS is to provide political, strategic, technical, administrative and managerial backstopping from the different levels of the Organization to Country Teams, for effective delivery and improved performance of WHO at country level. Functions Under the direction of the Assistant Regional Director, the CAS gathers, analyses, and provides/disseminates data and intelligence. The CAS also provides policy support and advice to the Regional Director, on how to improve WHO's performance in countries in the Africa Region. Its functions are two fold: i) effective country and management and information. inter-country support; and ii) knowledge
Effective support: The support provided to WHO Country Teams, by the CAS is for policy formulation, implementation and monitoring. Follow-up on the implementation of the WHO Country Focus Policy at country level. Provide evidence for follow-up of the managerial process of WHO in collaboration with relevant units. Facilitate and ensure synergies between country, and inter-country support. Support countries with the development of Country Cooperation Strategies. Knowledge management and information: To generate information and provide orientation for improved leadership capacity Manage country and IST reports Create and update the Expert Roster in order to make available experts for country offices as well as partners. The CAS also analyses country reports, responds to the opportunities for technical support articulated in these reports; and assists Country Offices with their workplans (often at the review phase). Organizational structure The CAS is comprised of a Coordinator, two Administrative Assistants/Officer; a database manager, and two Medical Officers - one to support to ICSTs and one to provide country support. Areas for improvement A number of areas needing improvement, was identified. Each area could be largely attributed to the unfilled positions due to high staff turnover: -7-
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1. A policy direction needs to be developed in collaboration with the Partnerships and Resource Mobilization team on linking the General Programme of Work, the Medium Term Strategic Plan and the CCS. 2. Better follow-up of CCS implementation is needed, as is intelligence sharing and communication from the Regional Office to countries, and between countries; and attention should be focused on facilitating the sharing of best practices between these countries. 3. Additional support to the optimal functioning of ICSTs and the Regional Office in their work with countries is needed. 4. The action points agreed during partnership meetings need to be disseminated and followedup on. The CSU Network commits to : Sharing the attributes of each Regional Country Support Unit. Making this information available and ensuring that it is up-to-date, through SharePoint.
2. 5th Global Meeting of HWCOs with the Director-General and the Regional Directors The 5th Global Meeting of the Heads of WHO Country Offices with the Director-General and Regional Directors was held at the WHO Headquarters in Geneva from 2 to 5 November 2009. The meeting was attended by 286 participants. Participants included the Deputy Director-General, Assistant Directors-General, Deputy Regional Directors and Directors of Programme Management as well as 141 Heads of WHO Country Offices, and Directors and other senior staff from Regional Offices and Headquarters. The overall purpose of the three-day policy dialogue between the Director-General, the Regional Directors and the Heads of WHO country offices (HWCOs) was to improve and strengthen WHO performance in countries. Three themes were selected by the Global Policy Group (GPG). These include: 1. Strengthening WHO's response to public health and humanitarian emergencies. 2. Responding to the financial and economic crisis. 3. Strengthening WHO's performance at the country level. The draft key action points agreed at the meeting were shared with the CSU Network for their inputs. Two important observations were made. First, in terms of responsibility, it was noted that the role of Country Offices was absent from the large majority of outputs related to the key actions - and that Country Teams need to take these actions forward and their roles should be reflected as such in the draft plan of action. Second, it was suggested that the deadline of December 2011 be replaced by a deadline of November 2011, when the 6th Global Meeting is scheduled to take place. Each point was discussed separately, and CSUs made suggestions for their improvement. Minor edits were made directly to the Draft Plan of Action during plenary. Session1: Strengthening WHO's response to public health and humanitarian crises The actions related to this first session were considered very much in line with the points made by the Director-General in her opening address to the participants of the 5th Global Meeting, regarding the important role of WHO in emergency preparedness and response. CSU agreed that the follow-up of recommendations will need to be a joint effort between HQ and corresponding regions - and that better coordination between HQ and the regions will be needed for timeline implementation. Participants identified the CSU role in taking this forward as ensuring workplans take on these priorities and measuring their implementation; bringing the issues and -8-
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challenges experienced by HWCOs to the relevant technical departments at HQ. The CSUs committed to actively fulfilling these roles, using quarterly reports as inputs at regional and other relevant meetings. Session 2: Responding to the financial and economic crisis Participants felt that the expected outputs related to the financial and economic crisis would be difficult to achieve, given the current resource constraints (human and financial) affecting Country Offices. In addition, participants expressed concern that current reporting procedures will not generate an accurate picture of the impact the financial crisis is having on country offices. Importantly, the absence of an output related to internal WHO efficiency savings (such as cutting back on the number of meetings, increasing the use of video- and tele-conferencing), was highlighted. The need for efficiency savings was clearly articulated by the Director-General during the 5th Global Meeting, and it the CSUs suggested that a separate expected output for be included to reflect this. HWCO participants emphasized the need for country offices to be strategic in deciding what they can measure in a country given based on the available resources, keeping in mind that the purpose will be to provide strong arguments to protect health at the highest level. Skills in and knowledge of health economics are not always available in country offices, but instead, COs might be able produce data related to resources of medicines and other supplies or the impact of an outbreak that could be indirectly attributed to the financial crisis. CSUs agreed that CCO, on behalf of the Network, should pursue the issue of intelligence gathering related to the financial crisis, with the Health Financing team. It was also suggested that the PAHO reporting form be used as an example of what's being done and how the intelligence is being used. It was similarly agreed that the CSU's role here is also to ensure that technical programmes take this key action on board - that the Network would need to come up with a way of supporting country offices for inclusion in their workplans. Session 3: Strengthening WHO performance at the country level Compendium of national expertise The action of establishing a compendium of national expertise and the CSU Network's role in this was discussed at length. The goal of this compendium is to ensure timely access to quality technical support that contributes to rather than fragments support to the National Health Strategy/Plan - and address the current 'inaccessibility of expertise'. This action was suggested by the Director-General and the CSU Network is well positioned to take on the challenge of facilitating its development. The CSU Network committed to supporting the process of establishing this compendium, by working closely with HWCOs who will identify national expertise, and with the technical departments in Regions and Headquarters, to access existing inventories of expertise. The Network will facilitate this process of developing, maintaining, widely disseminating this roster of expertise, and ensuring that it is easily accessible across the entire Secretariat. Capacity of Country Teams to work with other UN agencies and development partners Discussions around this action point (5) focused on the need to reflect the linkage between the CCS and the health component of the Common Country Assessment (CCA)/UN Development Assistance Framework (UNDAF), keeping in mind that the ultimate goal is for WHO to put health -9-
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at the top of the development agenda. It was agreed that the goal is to end up with a solid analysis that all partners use and a NHSP that all partners support. This output was revised to read: WHO Country Teams in new UNDAF countries led the development of the health component of the CCA/UNDAF in support to the National Health Strategy/Plan, using the CCS and supported by Regional Offices and relevant HQ departments. South-South cooperation, technical cooperation among countries and inter-country collaboration The sharing of financial resources and technical expertise in a more horizontal manner has continued to gain rapid support for consolidation and expansion this past year. Director CCO reported on the grouping of HWCOs according to the commonalities shared by and challenges facing their country of assignment, during group work sessions at the 5th Global Meeting. Working with country offices "grouped" according to country groupings based on their similarities, strengths and development challenges will help the entire Secretariat to share and learn from experiences and good practices. It was anticipated that use of these groups during the 5th Global Meeting would serve as a first step towards enhanced inter-country and South-South collaboration, beyond regional boundaries. The next steps as agreed at the 5th Global Meeting are to i) strengthen existing networks such as “Small Island Developing States” (SIDS) countries that are part of the Countdown Initiative and ii) establish the network of Newly Industrialized Countries (NICs). Use of these networks, in the provision of support to countries and in the backstopping efforts of the Regions and Headquarters, will enhance WHO’s performance in countries. The 5th Global Meeting also committed to supporting innovative ways of working – specifically Technical Cooperation among Countries (TCC), Inter-Country Cooperation, and South-South Cooperation – as well as the sharing of related good practices, across the Secretariat. The CSU Network agreed to take responsibility for insuring these outputs are delivered on. Milestones include the establishment of the NICs network by June 2010, and a report on support to TC, Inter-Country Cooperation, South-South Cooperation and the sharing of good practices; by October 2011, prior to the 6th Global Meeting. A first step will be to compile lessons and experiences related to innovative ways of working.
The CSU Network commits to: Putting efforts to having the key actions agreed at the Fifth Global Meeting of Heads of WHO Country Offices with the Director-General and Regional Directors as a standing agenda item at each regional and sub-regional HWCO meeting. Including the relevant key actions from the Fifth Global Meeting in the CSU’s 2010-2011 workplans. Following-up with relevant technical programmes in ROs and HQ to ensure that the key actions from the Fifth Global Meeting are integrated into their workplans and that they are implemented in 2010-2011. Advocating for health financing unit to enable Country Teams and intercountry support teams to monitor the impact of the financial crisis, e.g. providing intelligence, simplified reporting format and feedback. Facilitating the development of a compendium of national expertise, to be built from the country level and validated by the regions, and monitor its accessibility and maintenance. - 10 -
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Monitoring the completion of PMDSs by all HWCOs and advocating for each PMDS to reflect the need to be an effective and inclusive team member with partners in country - in policy dialogue, planning and implementation of the National Health Development Strategies/Plans.
Ensuring the discussion on efficiency savings within WHO, to respond to the financial crisis, is reflected in the Key Actions from the 5th Global Meeting. Reflect the linkage between the CCS, the UN Development Assistance Framework (UNDAF) and other partnership platforms, in the proposed outputs of Key Action 5, to read as follows: "Increase the WHO Country Teams' capacity to work with other UN agencies and development partners to advocate for and mobilize multi-sectoral contributions towards the National Health Strategy/Plan, for better health outcomes."
3. United Nations Development Assistance Framework (UNDAF) Role of the CSU in supporting the UNDAF process In 2010 the UNDAF will be rolled-out in 46 countries. In 2011, 28 roll-outs are planned. Support to the UNDAF roll-out is through regional training provided by the relevant regional Peer Support Group (PSG) UNDAF quality assurance mechanism, involving all interested agencies at the regional level. Through the UN Regional Directors' Team, Regional Offices have also become increasingly involved in the regional UNDAF PSGs. WHO is participating in or has expressed interest to be part of five Peer Support Groups, in all regions excluding EMRO. It is critical that WHO is involved in regional UNDAF training, acting as the convening/coordinating agency responsible for overseeing the work of the PSG, whenever possible - and sharing intelligence and best practices across the Secretariat. Update on the UNDAF and other UN Reform Issues In February 2009, new UNDAF Guidelines were rolled out, and the guidance note on the use of the CCS to shape the health dimension of the UNDAF was widely disseminated. These guidelines reflected lessons learnt from the Delivering as One experience – related to aid effectiveness, emphasizing alignment ownership and alignment with country cycles. Implementation of these guidelines, did however, prove difficult, as so many individual agencies tried to address their concerns in the guidelines. The UNDG has since simplified the guidelines, drawing on lessons learnt from this year's roll-out, to facilitate implementation. The new package will be made available before the end of 2009. These new simplified guidelines give flexibility to the UN Country Team to manage the country’s calendar, and to adapt the time frame of the UNDAF to the country’s cycle and context. In addition, they no longer require a heavy CCA exercise involving multiple consultants. Instead, countries can be proactive and anticipate dimensions for analysis in an inclusive manner, but without the burden required by the previous guidelines. Nonetheless, feedback on issues/best practices from the field is still much needed to shape a corporate approach for WHO contribution to the UNDAF and UN Reform at country level.
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Summary of discussion: To ensure the UNCT works in an organized and consolidated manner, outputs should be included in the UNDAF action plan, although implementation remains the responsibility of the individual agency. Each agency is subsequently responsible implementation of its activities and reporting against the Results Matrix. A separate set of guidelines on including joint programmes in the UNDAF Action Plan, is available. Not all activities being implemented by WHO in the country need to be reflected in the UNDAF. The UNDAF WHO to ensure it's contributions are supporting national health strategies and plans as negotiated with the Government, and are not duplicating. The goal is for WHO to ensure that health is well represented and high on the country’s development agenda. Contribution to the UNDAF workplans: Planning and implementation are closely linked. At the planning stage, agencies (either through their own activities or joint programmes) are required to clearly define their contribution against results outcomes. Fundraising is done collectively and funds pooled and made available through a/the Multi-Donor Trust Fund (MDTF) at country level. All funding gaps should be identified in the UNDAF Action Plan. The UNCT under the guidance of the Resident Coordinator (RC) chooses how to report on progress – annually or other In Cuba, the UNDAF is considered the UN system’s collective response to the national plan, although not all the activities being implemented by the different agencies is reflected in it. For example, WHO has over forty results at country level, but only a handful are reflected in the UNDAF. The situation in country is more complex than it appears at the global level. The Resident Coordinator represents the UN Development Programme (UNDP), and in some cases, this arrangement can be a barrier to direct communication between the HWCO and Senior Government Officials, and as such combined with WHO's budgetary framework and the Global Management System (GSM), adversely impact WHO’s performance at country level. Some other obstacles include the increased number of non-resident agencies where there are more resources; the challenges of including health system strengthening in the UNDAF Action Plan. If WHO wants to lead the work of the UN, in health, it needs to ensure that most of its activities do fit into the UNDAF. Some HWCOs consider their contribution to the UNDAF a burden rather than an opportunity to put WHO in the ‘front row’ and show that WHO is the leader in health – which the Minister of Health should call on WHO. Across the Secretariat there is a perception that the CCS and the UNDAF processes are potentially complementary frameworks for planning, but that WHO has not yet advanced to a point where WHO can capitalize on this potential complementarity, due to top-down planning, rather than planning based on the situation in countries. o PRP is taking the concerns about the short-comings of top-down planning very seriously and have outlined a number of steps on how to better match the MTSP with the priorities identified in Country Cooperation Strategies. There are frameworks other than such as the UN Trust Fund for Human Security framework, that are more comprehensive than the MDG framework and thus allow contributions from more agencies. A wider conceptual framework is likely to be particularly helpful to countries experiencing crises where there is a need to bridge the health and other sectors.
The CSU Network commits to: Facilitating and monitoring support to Country Teams involved in the 2010-2011 UNDAF rollout, with relevant partners.
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Fostering collaboration among concerned units in ROs and HQ to ensure effective WHO contribution to the UNDAF roll-out, in particular, to the regional quality assurance mechanisms, including the peer support group and convening agency mechanisms. Developing and maintaining a calendar of important UNDAF-related events at the Country, Regional and Global levels, and make it easily accessible, in order to ensure timely WHO preparation for and contribution to the roll-out.
4. Renewing Country Focus It has been ten years since the Country Focus initiative was launched, and a decade on, the situation in countries has changed dramatically. The aid environment has also changed, countries’ expectations of WHO support have changed and partners’ expectations of WHO have changed. However, WHO’s policies, strategies and practices have not adapted accordingly. Few Country Offices have adequate capacity to support the development, implementation, monitoring and assessment of National Health Strategies/Plans (NHSPs), and health is often absent from a country’s UNDAF. WHO’s current focus is on translating global commitments such as the Millennium Development Goals (MDGs), the International Health Regulations (IHR) (2005) and the Framework Convention on Tobacco Control into better health outcomes in countries. And while WHO fulfils its current roles well, they do not adequately respond to the changing environment. Using the ‘lenses’ of the Paris Declaration on Aid Effectiveness and taking on board the major global health commitments as well as the above-mentioned changes, the WHO Secretariat now needs adjust its policies, strategies and procedures, and strengthen support to and the capacity of Country Offices, to: 1. Advocate for and support National Health strategies and Plans including the health components of other development strategies/plans. 2. Build national capacity for risk assessment and response to crisis situations and public health and humanitarian emergencies and events. Doing so, will enable WHO to achieve its vision of 'where it wants to be' in 10-15 years time. The CSU Network amended the vision to read as follows: WHO is a technical adviser and trusted broker to Member States, that: i) supports the Government to develop, implement, monitor and assess the NHSP; ii) facilitates the development partners’ contributions towards the NHSP; and iii) leads the international response to public health events and emergencies - for better and more equitable health outcomes. Revising the draft ‘renewed Country Focus’. Working in two groups, participants addressed four questions, with a view to improving the draft ‘renewed Country Focus’ paper and laying the foundation for a roadmap to achieving this visions The questions were as follows: 1. Does the proposed vision reflect where we want to be? How could we express this vision better? 2. What adjustments need to be made to the Secretariat’s policies, strategies and practices, to realize this vision? 3. How could the country office support mechanisms be further improved, including the roles of the CSU Network? 4. What are the practical and realistic steps to share the vision across the Secretariat and take this forward? - 13 -
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Questions 1 and 2 During the report-back by each group, proposed modifications related to questions 1 and 2 were made directly to Section 8 of the paper. Suggestions were to reflect the need to: adjust the Secretariat’s managerial practices, particularly those aimed at strengthening national systems, in line with the Paris Declaration and the AAA; raise awareness of country support policies accelerate the decentralization process, particularly of staff and funding. Document and disseminate new ways of cooperation and related good practices. Expand on the ‘unfinished agenda’ to include: i) making WHO planning more responsive to country needs; ii) better matching skills and competencies with the changing roles at country level; iii) working as an effective partner; iv) strengthening capacity for resource mobilization. Work as one-WHO, for a coherent and coordinated response to corporate policy. It was agreed that inputs would be taken on board, including the need for branding and a communication strategy, and multiple versions of the vision circulated for further feedback. Question 3 Regarding improvements to country office support mechanisms, participants suggested the following: The CSU could use the country focus agenda to outreach to other programmes regardless of their scope of work. Linking of the CSU meetings agenda, agreed actions and expected outputs, with the agenda of the DPMs/CCO/GPG meeting; as well as regional WR meetings and subregional meetings. Effective feedback on CSU performance and overall support from technical and admin areas, using surveys and incentives such as awards to the best supporting units/departments/cluster. Interregional cooperation to strengthen CSU functions and improved linkages between relevant networks (CSUs, planning, partnership, resource mob etc) across Secretariat. Identifying existing mechanisms in regions, to support intercountry and South-South cooperation. Building on these mechanisms, CSU network to propose a mechanism for inclusion in the next MTSP. Question 4: Overlapping with Question 3, but more specifically regarding practical steps to take the renewed Country Focus forward, the following suggestions were made: Develop and have each country office use a standardized framework, to conduct an analysis of current roles, to identify gaps, based on the CCS, where investment will be needed for implementation of the new roles. Based on gaps identified, each country office to develop a comprehensive development plan for the country office, which includes staff security and is in line with the CCS, to orient investment. Ensure the results of these development plans are integrated into the next MSTP, bringing the issues to the review of the MTSP in mid 2010 and beyond. Monitor the implementation of these development plans and advocate for internal allocation of funding to fill the identified gaps. Disseminate the outcomes of the South-South Development Solutions Forum on Global Health held in Washington on 16 December, across the network. Call for a sharing of similar good practices in other regions. Reinforce and monitor compliance with guidelines for working with countries in all networks in all regions. Have the renewed Country Focus endorsed by DPMs and other networks Develop a communication strategy for internal purposes; and also develop a component for external communication – taking advantage of important events and focusing on incentives for the entire Secretariat backing and implementing the renewed Country Focus. - 14 -
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CSUs to act as a change agent to promote the renewed Country Focus. Advocate for the renewed Country Focus to be a standing agenda item at all Regional and Global Meetings of HWCOs.
In implementing these next steps, it will be important to focus consistently on ensuring Headquarters are behind the policy and that it becomes institutionalized. Change will only be achieved if direction is provided by the highest level of management, and if there is also buy-in at the senior management level. The Network needs to capitalize on the momentum generated by the DG’s reiterated commitment to ensuring the work of the entire Secretariat is aligned with country needs, as articulated in the CCS.
The CSU Network commits to: Broadening the proposed vision for country focus: where we want to be: and circulating options among Regional CSUs and HWCOs. Playing the following additional roles: o Acting as a change agent to promote renewed country focus, and related new ways of working. o Further reaching out to, and improving linkages between existing networks and units/departments/clusters, to enhance their relevance to country needs o Fostering interregional cooperation to strengthen the country support function o Fostering coherence of technical support in line with the CCS priorities o Advocating for equal opportunity among country offices, including effective implementation of WHO 'multilingualism' policy o Reinforcing and monitoring compliance with guidelines for working with countries in all networks in all regions. Promoting the following actions: o Develop a standardized framework for each country office to conduct an analysis of WHO's current roles/functions/profiles, to identify gaps based on the CCS, and needed adjustments according to the WHO renewed Country Focus o Based on gaps identified: Provide each country office with adequate support to develop a realistic and comprehensive development plan for the country office, which includes staff security and is in line with the CCS, to orient investment. Monitor the implementation of these development plans and advocate for internal allocation of funding to fill the identified gaps. Work with the Department of Planning, Resource Coordination and Performance Monitoring (PRP) to ensure the results of these development plans are integrated into the next MSTP, bringing the issues to the review of the MTSP in mid 2010 and beyond. o Call for good practices to be shared by all Regions, and disseminate across the Network, including the outcomes of the December 2009 joint PAHO/WHO-UNDP South-South Cooperation Forum. o Identify existing mechanisms in regions, to support intercountry and South-South cooperation. o Building on these mechanisms, CSU network to propose a mechanism to highlight South-South cooperation and inter-country/region cooperation in the next MTSP. Taking the following steps: o Finalizing the renewed WHO country focus and roadmap, for submission to Senior Executive Management. o Adopting a communication strategy to disseminate/market the renewed WHO country focus within the Secretariat, and among partners.
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Other commitments: Advocating for effective feedback on CSU performance and overall support from technical and administrative areas, using surveys and incentives (e.g. awards to the best supporting units/departments/clusters). CSU Network to develop a mechanism for the sharing of strategic information beyond the current DG briefings, starting with the exchange of existing reporting forms.
5. Selection, appointment, induction and development of HWCOs A competency based process for the selection of Heads of WHO Country Offices (HWCOs) has been implemented through the establishment of a global roster of pre-qualified candidates for internationally recruited HWCOs and the introduction of Assessment Centres. A HWCO orientation and development programme has been developed based on needs identified by HWCOs. It seeks to prepare them for their diplomatic, political, and managerial responsibilities; as well as enhance their technical, communication and negotiation skills. The first Global Induction of HWCOs took place in April 2009. 23 new HWCOs participated and a report of the induction is available at this meeting. The process of selecting and appointing HWCOs has begun, following clearance from the GPG. Initial feedback on the new process has been positive, and so far, it appears to have been well received by many stakeholders, giving credibility to HWCOs and improving the Secretariat's image. Orientation and development of HWCOs: The orientation and development programme begins with an assessment of the candidate's competencies, skills and potential, including their public health knowledge and competencies, and then prepares HWCOs for their responsibilities using face to face, online and didactic training packages1 combined with a mentoring programme to enhance their technical, communication and negotiation skills, over a period of 12 months. It is providing career development opportunities to HWCOs, including increased mobility, across regions and ultimately contributing to improved performance in countries. Summary of discussion: The content of the HWCO development programme needs to be discussed among the CSU Network, especially considering the results of the evaluation of the induction that took place in April. Mentoring of HWCOs is the responsibility of the CSU Network and needs to be taken forward. Regions are best placed to lead the mentoring process given the regional and country specificities/contexts HWCOs are exposed to. The CSU Network should used its intelligence to facilitate the HWCO selection decision making process at the Regional and HQ level, and also the development (by providing inputs into the design of programmes to address weaker competencies). This issue of deficits in continuing education across the entire Secretariat was also highlighted.
1 These packages include: 1) the country package (partnership and UN reform, CCS, and managing the WHO CO); 2) the technical skills package (IHR, emergency preparedness and response, trade and health, individualized technical training); and 3) the senior management package (political skills, communication skills, global leadership).
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6. Improving WHO's performance in countries in a resource constrained environment Implications of budget constraints Voluntary contributions comprise approximately 80 per cent of WHO's budget. This pattern of financing is unsustainable at the best of times, but has been significantly compromised/compounded by the recent financial and economic crisis. The value of pre-crisis pledges was almost halved, and the donor Member-States are reducing their contributions to support domestic priorities. Failure to mobilize resources for Strategic Objectives (SO) 12 and 13 can seriously hamper the performance of country offices as well as the support they receive from their Country Support Units, especially: i) to renew and implement their CCSs as planned; ii) to adequately staff the Country Support Units; iii) to guarantee funding for staff security; and iv) to strengthen the capacity of country offices to engage in the UNDAF processes and other development platforms. The CSU discussed the challenges related to the resource constrained environment foreseen for 2010-2011 and what can be done to minimize the impact of less funding for SOs 12 and 13, on WHO's performance in countries. Summary of discussion: In SEARO, country support is largely dependent on the funds from CCO core voluntary contributions (CVC). Without these funds for the next biennium, it may not be possible for the region to renew the six Country Cooperation Strategies nearing the end of their cycles. In addition it will not be possible to hire one much needed international P4. Without HQ funds, SEARO CSU will have great difficulty funding its planned activities, especially as AS funds cannot be used for country support. Similarly, without new funds, AFRO will not be able to continue HWCO capacity building activities, not will it be able to recruit staff to undertake planned CAS missions. In addition its ability to support countries in their UNDAF roll-out, and to map CCS priorities with the MTSP, facilitate the sharing of best practices; will be constrained. Fulfilling the mission and functions of the CAS will not be possible with the current funding allocations. In EURO, impending changes in the Regions Director's Office makes it difficult to predict funding gaps for the 2010-2011 Biennium. Nonetheless, there is a current gap in funding for salaries of approximately 3 million USD gap, if no new staff are recruited; a 0.5 million USD gap for implementation of planned regional activities in countries. In AMRO, however, the Regular Budget was recently approved with a slight increase - a measure of Member State's commitments to WHO. In WPRO, the situation seems much the same as it is in SEARO but to protect staffing arrangements in Country Offices, staff salaries will be moved from AC to VC. Countries are not always supporting of this decision given that they consider AC to be 'their own money', however it is WHO's role to convince Ministries of Health that doing so will enable more resources to be mobilized, through partnerships such as Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the GAVI Alliance for example. Discussions highlighted the need for a resource mobilization strategy, especially in light of the resource constraints associated with the financial and economic crisis. The CSU Network commits to: Completing the analysis of the funding gap in SO 12 and 13 for country office functioning and country office support. As part of the standardized country office development plan framework, propose a methodology for costing the re-profiling of country offices in line with the CCS, where needed.
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Gathering evidence of the benefits for the country, of having the adequate mix of competencies and ratio of national and international staff in country offices, including for increased resource mobilization for the countries.
Resource mobilization CCO and PRP gave a joint presentation of feedback from Global Resource Mobilization Support Team (GRMST) meeting which took place in November 2009. Participants were updated on the challenges related to resource mobilization (RM) at country level, and the outcomes of the November Global Resource Mobilization Support Team (GRMST) meeting. Specifically, the presentation identified upstream as well as operational challenges for WHO financing at Country Level and outlined WHO's (new) approach to resource mobilization as articulated in the draft Resource Mobilization Strategy. Challenges at the upstream level, requiring more complex changes to address, were as follows: 1. Top-Down planning & budgeting vs. bottom-up with greater alignment with National Plans 2. Traditional culture of centralized RM - the mentality that WHO is 'different' from other Agencies and does not need to mobilize resources. 3. Perception of WHO as (or not as) credible/influent actor at country level in a rather crowded and competitive context 4. Policy adviser/normative vs. Implementing agency - that there is confusion among donors regarding WHO's role at country level, and a (mis)perception that resources should be given to the global level, as WHO is not an implementing agency. Challenges at the operational level, which can be address quickly and effectively, were as follows: 1. Effective and strategic communication on health issues and WHO's role 2. Positioning in and using UNCT & other partnership platforms - which is crucial to WHO's ability to mobilize resources 3. Intelligence flow/sharing and adequate support to WCOs 4. Identifying and costing funding gaps 5. Limited delegation of authority (agreements, reports) - as the Secretariat is not using generic Memoranda of Understanding (MoUs) even though they would support us to work more efficiently - simplifying MoUs would ensure opportunities to access small funds are not missed. 6. Capacity development (leadership and management skills) of the HWCO and WHO Country Teams. Recommendations of the GRMST at the meeting on resources mobilization at country level were as follows: 1. Country and regional offices should actively participate in the conceptualization and development of the global WHO resource mobilization strategy. 2. National development strategies, costing and financing should be supported. 3. WHO's contribution should be aligned to national health and development strategies/plans - using the CCS and reflecting the MTSP. 4. WHO visibility, influence and presence should be improved through active participation in UNCT processes and other relevant country partnership platforms; 5. Country Offices need clear mechanisms with which to seek and secure funds; 6. Guidelines and support for the implementation of RM activities (based on existing materials and approaches developed by HQs and ROs) should be developed, and made available on the intranet and internet. 7. Delegation of authority for resource mobilization should occur. - 18 -
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8. Capacity development efforts are needed to identify and nurture opportunities, including leadership, advocacy and communications for resource mobilization; as a part of overall capacity development of HWCOs and WHO Country Teams. 9. The GRMST should collaborate more actively with other networks such as the CSU Network. Summary of discussion: The participants highlighted the importance of mobilizing resources at the country level, to seize, among others, the increased funding opportunities, particularly in times of financial crisis. Participants felt that given the resource constraints foreseen for the 2010-2011 biennium, the Secretariat's priority should be to build the capacity of Country Teams to work with donors, manage partner relations and prepare proposals. It was also agreed that the entire Secretariat needs to be involved in the revision/finalization of the Global RM Strategy, and when the report of on the proposed RM Strategy is shared; the CSUs will provide their inputs to ensure this opportunity makes a difference in country. In addition, CSUs will ensure the relevant staff at Regional and Country Levels is actively involved in this process. Suggestions for limiting the impact of fewer resources on countries, included: Targeting the private sector on the basis on social responsibility. Using South-South and similar forms of horizontal cooperation as a cost effective way of supporting countries in a resource constrained environment. Showing Ministries of Health that the costs of having a HWCO in each country are outweighed by the benefit - that HWCOs are critical to raising funds that cover staffing. Providing HWCOs with tools to support resource mobilization (RM), a starting point for which is mapping the principle donors to identify the RM skills needed to access donor funds. It is a false economy not to fund RM capacity building and high staff with these skills. Identifying ways to help HWCOs access resources offered by Multi-Donor Trust Funds (MDTFs) and interagency programmes like the UN Trust Fund for Human Security. Involving Regions, HWCOs and their Country Teams into the RM process, to facilitate the building of relationships with donors and more constructive partnerships. o Countries are conspicuously absent from the draft report on the RM strategy. This is of particular concern as it is people in countries who know best about RM at country level. Based on nominations from Regions, HWCOs should be involved in the development of this strategy and efforts should be focused on capacity building through training at country level. o The RM strategy should also focus on building the capacity of technical staff sitting in meetings with potential donors everyday, to network and mobilize resources through these interactions and relationships. WHO needs to document when, how and what resources are mobilized at country level, so that best practices can be identified, and staff costs justified as an investment rather than an expense. The CSU Network commits to: Working with PRP, the Department of Partnerships and UN Reform (PUN) and relevant regional units, to ensure that WHO Country Teams are informed, share experiences and receive guidance on funding opportunities at country level, in the context of the UN system (expanded Delivering as One window, MDG Fund, other Multi-Donor Trust Funds).
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Working with the GRMST Network to ensure the inclusion of resource mobilization at country level, in WHO's global strategy for resource mobilization, and fostering the involvement of HWCOs in the process.
Collaborating with the GRMST Network, especially to take forward the recommendations on RM at country level. Reinforcing and accelerating ongoing capacity development efforts targeting the HWCOs and their teams, building on experiences and existing tools; and making corporate RM learning/training material available.
7. AOB Update on the Country Cooperation Strategy (CCS) The Network was provided with an update on the overall status of the CCS and the development of the Country Cooperation Strategy Guide 2010. All countries with a country presence now have a CCS and the CCS Guide 2010 incorporates lessons learnt from the first generation CCS processes, such as the need for flexibility in the process including the signing of the document, which is increasingly shared with Ministries of Health. It also reflects elements of the renewed Country Focus. As suggested by the CSU Network at the 8th CSU Network Meeting, the Country Cooperation Review has been fully integrated into the CCS Guide 2010. A prototype of the 'CCS Key' has been developed and piloted in Jamaica, Paraguay and Nicaragua during their second generation CCS processes. CSU Network Portal Due to staff turnover and competing time commitments, there have been some gaps in the availability of Portal focal points across regions. As the Portal has not been maximized to its full potential, given the current financial constraints and the availability of new technologies, the Network members, suggested closing the Portal. Instead, "thematic" and time-limited SharePoints will be established as decided by the Network. The SharePoint is user friendly, and comes at no cost. This proposal will be discussed with CSU Network members who were absent from the meeting. Next CSU Meeting The next CSU Network Meeting will be likely to take place in Geneva, prior to or following another meeting, so as to save on costs. The meeting planned for November 2010 will be hosted by SEARO, WPRO or EURO. The hosting region, date and venue are still to be decided.
The CSU commits to: Ensuring all participants of the next CSU Network meeting, are fully briefed in a timely manner, on the purpose, background and functions of the CSU Network, by their respective CSU.
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Annex 1: List of Participants World Health Organization
9th CSU Network Meeting 30 November - 2 December 2009 Harare, ZIMBABWE
L i s t of P a r t i c i pa n t s REGIONAL AND COUNTRY OFFICES AFRO 1. Dr Matshidiso Moeti ARD/AFRO Telephone: 39386 E-mail: moetim@afro.who.int Telephone: 39329 E-mail: drameb@afro.who.int Telephone: 38083 E-mail: mandlhatec@zw.afro.who.int
2. Dr Babacar Drame CAS/RDO 3. Dr Custodia Mandlhate WR/Zimbabwe
AMRO 4. Dr Mariela Licha Salomon CSF/AMRO 5. Dr Lea Guido Lopez PWR/Cuba Telephone: +1 202 974 3197 E-mail: lichasal@paho.org Telephone: +53 7 8375808 E-mail: guidolea@cub.ops-oms.org
EMRO 6. Dr Marthe Everard WR/Somalia everardm@nbo.emro.who.int Telephone: +98 21 88363717 E-mail:
EURO 7. Rasul Baghirov Technical Officer MSP/EURO Telephone: +45 39171264 E-mail: rba@euro.who.int
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SEARO 8. Dr. Lin Aung Technical Officer PPC/SEARO Telephone: +91 11 233092418 E-mail: linaung@searo.who.int
WPRO 9. Dr Wiwat Rojanapithayakorn WR/Mongolia Telephone: 8220120 E-mail: wiwatr@wpro.who.int
HQ PARTICIPANTS 10. Dr Marie-Andrée ROMISCH-DIOUF Director, CCO 11. Dr Shambhu ACHARYA Coordinator, CCO 12. Dr Abdel Wahed EL ABASSI Coordinator, CCO 13. Ms Bénédicte GALICHET Technical Officer, CCO 14. Ms Clare Creo Elizabeth Technical Officer, GMG/PRP Telephone: 11996 E-mail: dioufm@who.int Telephone: 14270 E-mail: acharyas@who.int Telephone: 11462 E-mail: elabassia@who.int Telephone: 11495 E-mail: galichetb@who.int Telephone: 14920 E-mail: creoc@who.int
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Annex 2: Agenda of the 9th Country Support Unit (CSU) Network Meeting Harare, Zimbabwe 30 November - 2 December 2009 Time Monday, 30 November 2009 Opening and introduction Opening - Welcome (WR Zimbabwe) - Opening (ARD/AFRO) - Security and administrative briefing Introduction - Review of agenda and objectives th - Review of key action points from the 8 CSU meeting Chair: CCO Tea/coffee break th 5 Global Meeting of HWCOs with DG and RDs Presentation of AFRO CAS Unit's role and functions
Tuesday, 1 December 2009 Renewed country focus continued - Update on renewed Country Focus: plenary discussion
Wednesday, 2 December 2009 Selection, appointment and development of HWCOs - Update on the assessment process as part of the selection, appointment and development of HWCOs and way forward Chair: EMRO
9.00 - 10.30
Chair: AFRO
10.30-11.00
11.00-12.30
Tea/coffee break Renewed country focus - Group work on the implications of the renewed country focus for CSUs and the role of CSUs in its implementation Chair: AFRO cont…
Tea/coffee break Financing WHO at country level - Implications of budget constraints for the forthcoming 2010-2011 biennium - Resource mobilization needs for countries, and to support WHO's country work Chair: WPRO
- Role of CSUs in the implementation and follow-up th of key action points agreed at the 5 Global Meeting of HWCOs with DG and RDs Chair: SEARO 12.30-14.00 14.00-15.30 Lunch break - Next steps and way forward to support implementation of the key action points agreed at the th 5 Global Meeting Chair: SEARO cont… Tea/coffee break UNDAF - Implications of the simplified UNDAF guidelines and the UNDAF Action Plan, for WHO at country level. Chair: EURO
Lunch break - Group work continued Chair: AFRO cont… Chair: CCO Tea/coffee break Renewed country focus cont… - Group report back on implications for CSUs and the role of CSUs in the implementation of the renewed country focus Chair: AFRO cont…
Lunch break - Way forward/next steps including 10 CSU Network Meeting - Any other business th
15.30-16.00
16.00-17.00
Department of Country Focus World Health Organization 20, avenue Appia 1211 Geneva 27 Switzerland Tel.: +41 22 791 2111 Fax : +41 22 791 3111 www.who.int/countryfocus