WPRJRC54/SRl3 SUMMARY RECORD OF THE THIRD MEETING (Who Conference Hall, Manila) Tuesday, 9 September 2003 at 09: 15 CHAIRPERSON: Dr Manuel DAYRlT (Philippines) CONTENTS page 1. 2. 3. 4. Address by the incoming Chairperson ............................................................................. . Report of the Regional Director (continued) ................................................................... . Programme budget 2002-2003: budget performance (interim report) ............................. . Proposed programme budget: 2004-2005 ........................................................................ . ANNEX - Address by the incoming Chairperson ................... ............. ............................ 100 100 101 105 115
99
100
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
1.
ADDRESS BY THE INCOMING CHAIRPERSON: Item 4 of the Agenda The CHAIRPERSON addressed the Committee (Annex).
2.
REPORT OF THE REGIONAL DIRECTOR: Item 8 of the Agenda (Document WPRlRC5412) (continued) The REGIONAL DIRECTOR, responding to comments and quenes made on his report,
grouped his replies by theme. In response to the suggestion by the representative of Fiji that in future he should include information on the implementation of programmes financed by country allocations in his report, he proposed that such information be incorporated instead into the reports on budget performance. The representative of China had asked that the report be made accessible to a wider public. In his view, one of the main purposes of his report was to provide detailed explanations to Member States of how the Regional Office had responded to their health needs and problems. That information would not necessarily be of interest to other readers. A balance would need to be struck between accountability to countries and accessibility to a broader public. He would consult with Member States on ways of making the report more accessible. Several representatives had emphasized the importance of strengthening surveillance for severe acute respiratory syndrome (SARS). Discussions had been held over the past few months with various agencies, and the Asian Development Bank had agreed to provide substantial support. At least four additional experts would be stationed at the Regional Office and would travel to countries in the Region to advise them on strengthening surveillance and laboratory systems for SARS and other infectious diseases. The representative of Japan had suggested that a special publication be prepared on the SARS outbreak; the representative of Kiribati had also asked for a complete record. A booklet was already being prepared, based on reports from countries on how they had handled the crisis, which he hoped would be distributed by the next session of the Regional Committee. The representative of the United States of America had warned that the approach advocated by the Regional Office for combating HIV/AIDS might promote promiscuity. He agreed with the representative that it was essential to promote healthy behaviour, including sexual abstinence and fidelity, but it was also critically important to deal with the reality of high-risk behaviour through evidence-based strategies. He noted that the two countries in which leprosy was still a public health problem had stepped up their efforts to reach the regional target of elimination, with the support of the Sasakawa Memorial Health Foundation.
SUMMARY RECORD OF THE THIRD MEETING
101
He was pleased to note that several countries in the Region had signed the WHO Framework Convention on Tobacco Control, and the representatives of the Republic of Korea and Viet Nam had expressed their strong commitment to that treaty. As the Director-General had said, however, signature was only a first step towards implementation of the provisions. In response to the comments of the representatives of several countries concerning health sector reform, he said that much progress had been made in that respect over the past five years. The representatives of Japan and the United Kingdom had stressed the importance of patient safety, and the representative of Palau had endorsed a holistic approach to patient care. More attention would be paid to improvements to patient care and safety in the future. In some countries, medical services in the Region had reached a level that would allow more attention to be paid to their quality, and not only to the quantity. There being no further comments, the CHAIRPERSON requested the rapporteurs to draft an appropriate resolution. 3. PROGRAMME BUDGET 2002-2003: BUDGET PERFORMANCE (INTERIM REPORT): Item 9 of the Agenda (Documents WPRJRC54/3 and WPRlRC54/3 COIT.l) The REGIONAL DIRECTOR, introducing the interim report on the budget performance for the biennium 2002-2003, contained in document WPRJRC54/3, said that it gave details of the financial implementation of the regular budget and extrabudgetary sources from 1 January 2002 to 31 May 2003. It also provided information on programme outcomes, covering the period from 1 January 2002 to December 2002. That information was based on a mid-biennium assessment exercise that had been conducted by all focuses and country offices. He said that detailed information on WHO activities during the biennium could be found in the Regional Director's reports for 2001-2002 and 2002-2003. The interim report was intended to keep Member States informed of developments since the budget proposals had been presented to them in 2001. It was part of the process of transparency that was a feature of financial reporting in the Region. He explained the details of financial implementation, which were outlined in Annexes 1 and 2 of the document. Annex 1 showed the changes in the overall amount of the original budget between its presentation to the Regional Committee in September 2000 and 31 May 2003. Annex 2 showed the status of financial implementation by theme and focus. Column 2 of that annex showed the changes due to efficiency savings and other programme changes. The appropriation resolution adopted by the Health Assembly in May 2001 for the financial period 2002-2003 had encouraged Dr Brundtland to continue her efforts to effect efficiency savings,
102
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
in accordance with resolution WHA52.20, to be applied towards the required adjustments for cost increases and currency fluctuations. An additional US$ 1.3 million, largely from staff-related costs, had been distributed to a number of programme activities. After those changes had been made, the operating budget was as shown in column 3. The total regular budget obligation incurred by 31 May 2003 was US$ 55 845 698, representing 77 .68% of the effective working budget. Preparation and control activities to combat the outbreak of SARS in the Region had been given high priority, and that had delayed implementation of some activities of lower priority, including several meetings. Now that SARS had been successfully controlled, he expected that regular budget funds would be fully obligated by the end of the biennium. The extrabudgetary funds used for regional and country activities appeared by focus in Annex 2, column 6. The total obligation, as at 31 May 2003, was US$ 43 183 627. Columns 7 and 8 showed total implementation of all funds and implementation by focus as percentages of all funds used. All country offices and focuses had undertaken a mid-biennium assessment of programme budget implementation. Annex 3 showed the outcome of that exercise and described progress towards the achievement of expected results, as had been requested by the representatives of several Member States at the fiftieth session of the Regional Committee. The final report on the budget performance would be presented to the Regional Committee at its fifty-fifth session in 2004. Dr UEDA (Japan) welcomed the format of the interim report, which correlated with information contained in the Report of the Regional Director and the programme budget for 2002-2003. Noting with satisfaction the financial implementation rate and the volume of
extrabudgetary resources expended, he urged WHO to make every effort to deliver its programmes as planned. Mrs PIERANTOZZI (Palau) expressed her concern that the regular budget allocation to the Region was decreasing, despite rising costs and unexpected challenges. The Region's sound
performance and greater efficiency seemed to lead only to reductions that benefited other regions. Mrs BLACKWOOD (United States of America) commended the report's clear presentation of information, particularly Annex 3. The Region had made good progress, which reflected the
usefu lness of results-based budgeting and the definition of clear and measurable indicators.
SUMMARY RECORD OF THE THIRD MEETING
103
Dr SELUKA (Tuvalu) welcomed the report, which provided health managers with the information they needed to make rational decisions for future planning. He thanked WHO for its support, which had made it possible to finance postgraduate training for health professionals. Dr WANG (China) observed that successful performance, as reflected in the implementation rate, was the result of close cooperation between WHO's Member States and secretaliat, which should be maintained in order to ensure full implementation of programme activities. Noting the reference to the mid-biennium assessment, he asked how that exercise had been conducted. Had it indicated any problems in programme implementation? If so, what measures had been taken to solve them? Future assessments should cover, not only programme activities, but also problems encountered and challenges for the future. Dr LOPEZ (Philippines) commended the clear and transparent presentation of budget allocations and the use of funding. He thanked WHO for its support for his country's poliomyelitis immunization campaign and its health sector reform, which had been financed from extrabudgetary resources. Dr Nao BOUTI A (Lao People's Democratic Republic) expressed his appreciation that regular budget allocations to least developed countries had not been reduced. Although such financing was intended for strategic interventions, a major problem in his country was lack of funds to cover "local costs". It had used WHO allocations to cover shortfalls in the health sector budget, but amounts that could be used in that way were limited to 15% of the total. He requested that that limit should be reviewed. Dr KING (New Zealand), referring to identification of priorities for expenditure, pointed out that the Regional Director's report had shown that the mortality rate was high for noncommunicable diseases, and that a few risk factors accounted for a considerable part of the global burden of disease. Why, therefore, had the largest budgetary reductions been made in such areas as community health, noncommunicable diseases and mental health? If such areas were identified as priorities, they should be followed through in term of programmes. Dr MANN (Papua New Guinea) asked if it was possible to indicate what percentage of extrabudgetary resources had been earmarked for each country. The REGIONAL DIRECTOR said that he would respond to Palau's intervention under agenda item 10, Proposed programme budget: 2004-2005. Referring to queries raised by the representative of
104
REGIONAL COMMITIEE: FIFTY-FOURTH SESSION
China concerning the mid biennium assessment, he explained that that exercise was to be conducted at the end of the first year of each biennium for all focuses and all countries, in order to ascertain problems encountered and gauge progress towards expected results. The assessment had indicated that, overall, all countries and focuses had made reasonable progress. However, the speed of the exercise and its quality and depth of understanding could be improved; staff were being trained for that purpose. rectified. Responding to the question raised by New Zealand, he explained that resource allocations had to be reprogrammed in the course of implementation. Whether a programme was a priority or not, some adjustment was inevitable. Reductions in one area meant increases in another, where the need was greater. The SARS outbreak was a case in point: reprogramming had made it possible to allocate resources to several countries, including from extrabudgetary resources, and resources for Communicable disease surveillance and response had increased. Healthy settings and environment had received additional resources for activities in food safety, health and environment, and health promotion. Although the final allocation to Healthy settings and environment was lower than He agreed that any problems identified should be recorded so that they could be
originally planned, a minor reduction in no way meant that those activities were no longer a priority. Certainly health promotion and healthy settings were among the most important issues that had to be tackled in the coming years, and he hoped allocations could be increased in the next biennium. In reply to Papua New Guinea, he recognized that the allocation of extrabudgetary resources among the three levels of the Organization lacked transparency. Some funds were earmarked by donors for specific purposes; others had no strings attached and were given to the Organization as a whole. However, it was often difficult to know how much had been received, or how it would be allocated to regions and countries. It had been proposed that principles governing the allocation of extra budgetary resources should be drawn up, but that suggestion had not yet been taken up. The Director-General had indicated that the use of extrabudgetary resources would be based upon country needs, and that Member States would know the level of their allocations at the beginning of the budget cycle. He pointed out, however, that, unlike the regular budget, there were inherent difficulties in projecting the amount of extra budgetary funding for the biennium. The DIRECTOR, PROGRAMME MANAGEMENT, responding to the query from the representative of the Lao People's Democratic Republic, explained that the 15% limit on "local costs" was an Organization-wide policy. WHO tried to use its limited resources at country level for such strategic activities as training or policy development; they were not intended to supplement national budgets or to cover recurrent costs. It was unlikely that that policy would change.
SUMMARY RECORD OF THE THIRD MEETING
105
4.
PROPOSED PROGRAMME BUDGET: 2004-2005: Item 10 of the Agenda (Documents WPRJRC54/4, WPR/RC54/4 Corr.! and WPR/RC54/INF.DOC.ll) The REGIONAL DIRECTOR presented document WPRJRC54/4 - Proposed programme
budget: 2004-2005. At the fifty-third session of the Regional Committee, he had presented a proposed programme budget for 2004-2005 that had consisted of three parts: the global budget, the regional overview and the indicative country planning figures for the Region. Members States had been able to comment on the budget for the Organization as a whole, prior to its submission to the Executive Board and to the World Health Assembly, and before the preparation of the detailed plans. In preparing the budget, the General Programme of Work for 2002-2005 and WHO in the
Westem Pacific Region: Aframeworkfor action had provided the global and regional orientations. The proposed programme budget was contained under the four themes that guided WHO's work in the Region (Combating communicable diseases, Building healthy communities and populations, Health sector development, and Reaching out and programme management), as well as Administration and finance. These themes were broken down into focuses. The budget was also presented under countries and areas of the Region. Document WPR/RC54/4 was an expansion of the regional overview that had formed part 2 of the document the Regional Director had presented to the Regional Committee at its fifty-third session. It had been prepared according to the principles of results-based management. Regional objectives
and expected results had been developed for each focus, bearing in mind the relevant goal, objective and expected results from the related global areas of work and the needs of the Region's Member States. Country goals and objectives were in line with the corresponding goals and objectives of regional focuses. Performance indicators would be used to monitor progress regularly and would be used as the basis of assessments of programme budget implementation, conducted at six-monthly intervals. In order to improve alignment with the global areas of work, for the 2004-2005 biennium, the
focus on Health systems reform had been split into Health systems development and financing, and Health technology and pharmaceuticals. Another new focus, Programme planning, monitoring and evaluation, had been added, reflecting the importance attached to that part of WHO's work. Activities to strengthen WHO's
106
REGIONAL COMMITTEE: FIFTY -FOURTH SESSION
presence in countries were included in that focus. This reflected WHO's determination to strengthen its country presence. The proposed programme budget for 2004-2005 was the second in the Western Pacific Region to use the principles outlined in resolution WPRJRC50.RI, adopted by the Regional Committee at its fiftieth session. That resolution had been designed to make the process of determining country allocations more transparent and to ensure that it was based on objective criteria. As a consequence of the appropriation resolution adopted by the Fifty sixth World Health Assembly, the regional allocation for 2004-2005 was US$ 71 540000. The distribution of resources among the six regions continued to be governed by a resolution on the review of the constitution and regional arrangements, adopted by the World Health Assembly in 1998, resolution WHA51.31. At its fifty-third session, the Regional Committee had expressed
concern at the continuing negative effect of that resolution on country planning figures and regional resources. Over three bienniums, the Western Pacific Region would have lost almost US$ 9 million. The Region's allocation for 2004-2005 was 2.4% less than for the current biennium, largely as a result of a reduction of US$ 1 957 000 due to the implementation of resolution WHASl.31. Further information on the impact of resolution WHA51.3l could be found in the information document entitled Regular budget allocations to regions. That document consisted of two parts: part 1 was a note for regional committees on regular budget allocations to regions, prepared by the WHO Headquarters secretariat; and part 2 was the perspective of the Western Pacific Regional Office secretariat and included information on the impact on the Region of the use of the model to determine regional allocations. Of the total regular budget for 2004-2005, 56% had been allocated to country activities. The remaining 44% had been allocated to regional and intercountry activities. In response to the continued emergence of threats to public health, including severe acute
respiratory syndrome (SARS), and following concern expressed at the Fifty-sixth World Health Assembly, an additional US$ 500 000 had been allocated to the Western Pacific Region for implementation of the Revised International Health Regulations. Dr NAIV ALU (Fiji) thanked the Regional Director for the clear and informative presentation of the proposed programme budget 2004-2005. Resolution WHA51.31 had been the subject of
discussions for the past five years. The reduction of US$ 8.7 million over three bienniums was
SUMMARY RECORD OF THE THIRD MEETING
107
significant, with implications varying from country to country and affecting even the internal workings of WHO. Fiji reaffirmed its support for resolution WPRlRC53.R2 which had been adopted by the Western Pacific Region in September 2002. It had called for the implementation of resolution
WHA51.31 over three bienniums only, ending at the conclusion of biennium 2004-2005. Resolution WHA51.31 had necessitated the Fiji Government providing additional funding for its important health programmes, specifically HNIAlDS, dengue fever, filariasis, leptospirosis and reproductive health. Another adverse impact had been the reduction of intercountry posts in the regional office, involving EPI, Environmental health, Health promotion and Health informatics. The WHO South Pacific Office had lost three intercountry posts and responsibilities had had to be shared among the staff. In line with enhanced measles and hepatitis B control efforts, Fiji would like appropriate
officers to be identified and recruited to manage those programmes, including an EPr programme officer to coordinate activities in all the Pacific island countries. He believed that with vision and planning, WHO and Member States, in partnership, would be able to sustain the present !evel of achievement in health in the Region despite a reduced budget allocation. That had been demonstrated in the past biennium and he was convinced that it could be done again.
Dr SULEIMAN (Malaysia), while welcoming the proposed programme budget 2004-2005, said that the reduction in the regular budget would require more modest activities and optimal use of funds. Malaysia considered the four themes of Combating communicable diseases, Building healthy communities and populations, Health sector development, and Reaching out and programme management as significant areas of concern. Also important were evidence-based proposals that would ensure sustainable and equitable financing of the health system which could protect health and reduce mortality, morbidity and disability. Globalization and its effect on the national health system had also been important to Malaysia and greater attention would be paid to health sector development. The presentation of the proposed programme budget, with clear goals, objectives, indicators and strategies, could be used as a useful guide, not only for assessment and follow-up action, but also for comparison against budget performance. Dr WANG (China) said the proposed programme budget truly reflected the challenges and problems facing the Region. It had also taken the global targets into consideration and thus it would be easy to measure the expected results during the biennium.
108
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
In the process of fonnulating the budget, WHO had been able to strengthen programme
management training in order to improve the quality of country budgeting, and he hoped that such training would continue in future. At the fifty-third session of the Regional Committee, China had voiced its concern over the proportion of global extrabudgetary resources allocated to the Region. For 2004-200S, he hoped that WHO would take advantage of extrabudgetary funds to build up programme management and public health. The country budget had been prepared at the end of 2002. However, the SARS epidemic had occurred during the first half of the present year, and he wondered whether there would be adjustments as a result. The reduction in the regular budget for three consecutive bienniums had not only had a negative impact on regular activities at national level, it had also seriously affected personnel arrangements and capabilities at regional level. He recommended that the provisions of resolution WHASl.31 should cease and a thorough evaluation of the current appropriation model be conducted so that WHO's resources could be rationally distributed and utilized in accordance with actual needs. Dr TANGI (Tonga) expressed concern about the country allocations and suggested that the representatives look more critically at resolution WHAS1.31. That resolution clearly indicated that the reduction for any region would not exceed 3% per year, which had been done, and that the reduction should be spread over a period of only three bienniums, 2000-2001, 2002-2003, 2004-200S. He had heard that some regions were trying to spread the reduction over a longer period, instead of ending it in 200S. He reminded representatives that, in Kyoto in 2002, they had agreed, in resolution WPRlRCS3.R2, that the reduction should end in 200S, and he wished to re-emphasize that point. He wondered whether that had been discussed by the Executive Board. If not, he requested the members of the Executive Board from the Region to put that point across very clearly at the next meeting. He gathered that 40% of the overall budget came from regular budget or regular donations of Member States, and 60% from extrabudgetary resources. In 2000-2001, the Western Pacific Region had received only 3.3% of this figure and in 2002-2003, only 4%. He felt that there had been a lack of transparency and that the regions had no say in detennining how funds were to be distributed. He sincerely hoped that transparency in allocations would become a reality, as mentioned by the Director-General. Mr COURSE (France) noted with concern the increase in the proportion of funding from extrabudgetary sources, in WHO as in other international organizations. Although it helped to
increase technical cooperation, if extrabudgetary funding predominated, this could result in the
SUMMARY RECORD OF THE THIRD MEETING
109
funding of politically attractive programmes rather than essential health priorities.
He therefore
encouraged the Regional Director to develop a unified budget, as contemplated by the DirectorGeneral. He welcomed the extra resources for revision of the International Health Regulations, but regretted the reduction in regular budget allocations to combat communicable diseases, including AIDS. The link between global health safety, surveillance and information technology should be stated more clearly. He welcomed the increase in regional resources for tobacco control. Mr DUONG HUY (Viet Nam) asked that the figure for the population of Viet Nam on page 225 of document WPRlRC54/4 be corrected to 82 million. Noting that the budget allocated to the Western Pacific Region and to his country had been reduced, partly because of resolution WHA51.31, he pointed out that the net result for Viet Nam, as stated on page 234 of the proposed programme budget, was a reduction of almost 7% in the regular budget compared with 2002-2003. In view of the country's situation in terms of infant and child malnutrition, communicable diseases, AIDS, the trend in noncommunicable diseases, and the sustainability of tuberculosis and malaria control, WHO's resource mobilization and technical support would be needed. Professor ENG Huot (Cambodia) noted the reduction in the budget, much of which affected healthy settings and financing of health systems. He wished to know which activities would be sustained at country level in those programme areas. Given that country budgets constituted only a fifth of the total budget, he asked the secretariat to set out country budgets by source at the start of the budgetary period. In a multi sectoral context, that would help health ministries in countries such as Cambodia to prepare medium-term spending plans and to identify shortages in the health sector. Mr DAVlES (Australia) strongly supported WHO's results-based budgeting, and asked for reporting of higher-level outcomes as well as outputs, which would provide a useful indication of progress in addressing regional issues. WHO had to be able to demonstrate results in that manner, in order to gain and retain donor support. He recognized the financial pressures on the Regional Office, and called for continuation of tight controls over administrative and personnel costs. Since 1998, extrabudgetary funding had fallen, along with regular budget provisions. The Western Pacific Region received the lowest of any region's extrabudgetary funding. which was not appropriate, given the size of the Region and the health problems it faced. Australia provided US$ 6.5 million annually in extrabudgetary funds, in support of work that directly benefited the Region. That support was intended to focus attention on the needs of countries. He strongly encouraged WHO to formulate clear criteria for allocation of extrabudgetary resources in the Region.
110
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Dr KING (New Zealand) supported implementation of resolution WHA51.3l for three bienniums only. The formula had to be reviewed regularly to ensure it corresponded with reality. The review that produced the formula had been a move away from budgeting by precedent to budgeting in the light of equity and greatest need; the formula itself now had to be reassessed in the light of those same principles. She remarked that there was scant incentive to advance health if funding was cut when this was achieved. The system had to include incentives. She agreed with the representative of Tonga that the Western Pacific Region had to express its views on resolution WHA51.31 strongly at the next meeting of the Executive Board. Turning to extrabudgetary funding, she asked how it was allocated, whether the same allocation criteria applied across all the regions, whether the funding was earmarked, and whether moral judgments on countries or programmes were made in the process of allocation. If such judgments were indeed made, then perhaps it would be wise to wait and see where extrabudgetary funding went before allocating regular funds. She pointed out that the budget did not reflect total expenditure on health in a region, and that WHO should know how much was spent, and on what, before it decided where to allocate its resources. Mrs BLACKWOOD (United States of America) noted that the regular budget for 2004-2005 once again showed a decrease in line with resolution WHA51.31. That had been a decision by consensus in 1998, a hard one for the four regions that suffered cuts over three bienniums. WHO was to make a full evaluation of that process and report to the Executive Board and the World Health Assembly in 2004. That evaluation would cover the global impact of the resolution. The exclusion of Headquarters from that resolution was something that would need to be examined when the WHO Executive Board considered the issue. She approved the level of detail on allocations in the document under consideration, and the distribution of resources, but regretted that expected results and indicators were not always readily measurable. Baseline data should be available whenever possible to show whether results were
minimal improvements or substantial advances. She enjoined the Regional Office to continue to refine its approach. She welcomed the projected increase in extrabudgetary funding, but asked how sure the Regional Director was of receiving the US$ 140 million in question. The amount did reflect proposed requirements, but she wondered if the figure was realistic. The comparison of figures for 2003-2003 with those for 2004-2005, on page 9 of the document, showed a total of US$ 73 262 000 for 2002-2003, but that had never been the working amount: the
SUMMARY RECORD OF THE THIRD MEETING
III
final report showed it had been changed prior to implementation to US$ 71 578000, which meant that the budgetary reduction had not been as great as it appeared. She asked for that point to be taken into account in future presentations. Mr KIM (Republic of Korea) noted that the 2004-2005 country allocation for the Republic of Korea was 89% less than in the previous fiscal period; while he understood the rationale, he shared the concern of other countries about the implications for the Region. His country was paying Close
contributions as scheduled and was working hard to increase funding for the future.
connections existed between healthy settings, noncommunicable diseases and the Tobacco Free Initiative; there was a danger of overlapping or omission in the intersections between those programmes. Similarities in indicators in those programmes showed that coordination was important, and the secretariat should use an integrated approach to improve presentation of the budget plan for the next fiscal period. Indicators tended to be lacking in objectiVity; better indicators were needed to measure programme results as accurately as possible. Mr NAKAZAWA (Japan) referring to resolution WHA51.31 and the resultant 2.67% cut in the budget proposed for 2004-2005, asked for the effects of that resolution to be ended with that biennium. Japan's support for WHO was in two main areas: control of communicable diseases, and a geographical focus on the Western Pacific Region. Japan, therefore, had made a significant voluntary contribution to the Western Pacific Region, but the Region had not received sufficient extrabudgetary funding from Headquarters. He welcomed the Director-General's decision to devolve resources to country level, and proposed that a new mechanism for budget allocation be used from 2006 onwards, one which included Headquarters as well as the regions in the formula. The Western Pacific Region should receive more extrabudgetary funding. Dr LOPEZ (Philippines) regarded the 56% aIJocation to country activities in the proposed budget as evidence of the commitment by WHO as a whole and the Western Pacific Region in particular to strengthening its country presence, a trend which would increase in 2005-2006 as Headquarters devolved functions to the regions and countries. The additional information on each country and area in the Region, the expected results, indicators and estimates for extrabudgetary funding, and results-based programming, all accorded with the spirit of transparency evoked by the Director-General. He welcomed the new focus on Programme planning, monitoring and evaluation, along with the increase in funding from Headquarters for implementation of the revised hlternational Health Regulations, in response to emerging threats such as SARS. In preparation of the proposed programme budget, the General programme of work 2002-2005 and the Framework for action had been used; in view of ongoing United Nations reform and the focus on the Millennium Development Goals, some fine-tuning would be needed at country level.
112
REGIONAL COMMITTEE: FIFTY -FOURTH SESSION
Mr MASlKEVANUA (Vanuatu) followed other speakers in encouraging WHO to continue to make its budget more transparent, and thanked the Organization for its approval of his country's successful implementation of its projects. The REGIONAL DIRECTOR thanked representatives for their comments and replied to the specific questions that had been raised. As the representative of Fiji had indicated, several posts across different programme areas in the Region had been cut, including an immunization post in the WHO country office in Fiji. Those cuts were a direct result of the impact of resolution WHA51.3I. He was currently trying to mobilize extrabudgetary funding to ensure continued implementation of the programmes concerned. Replying to questions raised by the representatives of China, Tonga and the United States of America, he explained that the Regional Office had estimated that the Region would be allocated around 7% of the extrabudgetary funds likely to be received by WHO during 2004-2005. While the overall level of the regular budget was known in advance of the biennium, since it was based on assessed contributions by Member States, extrabudgetary funding could only be predicted - a difficult process. The likely sum was arrived at through discussions with Headquarters, Member States and donors, taking various factors into consideration: indications by donor countries (whose budget cycles were often different to those of WHO) and organizations; evaluation of the current programme situation, including cuts made because of the impact of resolution WHA51.31; and estimation of future programme requirements, given the need to restore cuts to important programmes, and anticipated additional needs, such as strengthening of communicable disease surveillance. The representative of China had asked whether it was possible to adjust country programmes to meet unanticipated changes, for example by diverting allocations for noncommunicable disease programmes to cover unexpected requirements in communicable disease programmes, such as those arising from the recent SARS outbreak. Clearly, countries should have some flexibility in that regard. In reply to the representative of the United States of America, he confirmed that the regular
budget total approved by the Health Assembly for the Region for 2002-2003 had been US$ 73 million, while the working allocation available at the start of that biennium had shown a reduction to around US$ 71.5 million. The difference was due to sums withheld by the DirectorGeneral to cover the shortfall in collection of assessed contributions and additional security costs (2% and 0.3% of the total, respectively). He anticipated that similar adjustments would be made in respect of the regular budget for the 2004-2005 biennium so that once again the working allocation would be slightly less than the total shown in the proposed programme budget document.
SUMMARY RECORD OF THE THIRD MEETING
113
He agreed with the representative of New Zealand that it was important to see the whole picture as regards total expenditure on health in a region. Allocation of extrabudgetary funds was a complex process. Some funds were earmarked entirely for a particular country and activity while others were only partially earmarked. In the latter case, a donation made for a particular activity in one Region may be retained at Headquarters. Although it would in due course be spent on an activity in the specified Region, it would not necessarily be channelled through the Regional Office. Objective criteria for the allocation of extrabudgetary funds, and better monitoring and evaluation of their use was required to ensure greater transparency. The DIRECTOR, PROGRAMME MANAGEMENT, responding to comments from the representatives of the United States of America, Republic of Korea and Australia, explained that, under the results-based budgeting process adopted by WHO, the expected results and indicators in the regional proposed programme budget referred to what could be achieved by the WHO secretariat, in other words to WHO's manageable interest, while the objectives were the collective goals of WHO and the Member States. For example, an objective for tuberculosis was the strengthening of tuberculosis control programmes so that 70% of smear-positive cases could be detected. However, it was difficult to identify expected results and indicators that could be considered, strictly speaking, as WHO's manageable interest alone, one factor being that, once staff costs had been deducted, many regional and country programmes had very limited budgets (often much less than US$ 100 000). Nevertheless, work was continuing to refine the expression of expected results and indicators. Those for 2004-2005 showed improvements compared to those for 2002-2003, and it was hoped that, with guidance and training, staff would make further progress in that area in the future. The REGIONAL DIRECTOR, responding to a request for clarification from the representative of the United States of America regarding possible differences between the approved level of the regular budget for 2004-2005 and the working allocation provided at the start of that biennium, said that it was for the Director-General to decide on the strategy to be adopted nearer to the time of implementation. However, it was his understanding that sums of the order of those applying in 2002-2003 were likely to be withheld, for the same reasons. The CHAIRPERSON said that a consensus appeared to be emerging that the Regional Committee considered that resolution WHA51.31 should be re-examined at Executive Board level. He requested the Rapporteurs to prepare an appropriate draft resolution for consideration later in the session.
The meeting rose at 12:00.
ll4
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
SUMMARY RECORD OF THE THIRD MEETING
115
ANNEX ADDRESS BY THE INCOMING CHAIRPERSON I would like to welcome you all to the historic city of Manila, a melting pot of the Eastern and Western cultures, traditions and races. During your brief stay, I hope that you will discover the interesting facets and diversity of Filipino culture that make it unique, as well as the convergence points that we share with the entire global community. Distinguished representatives, I wish to thank you sincerely for giving me the honour and the privilege to be the Chairperson of the fifty-fourth session of the Regional Committee for the Western Pacific. It is an honour for me to chair this very important gathering especially at this time when all of us are being called upon to collectively take a fresh look at and face the emerging challenges of the new millennium. It is also significant that this is a time when the World Health Organization is turning over a new leaf in its leadership, at both global and regional levels. Dr J.W. Lee, who is no stranger to this Region, recently assumed the post of Director-General, and yesterday, the Committee nominated Dr Shigeru Omi for a second term as Regional Director for the Western Pacific Region. The Director-General, Dr Lee, shared with us his vision for WHO when he addressed the Fiftysixth World Health Assembly in May this year and our own body yesterday morning. He talked about the core values of security and justice, and thus the need for "leadership in the ongoing struggle for security from infections, and justice for those worst affected by diseases of poverty". This is very much in tune with what the Regional Director, Dr Omi, said yesterday about harnessing the Region's resources to address the health needs of the disadvantaged or those who for some reason may have been neglected. Dr Omi also spoke about advocating a holistic approach to health care and the need to develop or enhance the health infrastructure and I am sure that these issues will be on Dr Lee's agenda too. The "changing of the guards" has presented us with the many opportunities to take advantage of the vision and the leadership of Dr Lee and Dr Omi. We look up to this leadership as we chart new goals and directions in the face of changing realities. Dear Colleagues, recent events have underscored that in this era of globalization, our community of nations needs effective global health leadership. As mentioned yesterday by both the Director-General and the Regional Director, the threat of severe acute respiratory syndrome or SARS was a defining moment in global public health, especially for the Western Pacific Region. It
highlighted how a single new disease could bring out the best in our capacity to respond to a global
116
REGIONAL COMMITTEE: FIFTY-FOURTH SESSION
Annex public health threat and to overcome the obstacles that came our way. At the outset, allow me to thank WHO, especially the Western Pacific Regional Office, for its leadership and unwavering support to Member States in the Region throughout the SARS outbreak and up to the present, as we continue our work to fully understand this new health challenge. Our collective experiences with SARS highlighted four important lessons. First, they
underscored the importance of achieving speed in surveillance and in identifying a public health threat at the global level. Second, it was critical that our health systems were consistent in their response, despite the inherent limitations we faced. Third, effective communication, within the global health infrastructure as well as with the general public, galvanized cooperation, not only from the public but from other sectors as well. And last but not the least, our credibility as the vanguards of public health allowed us to exert our influence over a situation and over sectors with remote and even distant mandates, which made an important difference in controlling the spread of the disease. This could not have happened without effective global health leadership. SARS taught us what public health may need to be in the years to come. We have seen and continue to be witnesses to how an inspiring and effective health leadership at the global and regional levels has steered us towards our goals of universal coverage for immunization, control of tuberculosis, reductions in the burden of disease from HIV/AIDS, ratification of the Framework Convention on Tobacco Control, and in protecting the gains we have made in primary health care. I look forward to our deliberations during the next few days, as these will clarify and guide us in translating these global objectives at country level. In today's globalizing world, the borders of the nation states have been blurred by the speed by which people, ideas and even biological agents can travel. Bold and strategic interventions are needed to ensure that the community of nations will work together to address these problems. Speed, consistency, communication and credibility - these must be at our command. Honourable Representatives, in the next few days, our discussions will also lead us to consider our response to challenges that are not new, but which demand our continuing attention and action. The growing burden of noncommunicable and other lifestyle-related diseases, the vulnerability of marginalized groups in a rapidly changing world, and unacceptable levels of infant, child and
maternal mortality in many countries still have to be addressed. I do believe that now is the time to take a serious look at how we have been addressing these problems, and to renew our commitment to ensuring a healthy population in the Region in the years ahead.
SUMMARY RECORD OF THE THIRD MEETING
117
Annex
In line with this, we must consider the infrastructure for health care that will enable us to respond to these challenges. The need to invest more in health, to use resources more effectively, to develop systems where equity is ensured and to build the capacity and the hwnan resources for the health sector are priorities. I therefore look forward to our round table discussion on Wednesday on the "Future directions for public health in the Region" when we will look at the evolving role of public health in our rapidly changing environment. Distinguished Representatives, there is a lot that is expected of us. However, I am confident that together, we will succeed. I look to WHO, even as it provides the global leadership in health, to also playa prophetic role by informing people about future trends and what may need to be done. And we, as members of this community of nations, must take on the challenges with resolve. At the same time we must be vigilant and seize opportunities to advance our work whenever and wherever we are called upon to do so. As we proceed with our work in the next few days, the need for effective global leadership must be at the back of our minds. But we must not define this leadership as something that elpanates and ends at the top, but as an enabling process that must be developed at all levels of our organizations in public health. I am talking about a leadership that we will take back to our respective countries where we make our mark and make a positive difference in the health of our people in these times of change. I would like to thank you for your trust and confidence when you elected me to be your chairperson. To my predecessor, Dr Hideo Shin ozaki from Japan, your excellent performance last year is worth emulating and inspires me to do my best to live up to all of your expectations. Once again, I welcome you to the Philippines and wish you all an enjoyable and fruitful stay.