WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU RÉGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Sixty-second session Manila, Philippines 10-14 October 2011 Provisional agenda item 10
WPR/RC64/4 21 August 2013 ORIGINAL: ENGLISH
PROPOSED PROGRAMME BUDGET 2014–2015
The Proposed Programme Budget 2014–2015 of the Western Pacific Region, aligned with the global Programme Budget 2014–2015 approved by the Sixty-sixth World Health Assembly in May 2013, provides the operational direction, accomplishments to be achieved and budget requirements for WHO in the Region for the two-year period beginning 2014. The Proposed Programme Budget 2014–2015 is structured around six categories of work and programme areas. It adopts a new results chain that better links the work of the Secretariat (outputs) to the health and development changes to which it contributes both in countries and globally (outcome and impact). The provision of a single budget figure covering both assessed contributions and voluntary contributions by category of work and programme area in 2014–2015 represents a significant departure in how the budget is developed. The preparation of Programme Budget 2016–2017 is included as a separate section for initial review and discussion under the Programme Budget 2014–2015 by the Regional Committee. The Regional Committee is requested to comment on the Proposed Programme Budget 2014–2015, briefly discuss the preparation of Programme Budget 2016–2017 and adopt a resolution for endorsement and implementation of the Proposed Programme Budget for 2014–2015.
WPR/RC64/4 page 2
1. CURRENT SITUATION
The Proposed Programme Budget 2014–2015 of the Western Pacific Region was developed according to the resolution on Proposed Programme Budget 2014–2015 adopted by the Sixty-third session of the Regional Committee. The Proposed Programme Budget 2014–2015 is the first of three programme budgets to be formulated within the context of the Twelfth General Programme of Work 2014–2019. The Programme Budget is envisaged as a transitional budget that responds to ongoing programmatic and managerial reforms at WHO while reflecting a realistic budget based on income and expenditures over the previous bienniums. It builds on lessons learnt and was developed in close collaboration with country offices, organization-wide technical networks and WHO headquarters. The Proposed Programme Budget 2014–2015 is structured around six categories of work (five technical categories and one category for corporate services and enabling functions) and their prioritysetting criteria which replace strategic objectives of the previous WHO Programme Budget. These were established based on the organizational priorities identified by the Member States through an intensive and broad-based consultation process: a meeting of Member States on programmes and priority-setting in February 2012. The six categories are: (1) Communicable diseases; (2) Noncommunicable diseases; (3) Promoting health through the life-course; (4) Health systems; (5) Preparedness, surveillance and response; and (6) Corporate services/enabling functions. The use of the priority-setting criteria along with the six agreed categories of work has resulted in the identification of 30 programme areas with 25 health-related priorities in the programmatic categories 1 to 5 that encompass 82 programmatic outputs. Progress towards each outcome will be measured in terms of changes in policies, practices, institutional capacities, reduction of risk factors and services, and services coverage or access through outcome indicators. Performance against outputs and deliverables will be measured through the successful delivery of products and services by the Secretariat at regional and country levels, as well as the resulting changes expected in policies, practices and capacities of Member States through output indicators. The total programme budget in the global Programme Budget 2014–2015 approved by the Sixty-sixth World Health Assembly in May 2013 amounts to US$ 3977 million, among which the Programme Budget for the Western Pacific Region amounts to US$ 270 million, or 6.8% of the total, broken down by category as follows: US$ 71.5 million for Category 1; US$ 42.1 million for Category 2; US$ 21.6 million for Category 3; US$ 54.2 million for Category 4; US$ 29.4 million for Category 5; US$ 44.3 million for Category 6; and US$ 6.9 million for Emergencies (see table below).
WPR/RC64/4 page 3 WPR Proposed Programme Budget 2014–2015 by Category and Programme (US$ thousands) Countries 1 - Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal 2 - Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal 3 - Promoting health through the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity and human rights mainstreaming Social determinants of health Health and the environment Subtotal 4 - Health systems National health policies, strategies and plans Integrated people-centered health services Access to medicines and health technologies and strengthening regulatory capacity Health system information and evidence Subtotal 5 - Preparedness, surveillance and response Alert and response capacities Epidemic- and pandemic-prone diseases Emergency risk and crisis management Food safety Subtotal 6 - Corporate services / enabling functions Leadership and governance Transparency, accountability and risk management Strategic planning, resource coordination and reporting Management and administration Strategic communications Subtotal Emergencies Polio eradication Outbreak and crisis response Subtotal Total Share between COs/RO 1 000 4 900 5 900 166 867 62% 900 100 1 000 103 133 38% 1 900 5 000 6 900 270 000 8 500 0 2 500 11 900 200 23 100 5 900 100 3 900 8 600 2 700 21 200 14 400 100 6 400 20 500 2 900 44 300 9 800 4 300 2 200 1 100 17 400 5 300 3 700 1 800 1 200 12 000 15 100 8 000 4 000 2 300 29 400 11 122 13 226 7 202 3 372 34 958 4 789 6 189 3 860 4 440 19 242 15 911 19 415 11 062 7 812 54 200 9 900 115 535 53 5 600 16 203 2 200 100 100 897 2 100 5 397 12 100 215 635 950 7 700 21 600 13 434 2 829 2 797 1 498 3 456 24 014 10 866 2 050 1 665 2 505 1 000 18 086 24 300 4 879 4 462 4 003 4 456 42 100 7 001 10 051 8 769 5 040 14 431 45 292 3 200 3 800 4 239 2 669 12 300 26 208 10 201 13 851 13 008 7 709 26 731 71 500 Regional Office Total
WPR/RC64/4 page 4 The Proposed Programme Budget 2014–2015 is envisaged as a transitional budget reflecting a realistic budget based on income and projected expenditure for Programme Budget 2012–2013. The proposed budget envelopes in the Proposed Programme Budget 2014–2015 for the Western Pacific Region are within the category envelopes for the Regional Office as approved by the World Health Assembly. Likewise, the share between the country offices and the Regional Office is in line with the WHA-approved figures. The budget envelopes to countries for Programme Budget 2014–2015 are in principle based on the level of projected expenditure for Programme Budget 2012–2013, except for some increases for a few countries with more available and confirmed voluntary contributions (VC) and staff cost requirement for Programme Budget 2014–2015. The allocations to the programmes and categories to countries/areas are based on identified country priorities through intensive consultations between WHO and Member States during the operational planning process from May to September 2013. Similarly, the Regional Office priorities have been identified through consultations with Member States and stakeholders in line with Regional Committee resolutions, regional strategies and action plans on priority programmes. Budget Envelopes by Countries/Areas (US$ thousands) Countries/Areas American Samoa Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Japan Kiribati Lao People's Democratic Republic Malaysia Marshall Islands Micronesia, Federated States of Mongolia Nauru Niue Northern Mariana Islands, the Commonwealth of the Palau Papua New Guinea Philippines Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Viet Nam Vanuatu Pacific island countries 2012–2013 67 36 15 812 18 334 419 1 694 36 36 34 512 13 073 814 284 558 4 755 98 93 37 116 18 504 11 449 1 336 35 5 039 95 908 119 19 368 2 240 17 558 2014–2015 69 36 18 723 18 231 432 1 546 36 36 34 675 14 401 939 293 694 5 502 101 96 37 120 16 764 11 298 1 946 37 5 272 98 1 012 124 19 781 2 410 19 232
WPR/RC64/4 page 5 The Programme Budget 2014–2015 operational planning is a fully integrated process that brings together: (a) programming based on the programme budget targets, deliverables and country priorities; (b) budgeting based on staff and resource requirements to achieve targets; and (c) financing based on available and expected income. It is a joint responsibility of the Regional Office, WHO country offices and the WHO global category and programme networks according to the organizationwide operational planning guidelines defining common business rules and process starting from early July to the end of December 2013 in four phases: programming; workplan development; global programme review; and financing and approval of workplans. Early preparation for operational planning focusing on resource projection, country/area priority identification and funding requirement, and human resources (HR) structure review and planning for the Regional Office and WHO country offices started in April 2013 on its own initiative. Based on priorities resulting from the consultations, relevant outputs and deliverables will be identified from the global Programme Budget 2014–2015 to which WHO country offices and the Regional Office will contribute and will be accountable for delivering under each category and programme area. This will be reflected in the detailed workplans at the operational planning. The Regional Office and country workplans should be fully financed by available funding: assessed contributions (AC) and voluntary contributions (VC) under WHO’s new approach for financing the programme budget as part of WHO’s ongoing reform aiming to achieve a fully-funded programme budget that is costed, realistic and driven by the priorities and expected outputs agreed by Member States.
2. ISSUES
The new financing approach has posed some challenges and uncertainties in terms of financing the workplans. In the past, the global programme budget includes proposed distribution of assessed contributions to regional offices and headquarters. Accordingly, the assessed contributions can be allocated to countries and areas. In 2014–2015, however, budget centres can no longer be provided with country planning figures for assessed contributions separately. The budget envelope will serve solely as a budget ceiling space without any assured flexible and actual funding for countries and areas, except for those with carry-over funds and expected/confirmed voluntary contributions, which are usually project based or highly earmarked. An analysis of funds available and funding gap has been undertaken during the operational planning process. The funding requirements and gaps to be identified by WHO will be presented and discussed with Member States and donors at the financing dialogue in November 2013 with a view to ensuring that all programmes in the Regional Office and country offices will be funded to at least 70% at the beginning of the biennium. The workplans would
WPR/RC64/4 page 6 need to be adjusted according to the results of the financing dialogue and resource mobilization during Programme Budget 2014–2015. Therefore, activities and HR planning in workplan development need to be prioritized with potential changes depending on available funding. After the global Programme Budget 2014–2015 was endorsed by the World Health Assembly in May 2013 and the first financial dialogue was completed in June 2013, only six months remained for operational planning before end of 2013. This time constraint limited the opportunity of WHO country offices and the Regional Office to identify specific outputs and deliverables, to which they will contribute, and the products and services which they will produce prior to the presentation of the Proposed Programme Budget to the Regional Committee. At the time of finalization of this programme budget document, discussions through the global category networks on output indicators, baselines and targets and priority countries were still ongoing. As a consequence, this information which would otherwise be provided does not appear. Selection of the specific outputs and deliverables, measurement of progress using output indicators, and products and services to be produced at regional and country levels will be finalized at the end of the operational planning in December 2013. The proposed programme budget remains the main instrument through which performance will be monitored and assessed. In previous bienniums, the indicators in the Organization-wide programme budget were supplemented by regional expected results and indicators defined by each region. With regional expected results and indicators no longer a part of the WHO results framework, the specific accomplishments anticipated in the Western Pacific Region by the end of the 2014–2015 biennium have been developed in the proposed regional Programme Budget for each programme output to which the Region contributes. With recognition of the above limitations of the Programme Budget for 2014–2015 as a “transitional budget”, the required information will be incorporated into the final version of the workplans of the Programme Budget 2014–2015 for WHO country offices and the Regional Office at the end of 2013.
3. ACTIONS PROPOSED
The Regional Committee is asked to comment on the Proposed Programme Budget 2014–2015, and adopt a resolution for endorsement and implementation of the Proposed Programme Budget for 2014–2015.
WPR/RC64/4 ANNEX 1
WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION
PROPOSED PROGRAMME BUDGET 2014–2015 OF THE WESTERN PACIFIC REGION
MANILA, 2013
The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Table of Contents INTRODUCTION ................................................................................................................................................. iii COUNTRIES AND AREAS OF THE WESTERN PACIFIC REGION .............................................................. vi Table of abbreviations .......................................................................................................................................... vii CATEGORY 1. COMMUNICABLE DISEASES ................................................................................................. 1 HIV/AIDS .......................................................................................................................................................... 1 Tuberculosis ....................................................................................................................................................... 2 Malaria ............................................................................................................................................................... 4 Neglected tropical diseases ................................................................................................................................. 6 Vaccine-preventable diseases ............................................................................................................................. 8 CATEGORY 2. NONCOMMUNICABLE DISEASES ...................................................................................... 10 Noncommunicable diseases .............................................................................................................................. 10 Mental health and substance abuse ................................................................................................................... 11 Violence and injuries ........................................................................................................................................ 12 Disabilities and rehabilitations ......................................................................................................................... 14 Nutrition ........................................................................................................................................................... 16 CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE ................................................... 18 Reproductive, maternal, newborn, child and adolescent health ........................................................................ 18 Ageing and health ............................................................................................................................................. 20 Gender, equity and human rights mainstreaming ............................................................................................. 22 Social determinants of health ........................................................................................................................... 23 Health and the environment .............................................................................................................................. 24 CATEGORY 4. HEALTH SYSTEMS ................................................................................................................ 27 National health policies, strategies and plans ................................................................................................... 27 Integrated people-centred health services ......................................................................................................... 28 Access to medicines and health technologies and strengthening regulatory capacity ...................................... 30 Health systems information and evidence ........................................................................................................ 32 CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE ....................................................... 35 Alert and response capacities ........................................................................................................................... 35 Epidemic- and pandemic-prone diseases .......................................................................................................... 36 Emergency risk and crisis management ........................................................................................................... 37 Food safety ....................................................................................................................................................... 39 Polio eradication ............................................................................................................................................... 40 Outbreak and crisis response ............................................................................................................................ 41 CATEGORY 6. CORPORATE SERVICES/ENABLING FUNCTIONS ........................................................... 43 Leadership and governance .............................................................................................................................. 43 Transparency, accountability and risk management ......................................................................................... 44 Strategic planning, resource coordination and reporting .................................................................................. 46 Management and administration ...................................................................................................................... 47 Strategic communications ................................................................................................................................ 48 EMERGENCIES .................................................................................................................................................. 50 PROPOSED PROGRAMME BUDGET 2014–2015 BY COUNTRIES AND AREAS ...................................... 51 AMERICAN SAMOA ..................................................................................................................................... 52 BRUNEI DARUSSALAM ............................................................................................................................... 53 CAMBODIA .................................................................................................................................................... 54 CHINA ............................................................................................................................................................. 56 COOK ISLANDS ............................................................................................................................................. 58 FIJI ................................................................................................................................................................... 59 FRENCH POLYNESIA ................................................................................................................................... 61 GUAM .............................................................................................................................................................. 62 JAPAN ............................................................................................................................................................. 63 KIRIBATI ........................................................................................................................................................ 64 LAO PEOPLE'S DEMOCRATIC REPUBLIC ................................................................................................ 66 MALAYSIA ..................................................................................................................................................... 68 MARSHALL ISLANDS .................................................................................................................................. 70 MICRONESIA, FEDERATED STATES OF .................................................................................................. 71 MONGOLIA .................................................................................................................................................... 73
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NAURU ............................................................................................................................................................ 75 NIUE ................................................................................................................................................................ 76 NORTHERN MARIANA ISLANDS, COMMONWEALTH OF THE........................................................... 77 PACIFIC ISLAND COUNTRIES .................................................................................................................... 78 PALAU............................................................................................................................................................. 80 PAPUA NEW GUINEA................................................................................................................................... 81 PHILIPPINES .................................................................................................................................................. 83 SAMOA ........................................................................................................................................................... 85 SINGAPORE.................................................................................................................................................... 87 SOLOMON ISLANDS .................................................................................................................................... 88 TOKELAU ....................................................................................................................................................... 90 TONGA ............................................................................................................................................................ 91 TUVALU ......................................................................................................................................................... 92 VANUATU ...................................................................................................................................................... 94 VIET NAM....................................................................................................................................................... 96 Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed Programme Budget 2014–2015 ................................... 99
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PROPOSED PROGRAMME BUDGET 2014–2015 OF THE WESTERN PACIFIC REGION INTRODUCTION The Proposed Programme Budget 2014–2015 of the Western Pacific Region, which was developed according to the Resolution on Proposed Programme Budget 2014–2015 adopted by the Sixty-third session of the Regional Committee and aligned with the Sixty-sixth World Health Assembly approved Programme Budget 2014–2015, is first of three programme budgets to be formulated within the context of the Twelfth General Programme of Work (GPW). The Proposed Programme Budget 2014–2015 of the Western Pacific Region is envisaged as a transitional budget that responds to ongoing programmatic and managerial reforms at WHO while reflecting a realistic budget based on income and expenditures over the previous biennium. It builds on lessons learnt and was developed in close collaboration with country offices, Organization-wide technical networks and WHO headquarters. The Proposed Programme Budget is structured around six categories of work—five technical categories and one category for corporate services and enabling functions—and their priority-setting criteria which replace strategic objectives, around which the work of WHO was previously organized. Technical categories
1. 2.
Communicable diseases: reducing the burden of communicable diseases, including HIV/AIDS, tuberculosis, malaria and neglected tropical diseases. Noncommunicable diseases: reducing the burden of noncommunicable diseases, including
heart disease, cancer, lung disease, diabetes, and mental disorders as well as disability, and injuries, through health promotion and risk reduction, prevention, treatment and monitoring of noncommunicable diseases and their risk factors. 3. Promoting health through the life-course: reducing morbidity and mortality and improving
health during pregnancy, childbirth, the neonatal period, childhood and adolescence; improving sexual and reproductive health; and promoting active and healthy ageing, taking into account the need to address determinants of health and internationally agreed development goals, in particular the health-related Millennium Development Goals. 4. Health systems: supporting the strengthening of health systems with a focus on the organization of integrated service delivery; financing to achieve universal health coverage; strengthening human resources for health; health information systems; facilitating transfer of technologies; promoting access to affordable, quality, safe, and efficacious health technologies; and promoting health systems research. Preparedness, surveillance and response: supporting the preparedness, surveillance and
5.
effective response to disease outbreaks, acute public health emergencies and the effective management of health-related aspects of humanitarian disasters to contribute to health security. Corporate services category 6. Corporate services/enabling functions: organizational leadership and corporate services
that are required to maintain the integrity and efficient functioning of WHO.
The six categories of work and their priority-setting criteria reflect organizational priorities established by Member States through a broad-based consultation process: a Member State meeting on programmes and priority-setting in February 2012; an outline presented at the Sixty-fifth World Health Assembly; and discussions at other governance forums, including: the six regional committees in 2012, Programme Budget and Administration Committee of the Executive Board in January 2012, the 132nd session of the Executive Board and web-based consultation. The six categories also reflect WHO’s comparative advantage and leadership priorities: advancing universal health coverage; health-related Millennium Development Goals; addressing the challenge of noncommunicable diseases; implementing the International Health Regulations; and addressing the social, economic and environmental determinants of health.
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The leadership priorities transcend the formal structure of the Programme Budget and catalyse collaboration across categories and programme areas. They also define the key areas in which WHO in the Western Pacific Region will seek to enhance visibility, shape the regional health conversation and extend its role in health governance. Along with the shift from strategic objectives to categories and programme areas, WHO has adopted a new results chain that reflects the standard United Nations system terminology and better links the work of the Secretariat (outputs) to the health and development changes to which it contributes both in countries and globally (output and impact).
Based on the priorities of countries and areas of the Western Pacific Region, the Proposed Regional Programme Budget 2014–2015 identifies from among the standardized Organization-wide outputs what the WHO country offices and the Regional Office, working through collaborative programmes with the countries and areas, will be accountable for delivering in each category and programme area. The Regional Proposed Programme Budget remains the main instrument though which performance will be monitored and assessed. In previous bienniums, the indicators in the Organization-wide Programme Budget were supplemented by regional expected results and their indicators defined by each region. With regional expected results and their indicators no longer a part of the WHO results framework, the specific accomplishments anticipated by the end of the 2014–2015 biennium have been developed in the Proposed Programme Budget for each programme output to which the Western Pacific Region contributes. The Programme Budget for 2014–2015 presents a significant departure in how the budget is developed: budget segments have been eliminated and a single budget figure is now provided covering both assessed contributions and voluntary contributions. In previous bienniums, the Programme Budget was broken down into three budget segments: base programmes over which WHO had exclusive strategic and operational control; special programmes and collaborative arrangements over which WHO had executive authority but not exclusive control; and outbreak and crisis response in which activities are governed by external events. The special programme segment was created principally to accommodate WHO-hosted partnerships that contributed to WHO results. As WHO did not have full control over the results and deliverables of the hosted partnerships, all hosted partnerships have been excluded from the Programme Budget 2014–2015. The provision of a single budget figure covering both assessed contributions and voluntary contributions by category of work and programme area at each level of the Organization provides a view of all resources from all sources that are needed to support the Organization’s work. It gives Member States an opportunity to approve1 and subsequently monitor the budget in its entirety.
Under changes in Organization’s financial regulations and rules approved by the Sixty-sixth World Health Assembly, the Health Assembly approves the budget as a whole rather than only approving the assessed contribution and noting a figure for voluntary contributions which was the practice in previous bienniums. Expenditure can only be incurred up to the amount approved subject to the availability of funds.
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Though the Proposed Programme Budget 2014–2015 is presented along budget lines that correspond to the agreed categories of work and programme areas, polio eradication and outbreak and crisis response, related to Category 5 (Preparedness, surveillance and response) and contribute to results within that category, from a budget perspective will be treated under the emergencies component, in order to allow a more flexible approach to managing the budgets. The proposed budget envelopes in the Proposed Programme Budget 2014–2015 for the Western Pacific Region are within the category envelopes for the Regional Office as approved by the World Health Assembly. Likewise, the share between the country offices and the Regional Office is in line with the WHA-approved figures. The budget envelopes to countries for Programme Budget 2014–2015 are in principle based on the level of projected expenditure for Programme Budget 2012–2013, except for some increases for a few countries with more available and confirmed voluntary contributions (VC) and staff cost requirement for Programme Budget 2014–2015. The allocations to the programmes and categories to countries/areas are based on identified country priorities through consultations between WHO and Member States during the operational planning process from May to September 2013. Similarly, the Regional Office priorities have been identified through consultations with Member States and stakeholders in line with Regional Committee resolutions, regional strategies and action plans on priority programmes. For Programme Budget 2014–2015, country planning figures for assessed contributions can no longer be provided to budget centres separately. The budget envelope will serve solely as a budget ceiling space without any assured flexible and actual funding for countries and areas, except for those with carry-over funds and expected/confirmed voluntary contributions, which are usually project based or highly earmarked. An analysis of funds available and funding gaps has been undertaken during the operational planning process. The funding requirements and gaps to be identified by WHO will be presented and discussed with Member States and donors at the financing dialogue in November 2013, with a view to ensuring that all programmes in the Region will be funded to at least 70% at the beginning of the biennium. After the global Programme Budget 2014–2015 was endorsed by the World Health Assembly in May 2013 and the first financial dialogue was completed in June 2013, only six months remained for operational planning before the end of 2013. This time constraint limited the opportunity of WHO country offices and the Regional Office to identify specific outputs and deliverables to which they will contribute, and the products and services they will produce prior to the presentation of the Proposed Programme Budget to the Regional Committee. At the time of finalization of this Programme Budget document, discussions through the global category networks on output indicators, baselines and targets and priority countries were still ongoing. As a consequence, this information that would otherwise be provided does not appear. Selection of the specific outputs and deliverables, measurement of progress using output indicators, and products and services to be produced at regional and country levels will be finalized at the end of the operational planning in December 2013.
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COUNTRIES AND AREAS OF THE WESTERN PACIFIC REGION Country American Samoa∗ Australia Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Hong Kong, China Japan Kiribati Lao People's Democratic Republic Macao Malaysia Marshall Islands Micronesia, Federated States of Mongolia Nauru Acronym ASM AUS BRN KHM CHN COK FJI PYF GUM HOK JPN KIR LAO MAC MYS MHL FSM MNG NRU Country New Caledonia New Zealand Niue Northern Mariana Islands, Commonwealth of the Palau Papua New Guinea Philippines Pitcairn Islands Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna Acronym NEC NEZ NIU MNP PLW PNG PHL PCN KOR WSM SGP SLB TKL TON TUV VUT VNM WAF
∗
Areas are indicated in italics
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TABLE OF ABBREVIATIONS ACT AeHIN AMR AOG APSED ART ASEAN CCS CRVS CSO EPI FCTC FETP GDP GPW HDI HERM HIIP HIS HRH IARC IASC ICT IER IHR ILI IPSAS IPV MDG MIYCN MOSS NCD NSP NTD OPV PC PHIN PIC Artemisinin-based combination therapies Asia eHealth Information Network Antimicrobial resistance Award Oversight Group Asia Pacific Strategy for Emerging Diseases Are receiving antiretroviral therapy Association of Southeast Asian Nations Country Cooperation Strategy Civil registration and vital statistics Civil society organizations Expanded programme on immunization Framework Convention on Tobacco Control Field epidemiology training programme Gross domestic product General Programme of Work Human development index Health emergency risk management Health Information and Intelligence Platform Health information systems Human resources for health International Agency for Research on Cancer Inter-Agency Standing Committee Information and communications technology Information, evidence and research International Health Regulations Influenza-like illness International Public Sector Accounting Standards Inactivated polio vaccine Millennium Development Goals Maternal, infant and young child nutrition Minimum Operating Security Standards Noncommunicable disease National Strategic Plan Neglected tropical diseases Oral polio vaccine Programme Committee Pacific Health Information Network Pacific Island Countries
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PIP PNG RAP SARI SBA SMG SPC STI UHC UNICEF VIP WFP
Pandemic Influenza Preparedness Papua New Guinea Regional Action Plan Severe acute respiratory infections Skilled birth attendants Senior Management Groups Secretariat of the Pacific Community Sexually transmitted infections Universal health coverage United Nations Children’s Fund Violence and injuries programme World Food Programme
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CATEGORY 1. COMMUNICABLE DISEASES
CATEGORY 1. COMMUNICABLE DISEASES Reducing the burden of communicable diseases, including HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and vaccine-preventable diseases.
This category specifically covers HIV/AIDS, tuberculosis, malaria, neglected tropical diseases and vaccine-preventable diseases. HIV/AIDS
Over the past year, impressive progress was made towards the global goals of achieving universal access to HIV prevention, diagnosis, and treatment; and contributing to achieving health related Millennium Development Goals and their associated targets by 2015. The major success is a nearly 20-fold increase in the number of people living with HIV who are receiving antiretroviral therapy (ART) from around 16 000 in 2004 to 308 000 by the end of 2012. Yet, more than 50% of people living with HIV are not aware of their HIV status and do not access treatment. Late diagnosis drives the steady increase of annual AIDS-related deaths (80 000 in 2011). The number of new HIV infections has stabilized at around 130 000 to 150 000 a year for most of the past decade. But HIV and sexually transmitted infections (STI) are increasing dramatically among men who have sex with men in cities across Asia. The 2013 WHO recommendations for initiating ART for people living with HIV at an earlier stage of the disease and immediately for HIV-positive pregnant women and the HIV-positive partner in discordant couples will not only improve health and prolong life but also reduce the rates of transmission of HIV (including from mother-to-child). Challenges remain formidable as there is a recognized need to reach high coverage levels of interventions from HIV testing, linkage to care and retention on treatment to harness the multiple benefits of ART at population level and to address the emerging HIV and STI epidemic among men who have sex with men and transgender people. The countries of the WHO Western Pacific Region (WPR) have a heavy burden of morbidity and mortality from viral hepatitis, mostly from hepatitis B (HBV) and hepatitis C (HCV) viruses. Liver cancer caused by hepatitis B is among the first three causes of death from cancer in men, and a major cause of cancer in women in this Region. It will take several decades until the impact of child vaccination is seen in adults. HBV remains hyper-endemic in China and many other countries in the Region with chronic HBV infection rates of >7% in most countries. Co-infection with viral hepatitis and HIV is increasingly recognized as a major public health problem and a broader approach to viral hepatitis beyond vaccination to include diagnosis and treatment and the management of HIV co-infection is timely. Priorities/focus for 2014–2015
Building on advances in the biennium 2012–2013, new opportunities exist to update and support of HIV/AIDS strategies and action plans in line with the global health sector strategy and track progress of their implementation. Key elements include: using antiretroviral medicines more strategically with the aim of maximizing their benefits for the prevention of HIV transmission; accelerating technological innovation in medicines and diagnostics to allow for simpler, safer, more affordable therapeutic regimens and decentralized service delivery; ensuring quality and reinforcing patient retention across the continuum of diagnosis, care and treatment; and monitoring the impact of expansion of periodic annual HIV testing and ART on HIV incidence, mortality and drug resistance. Expanding quality, reach and intensity of interventions for prevention and treatment of HIV and other STI for men who have sex with men (in particular young age groups), transgender people, sex workers and injecting drug users will remain priority. Supporting research-driven innovation including implementation and operational research at the country level will help improve programmes and services. The adaptation and implementation of new WHO norms and standards in preventing and treating paediatric and adult HIV infection, and building on the strong foundation of HIV approaches, WHO will intensify efforts in prevention and management of STI and developing a regional action plan for viral hepatitis in the Region.
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CATEGORY 1. COMMUNICABLE DISEASES
Cross-cutting issues/linkages with other programmes and partners
Important opportunities exist for leveraging broader health outcomes through HIV responses, by linking HIV programmes with other health areas, such as noncommunicable diseases, maternal and child health, chronic care and health systems. The existing infrastructure for HIV programmes and chronic care models for noncommunicable disease will be adapted to accommodate viral hepatitis and STI surveillance, screening and treatment programmes. Applying an approach to viral hepatitis beyond vaccination to include diagnosis and treatment is an emerging regional cross-cutting priority. Outputs to which WPR will contribute
1.1.1. Implementation and monitoring of the global health sector strategy on HIV/AIDS 2011‒2015 through policy dialogue and technical support at global, regional and national level Region’s accomplishments at the end of the 2014–2015 biennium
1.1.2.
Five countries have reviewed and updated HIV/AIDS strategies and action plans in line with the global health sector strategy on HIV/AIDS • Progress tracked in implementation of priority health sector interventions in regular reviews and reports • Regional networks of WHO quality-assured technical assistance providers and support engaged in implementing the global health sector strategy. Adaptation and implementation of most up-to-date norms and standards in preventing and treating paediatric and adult HIV infection, integrating HIV and other health programmes, and reducing inequities • Region’s accomplishments at the end of the 2014–2015 biennium
•
•
•
Five countries have reviewed and updated national guidelines for the prevention and treatment of HIV in line with 2013 guidelines on the use of antiretroviral medicines for the treatment and prevention of HIV infection Regional strategy for the prevention and management of viral hepatitis including HIV co-infections developed and presented at Regional Committee Meeting and new guidelines for screening and management of viral hepatitis disseminated Regional technical advisory group on the comprehensive management of viral hepatitis and co-infections established
Relevant Regional Committee Resolutions
WPR/RC60.R6 Asia Pacific Strategy for Strengthening Health Laboratory Services (2010–2015) WPR/RC58.R2 Progress Towards Achieving the Millennium Development Goals WPR/RC54.R5 Sexually Transmitted Infections, Including HIV/AIDS TUBERCULOSIS
The annual number of new tuberculosis (TB) cases has been gradually falling in the Region. Major progress has been made in expanding access to early case detection, while maintaining high cure rates. New diagnostics for the rapid diagnosis of TB and multidrug-resistant TB (MDR-TB) are being introduced. Interventions targeted at vulnerable populations such as migrants, prisoners and people living with noncommunicable diseases such as diabetes, have started in selected countries. Overall, the Region is on track to achieve the TB targets of the Millennium Development Goals set for 2015. Despite these achievements, TB is still a major health concern in the Region, with almost 1.4 million TB patients diagnosed annually and an estimated 130 000 deaths. The development and spread of drugresistant tuberculosis pose a major public health risk. In addition, risk factors for TB, such as smoking and diabetes are highly prevalent in our Region. Lastly, TB is concentrating in hard to reach vulnerable groups such as the poor and migrants.
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CATEGORY 1. COMMUNICABLE DISEASES
Equitable access to quality diagnosis and treatment for all TB patients requires increased involvement of all sectors, including the private sector. Elimination of catastrophic expenditures for people affected by TB has the highest priority, as failure to address these populations will result in unnecessary deaths and ongoing transmission. The rational introduction of new tools and interventions, including the programmatic management of MDR-TB, poses significant technical and management challenges for countries. Also, there is limited diagnostic capacity to detect TB in children and during early stages of the disease. Major financing gaps, especially in low-income and lower middle-income countries, need to be overcome by increased domestic funding and optimal use of international funding opportunities. These challenges need to be addressed in an effective mix of TB specific technical assistance and policy development, and broader strategies in the field of health systems strengthening, such as human resources for health and supply chain management. Priorities/focus for 2014–2015
WHO will further intensify efforts in line with WHO mandates, and focus on leadership and coordination, normative guidance, disease surveillance, technical support and operational research to build the evidence base for region-specific interventions. The Secretariat will provide a regional platform to strengthen country capacity to implement the Stop TB Strategy and ensure that related interventions reach the vulnerable and the poor. WHO also will support countries with the adaptation of the updated guidelines and responsible introduction of new tools and interventions for the diagnosis and treatment of all people with TB, including children, elderly and people suffering from drug-resistant TB. At the same time, WHO will effectively link up with other disease programmes and relevant sectors to ensure effective use of human and financial resources. Operational research will focus on: new diagnostic algorithms; advancing public-private mix models; TB risk-group policy development; and introduction of new drugs. Achieving the goals for TB control depends on well-functioning health systems and on tackling the social determinants of health. Hence, close collaboration between all WHO divisions is warranted. Cross-cutting issues/linkages with other programmes and partners
The TB programme will continue to collaborate with the HIV/AIDS programme for the early detection of TB and HIV co-infection, and the appropriate and timely treatment of both diseases. Diabetes and smoking are also proven risk factors for TB. Therefore the TB programme will work with noncommunicable disease programmes, and partners. Diagnostic tools such as chest X-ray belong to hospital services, and are shared by various programmes and services. Infection control and prevention falls under hospital administration. Therefore the TB programme will work with the hospital services for improvements in those areas in the context of health system strengthening. The responsible introduction of new drugs and regimens requires close collaboration in the field of legislation and accreditation. Lastly, the inclusion of TB in insurance schemes requires cross-cutting work within and outside the Organization. Outputs to which WPR will contribute
1.2.1
Intensified implementation of the Stop TB Strategy to scale-up care and control, with focus on reaching vulnerable populations, strengthening surveillance, and interventions and alignment with health sector plans facilitated Region’s accomplishments at the end of the 2014–2015 biennium
• 1.2.2
All seven countries with a high burden of tuberculosis in the Region have up-todate budgeted tuberculosis strategic plans
Updated policy guidance and technical guidelines on HIV-related tuberculosis, delivery of care for patients with MDR-TB, tuberculosis diagnostic approaches, tuberculosis screening in risk groups and integrated community-based management of tuberculosis Region’s accomplishments at the end of the 2014–2015 biennium
•
All seven countries with a high burden of tuberculosis in the Region have introduced and started roll out of WHO-recommended rapid diagnostics for tuberculosis and drug-resistant tuberculosis
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CATEGORY 1. COMMUNICABLE DISEASES
Relevant Regional Committee Resolutions
WPR/RC61.R4 Regional Strategy to Stop Tuberculosis in the Western Pacific (2011–2015) WPR/RC58.R2 Progress Towards Achieving the Millennium Development Goals WPR/RC57.R6 Tuberculosis Prevention and Control WPR/RC55.R8 Tuberculosis Prevention and Control WPR/RC54.R6 Tuberculosis Prevention and Control M ALARIA
Malaria is endemic in 10 of the 37 countries and areas in the WPR: Cambodia, China, the Lao People’s Democratic Republic, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea, Solomon Islands, Vanuatu and Viet Nam. However, with the remarkable progress reported in the Region between 2000 and 2011: an overall 46% reduction in malaria morbidity and 75% reduction in malaria mortality rates, the Region’s malaria endemic countries except Papua New Guinea have changed their national malaria programme goals from malaria control to malaria elimination. Nonetheless, there remains great variation between countries, and the burden of malaria is still substantial in some. In order to reach the 2015 goals of reducing morbidity and mortality of malaria by 75% compared to 2000, increased access to malaria prevention is required, especially sustainable vector control, as well as universal access to quality-assured diagnostic testing and effective antimalarial treatment. One of the biggest challenges to malaria control and elimination is the emergence of artemisinin resistant malaria. Artemisinins are the key compounds in artemisinin-based combination therapies (ACTs). ACTs are the first-line treatment for uncomplicated falciparum malaria in most endemic countries, and have been central to the remarkable recent success in global malaria prevention and control. While artemisinin resistance containment efforts on the Cambodia-Thailand border have been successful, new foci of resistance are being discovered in other areas of the Greater Mekong Subregion. Currently four countries in the Greater Mekong Subregion are affected: Cambodia, Myanmar Thailand and Viet Nam. This situation necessitates a regional response. The WHO strategic framework Emergency Response to Artemisinin Resistance in the Greater Mekong Subregion, which was launched on World Malaria Day 2013 in Cambodia, outlines existing guidance for artemisinin resistance containment and elimination and describes the areas where action is urgently needed in order to improve the response to artemisinin resistance. The risk of malaria resurgence due to decreasing international funding for prevention and control as well as to resistance to artemisinin and insecticides, demands sustained strategic investments from both donors and the countries in which malaria is endemic. In addition, strengthened surveillance systems are needed to monitor and evaluate the progress and impact of control and elimination measures and to target limited resources appropriately. The capacity of national malaria control programmes needs to be further strengthened to effectively be able to control and eliminate malaria. Moreover, there is a need to promote and support stronger collaboration between malaria and other health programmes and to involve non-health sectors. Sufficient and predictable financing of national malaria control and elimination efforts also must be ensured. The political commitment in the Region for malaria is unprecedented – as expressed in the Declaration of the 7th East Asia Summit on Regional Responses to Malaria Control and Addressing Resistance to Antimalarial Medicines which was signed on 20 November 2012 in Cambodia by heads of states from the Association of Southeast Asian Nations and Australia, China, India, Japan, New Zealand, the Republic of Korea, the Russian Federation and the United States of America – the Region now needs to capitalize on this. Priorities/focus for 2014–2015
In the biennium 2014‒2015, the Secretariat will support malaria endemic countries by developing approaches to strengthening capacity-building for malaria prevention, control and elimination, as well as for strengthening surveillance and identifying threats to malaria control and elimination and new
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CATEGORY 1. COMMUNICABLE DISEASES
opportunities for action. A global technical strategy for malaria control and elimination for the period 2016‒2025 will be developed, with strong regional inputs. The strategy will help to guide countries and implementing partners in sustaining the successes of the past decade and move towards malaria elimination. Furthermore, the Secretariat will update policy and technical guidance on vector control, integrated vector management, quality-assured diagnostic testing and effective antimalarial treatment, as well as on malaria elimination. Priority will be given to the problem of artemisinin resistance in the Greater Mekong Subregion. The Secretariat will continue to coordinate the regional response, supporting advocacy and resource mobilization, engaging in and brokering partnerships including those with researchers and non-health sectors, and providing technical cooperation at regional and country levels. It is of outmost importance that effective malaria control is implemented at all levels, aiming to delay if not prevent further spread of resistance within and beyond the Region. The drug resistance situation will be closely monitored throughout the Region, through active routine surveillance of therapeutic efficacy of national first-line malaria treatments, with the support of the Mekong and Pacific Malaria Drug Resistance Monitoring networks. Sustaining and scaling-up key vector control interventions where required using an integrated vector management strategy will continue to be supported in affected countries. To ensure maximum efficacy of vector control interventions, measures will be implemented to monitor vector resistance to insecticides through the reactivation of the insecticide resistance monitoring network. Addressing the remaining challenge of vivax malaria is a further priority, given the technical difficulty in treating it radically. Based on the new Global Strategic Plan on Plasmodium Vivax Malaria Control and Elimination, countries will be supported to provide the most effective control strategies against vivax, using current as well as new evidence as it becomes available. To support further intensified control and elimination of malaria, national programme capacity will be strengthened, particularly in surveillance and monitoring and evaluation, and avenues of ensuring predictable and sufficient financing will be actively pursued in collaboration with relevant partners. Cross-cutting issues/linkages with other programmes and partners
Expanding the use of quality-assured rapid diagnostic tests for malaria will provide an entry point for improving the management of all causes of fever, notably pneumonia and diarrhoeal diseases, and ensuring their proper treatment. More accurate diagnosis of fevers will help to ensure a more rational and targeted use of medicines, which is important to prevent antimicrobial resistance. Promoting the use of quality-assured pharmaceuticals, including antimalarials as well as effective essential medicine supply management and pharmaco-vigilance systems is a key priority across all disease categories. Strengthening surveillance to more effectively monitor the incidence of malaria and to better utilize available scarce resources will contribute to health systems strengthening. Reducing the malaria burden, which disproportionately affects the poor, improves maternal and child health and contributes to poverty alleviation. Moreover, the malaria work stream entails joint efforts, complementarity and support to relevant organizations in the United Nations system and key partnerships. These include United Nations Children’s Fund (UNICEF); the World Bank and the Asian Development Bank; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Foundation for Innovative New Diagnostics; the Roll Back Malaria Partnership; the Medicines for Malaria Venture; as well as technical and bilateral agencies and major foundations. Outputs to which WPR will contribute
1.3.1
Countries enabled to implement malaria strategic plans, with focus on improved diagnostic testing and treatment, therapeutic efficacy monitoring and surveillance through capacity strengthening Region’s accomplishments at the end of the 2014–2015 biennium
•
All endemic countries have strengthened programmes for malaria control and elimination, so that all countries meet their national targets 5
CATEGORY 1. COMMUNICABLE DISEASES
•
• 1.3.2
All endemic countries have strengthened malaria surveillance, monitoring and evaluation for all programme areas, so that quality therapeutic efficacy studies, insecticide resistance and routine surveillance data are available from endemic countries annually The Emergency Response to Artemisinin Resistance in the Great Mekong Subregion framework has been fully implemented in all 4 GMS countries
Updated policy recommendations, strategic and technical guidelines on vector control, diagnostic testing, antimalarial treatment, integrated management of febrile illness, surveillance, epidemic detection and responses • • All ten endemic countries have national strategic plans updated through malaria programme review All malaria endemic countries have updated guidelines for malaria treatment based on recent high-quality antimalarial drug efficacy results and have adopted integrated vector management strategies for vector control based on the latest insecticide resistance data Regional meeting held to develop input into the global malaria strategy post2015 Establishment of a regional technical advisory group for translating Malaria Policy and Advisory Committee recommendation. Regional Action Plan for Malaria Control and Elimination in the Western Pacific (2010-2015) Asia Pacific Strategy for Strengthening Health Laboratory Services (2010–2015) Progress Towards Achieving the Millennium Development Goals
• •
Relevant Regional Committee Resolutions
WPR/RC60.R5 WPR/RC60.R6 WPR/RC58.R2
NEGLECTED TROPICAL DISEASES
Globally, one billion people are infected with neglected tropical diseases (NTDs), with two billion at risk in tropical and subtropical countries and areas. NTDs are a major cause of disability and loss of productivity among some of the world’s most disadvantaged people. Reducing their health and economic impact is a global priority. The road map for accelerating work to overcome the impact of NTDs sets out a detailed timetable for the control and, where appropriate, elimination and eradication of the 17 specific diseases. Towards this end, partnerships with manufacturers are important in securing access to high quality medicines for control. NTDs are an issue in 28 countries in the WPR. Lymphatic filariasis is endemic in 22 countries with 37 million at risk of infection; the disease is targeted for elimination in the WPR by 2020. Soil-transmitted helminthiasis is widespread in the Region. Preventive chemotherapy for soil-transmitted helminthiasis is required for school aged children, pre-school aged children and women of child bearing age in at least 15 countries. Schistosomiasis is endemic in four countries with an estimated at-risk population of 262 million. The regional target date to achieve 75% national treatment coverage for control of soiltransmitted helminthiasis is 2016. Foodborne trematodiases is a concern in six countries of the Region; though treatment is in place in these countries, it needs scaling-up. Trachoma is endemic in parts of seven countries and four countries are suspected to have endemic foci; the target date for elimination is 2020. Further work is necessary to eliminate leprosy in three countries by 2016. Yaws is endemic in remote areas of three countries; renewed efforts are in place for eradication by 2020. Epidemics of dengue and chikungunya continue to be a problem in many countries. Western Pacific Regional Programme Review Group on NTDs has been established to review the progress towards NTD control or elimination and explore new opportunities, as well as provide specific recommendations for each endemic country to address its key NTDs challenges.
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CATEGORY 1. COMMUNICABLE DISEASES
In meeting the Region’s NTDs control and elimination targets a number of a major challenge need to be addressed. Mobilization of financial and human resources needs to be increased; deep seated high-risk behaviours need to be changed; the quality of preventive chemotherapy medicines, and surveillance of adverse effects need to be ensured and the pharmaco-vigilance on preventive chemotherapy medicines needs improvement. In addition logistical and epidemiological factors that hinder leprosy elimination need to be addressed; mapping and intervention measures in all endemic areas for trachoma need to be undertaken and clear guidelines on verification of elimination for schistosomiasis and other NTDs are required. Development of a feasible integrated vector management strategy to contain the dengue and chikungunya vectors is necessary for the Region. NTDs related sanitation and hygiene issues require forging long lasting collaboration with countries’ education, environment, water and sanitation, animal health departments. Logistical, manpower, and political issues must be overcome to achieve disease elimination in Papua New Guinea. Capacity-building of NTD endemic countries, laboratory quality assurance, data collection and management and surveillance is a vital aspect of the NTD programmes. Providing technical assistance to countries and areas with limited WHO manpower dedicated to NTDs at regional and country level is also challenging. Priorities/focus for 2014–2015
In the biennium 2014‒2015, the Region will focus on increasing access to essential medicines for NTDs. Expanding preventive chemotherapy and innovative and intensified disease management, strengthening national capacity for mass drug administration programme implementation, monitoring and evaluation, disease surveillance and certification/verification of lymphatic filariasis and trachoma elimination will remain a central concern. Water, sanitation and hygiene will be given priority in areas endemic for schistosomiasis and soil-transmitted helminthiases. The other priorities include: advancing the Regional Action Plan for NTDs in the Western Pacific (2012) that was endorsed by the Sixty-third session of the Regional Committee and draft regional plan of action on research in infectious diseases of poverty; progressing towards achieving elimination targets of lymphatic filariasis, schistosomiasis, trachoma, leprosy and yaws; scaling-up school deworming and achieving a coverage of 75% in endemic countries; facilitating the development and implementation of a regional integrated vector management strategy; developing and implementing integrated national action plans on NTDs; and mobilizing resources at the regional level. Cross-cutting issues/linkages with other programmes and partners
The prevention and control of NTDs carry wider benefits for health and development such as increased income, social inclusion, improved employment opportunities and maternal health and birth outcomes. Moreover, NTD work streams entail joint efforts, complementarity and support to related programmes within WHO including malaria, expanded programme on immunization (EPI), and school health as well as relevant organizations in the United Nations system and key partnership programmes in health and non-health sectors such as water and sanitation, education and animal health. Linkage between different disease programmes for morbidity and case management will increase the accessibility of health care to the affected people. Among the different NTD programmes, integration of lymphatic filariasis, soiltransmitted helminthiases, schistosomiasis and other helminth control interventions can maximize benefits and reduce operational costs. Advocacy and mobilization of resources involving donors and financial institutions is an important issue for NTD programmes. Outputs to which WPR will contribute
1.4.1
Implementation and monitoring of the WHO road map for NTDs 2020 facilitated. Region’s accomplishments at the end of the 2014–2015 biennium
•
•
All 28 endemic countries have developed and are implementing a national plan which specifies the control, elimination and eradication of target NTDs in line with the WHO/NTD road map and the regional action plan for NTDs Three countries have developed dossiers for verification of elimination of lymphatic filariasis and blinding trachoma and one country for verification of elimination of schistosomiasis
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CATEGORY 1. COMMUNICABLE DISEASES
•
• 1.4.2
Three countries have conducted a national programme review on soiltransmitted helminthiases and foodborne trematodes, and three countries have implemented leprosy action plans to reach the elimination threshold Six priority countries have implemented sustainable dengue/chikungunya vector control interventions and programmes for behaviour change
Implementation and monitoring of NTDs facilitated by evidence-based technical guidelines and technical support Region’s accomplishments at the end of the 2014–2015 biennium
• •
•
Six countries have adapted WHO recommended norms and standards for NTD Intensified Disease Management into national policies and guidelines Eight countries have adapted global strategies and guidelines towards improved prevention, case detection, case management and control of neglected tropical diseases into national policies and guidelines A regional integrated vector management strategy has been developed
Relevant Regional Committee Resolutions
WPR/RC63.R4 Regional Action Plan for Neglected Tropical Diseases in the Western Pacific Region VACCINE-PREVENTABLE DISEASES
Some 2.5 million children under the age of five years die from vaccine-preventable diseases each year, or more than 6800 child deaths every day. Immunization is one of the most successful and cost-effective public health interventions. Globally, more children than ever before are being immunized. The protection afforded by vaccines prevents more than two million deaths annually. Expanding immunization from a narrow focus on infancy or pregnancy to include other age groups is necessary both to close immunity gaps among older children or adults to achieve regional disease elimination and control goals, and because of the introduction of new vaccines. Up to one fifth of children born each year are hard to reach and are thus at risk for being excluded from immunization programmes. Other challenges include reaching migrant and marginalized populations, strengthening surveillance, and ensuring sustainable financing. Priorities/focus for 2014–2015
In the 2014–2015 biennium the focus will be on implementing and monitoring the Regional Framework for Implementation of the Global Vaccine Action Plan in the WPR by supporting the development of national immunization plans, strengthening national capacity for monitoring immunization programmes and ensuring adequate supplies and financing for immunization programmes. As part of the Regional Framework, efforts will be intensified towards the elimination of measles and the control of hepatitis B, and towards elaboration of the new regional goals for rubella elimination, accelerated Japanese encephalitis control, increasing routine vaccination coverage and evidence-based introduction of new vaccines. Cross-cutting issues/linkages with other programmes and partners
Efforts and deliverables related to work on the prevention and control of vaccine-preventable diseases carry wider benefits for health and development. For example, work related to preventing maternal and neonatal tetanus through promotion of clean deliveries and eliminating harmful cord care practices improves female and maternal health and birth outcomes. Similarly work in promoting institutional deliveries to aid in increasing coverage with hepatitis B birth dose, will improve birth outcomes. Enhancement of surveillance activities in line with the goals of control, elimination and eradication of vaccine-preventable diseases supports efforts to prevent and respond to outbreaks of both vaccinepreventable and non-vaccine preventable diseases. Introduction of new vaccines is done in the context of strengthening comprehensive measures for control of childhood pneumonia and diarrhoea and for cervical cancer.
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CATEGORY 1. COMMUNICABLE DISEASES
Work on vaccine preventable diseases relies on key partnerships with other organizations in the United Nations system, bilateral agencies and major foundations. Outputs to which WPR will contribute
1.5.1.
Implementation and monitoring of the global vaccine action plan as part of the Decade of Vaccines Collaboration strengthened with emphasis on reaching the unvaccinated and under-vaccinated populations Region’s accomplishments at the end of the 2014–2015 biennium
•
One country with immunization coverage <70% (only one country in the Region with immunization coverage <70%) has developed and implemented strategies within their national immunization plans to reach unvaccinated and undervaccinated populations
1.5.2.
Intensified implementation and monitoring of measles and rubella elimination and hepatitis B control strategies facilitated Region’s accomplishments at the end of the 2014–2015 biennium
• 1.5.3.
Six priority countries have conducted supplementary immunization activities to achieve their measles elimination goal
Target product profiles for new vaccines and other immunization-related technologies defined and research priorities to develop vaccines of public health importance and overcome barriers to immunization agreed Region’s accomplishments at the end of the 2014–2015 biennium
•
Vaccine-related demonstration/pilot studies for new vaccine introduction in the region coordinated
Relevant Regional Committee Resolutions
WPR/RC63.R5 Elimination of measles and acceleration of rubella control WPR/RC61.R7 Vaccine-Preventable Diseases: Measles Elimination, Hepatitis B Control, and Poliomyelitis Eradication WPR/RC56.R8 Measles Elimination, Hepatitis B Control and Poliomyelitis Eradication WPR/RC54.R3 Expanded Programme on Immunization: Measles and Hepatitis B
Proposed budget allocation: Category 1. Communicable diseases 2014–2015 (US$) Programme Projected Expenditure 2012–2013 Country Offices HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Total 7 322 000 9 093 000 10 828 000 2 944 000 13 433 000 43 620 000 Regional Office 2 568 000 4 579 000 4 177 000 3 454 000 10 509 000 25 287 000 Total 9 890 000 13 672 000 15 005 000 6 398 000 23 942 000 68 907 000 Proposed PB 2014–2015 Country Offices 7 001 000 10 051 000 8 769 000 5 040 000 14 431 000 45 292 000 Regional Office 3 200 000 3 800 000 4 239 000 2 669 000 12 300 000 26 208 000 Total 10 201 000 13 851 000 13 008 000 7 709 000 26 731 000 71 500 000
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CATEGORY 2. NONCOMMUNICABLE DISEASES
CATEGORY 2. NONCOMMUNICABLE DISEASES Reducing the burden of noncommunicable diseases, including cardiovascular diseases, cancers, chronic lung diseases, diabetes, and mental disorders, as well as disability, violence and injuries, through health promotion and risk reduction, prevention, treatment and monitoring of noncommunicable diseases and their risk factors.
This category covers the four primary noncommunicable diseases (cardiovascular disease, cancers, chronic lung disease and diabetes) and their major risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol), mental disorders and disabilities as well as the consequences of violence, injuries, substance abuse and poor nutrition. NONCOMMUNICABLE DISEASES
The noncommunicable disease (NCD) epidemic is a serious threat to health and development in the WPR. The major NCDs–cardiovascular diseases, diabetes, cancers and chronic respiratory diseases – account for more than 80% of all deaths in the Region and for 50% of all premature deaths (under 70 years of age) in low- and middle-income countries. There are an estimated 430 million smokers in the WPR, or about one third of the world's smokers. The other risk factors for NCDs also abound. Pacific island countries and areas have a very high prevalence of obesity, with adult prevalence as high as 75%. All countries in the Region report a prevalence of over 25% for high blood pressure. The leaders of the 22 Pacific island countries and areas have recognized the NCD crisis in the Pacific and called for a commensurate response. Progress has been made since 2008 in tobacco control and NCD surveillance and most countries have developed NCD policies and plans. However, capacity for multisectoral action, health system strengthening and financial and human resources are areas that need to be scaled up to enhance progress. Many countries also have articulated challenges in prioritizing evidence-based interventions and setting targets in the midst of competing priorities. Accelerated implementation of the WHO Framework Convention on Tobacco Control, the WHO Global Strategy to Reduce Harmful Use of Alcohol, the WHO Global Strategy on Diet, Physical Activity and Health, WHO Set of Recommendations on the Marketing of Food and Non-alcoholic Beverages to Children, the WHO Global Strategy for Infant and Young Child Feeding and work through settings based approaches can significantly contribute to the prevention and control of NCDs. Priorities/focus for 2014–2015
In the biennium 2014–2015 WPR will focus its efforts on tobacco control, salt reduction, promotion of healthy diet, obesity prevention and prevention and management of NCDs in primary care using a package of essential NCD interventions and in strengthening surveillance. Healthy settings, e.g. cities, islands, workplaces and schools will be promoted as a platform for intersectoral action. Strengthening infrastructure for health promotion (e.g. foundations, boards and councils) as well as sustainable financing of health promotion and prevention through tobacco taxes and other sources will be highlighted. The World Health Assembly endorsed set of nine global targets to be achieved by 2025 that will be used to benchmark and motivate action as well as increasing country accountability. Global and regional NCD action plans will be monitored through a limited set of action plan indicators. Cross-cutting issues/linkages with other programmes and partners
Vaccine-preventable diseases such as hepatitis B and human papillomavirus infections are important for cancer prevention. Maternal and fetal nutrition, risk exposures and behaviours during childhood and adolescence can lead to NCDs in adult life and be a major health concern among the elderly. An integrated life-course approach for primary health care provides an opportunity to improve health planning to address the NCD epidemic. For these reasons the NCD team in the Region is working with other WHO departments such as Control of Communicable Diseases, Maternal and Child Health, Ageing. Close collaboration is also needed with Health Services and Systems since health systems based on primary care that support universal health coverage are important in preventing major NCDs and their risk factors NCDs are major health concern among the elderly. WHO will work with United Nations
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CATEGORY 2. NONCOMMUNICABLE DISEASES
agencies, programmes and funds in the Region and also with regional partnerships, such as Association of Southeast Asian Nations (ASEAN) and the Secretariat of the Pacific Community (SPC). Outputs to which WPR will contribute
2.1.1
Development of national multisectoral policies and plans for implementing interventions to prevent and control noncommunicable diseases facilitated Region’s accomplishments at the end of the 2014–2015 biennium
•
Seven countries have established national multisectoral actions plans for the prevention and control of NCDs
2.1.2. High-level priority given to the prevention and control of noncommunicable diseases in national health planning processes and development agendas Region’s accomplishments at the end of the 2014–2015 biennium
• 2.1.3.
Two countries have integrated work on NCDs into their United Nations Development Assistance Framework
Monitoring framework implemented to report on progress in realizing the commitments made in the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the global action plan for the prevention and control of NCDs (2013–2020) Region’s accomplishments at the end of the 2014–2015 biennium
•
Seven countries are reporting on the nine voluntary targets
Relevant Regional Committee Resolutions
WPR/RC62.R2 Expanding and intensifying noncommunicable disease prevention and control WPR/RC60.R4 Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2010–2014) WPR/RC59.R5 Noncommunicable Disease Prevention and Control WPR/RC57.R4 Noncommunicable Disease Prevention and Control WPR/RC55.R7 Tobacco Control WPR/RC54.R8 WHO Framework Convention on Tobacco Control WPR/RC52.R6 Prevention and Control of Tobacco Use WPR/RC51.R5 Prevention and Control of Noncommunicable Diseases MENTAL HEALTH AND SUBSTANCE ABUSE
Mental and substance abuse disorders are among the leading causes of the global burden of disease. About one third of global suicide deaths are reported from the WPR. At least 2% to 3% of the population suffer from severe forms of mental disorders, such as schizophrenia, manic-depressive disorders, and severe depression. Other disabling forms of mental disorders, such as mild and moderate depressive disorders, anxiety disorders, and alcohol abuse, affect a further 5% to 10% of the population. Depressive disorders alone are responsible for 5.73% of the overall disease burden in the Region. Mental disorders affect people of all ages, classes and cultures. At population level, there are a number of factors that may continue to have negative impact on mental health in many countries and areas in the Region: disaster proneness, rapid population ageing, and dramatic changes in social norms and values accompanied with globalization and dramatic socioeconomic development. Mental health is not yet achieved the deserved priority position in the development and health agenda. There exist many barriers to successful implementation of mental health programmes, including, among others, poor awareness of importance of mental health, lack of mental health policy and legislation,
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CATEGORY 2. NONCOMMUNICABLE DISEASES
scarcity of human resources for mental health, and mental health being isolated from health services in general. Priorities/focus for 2014–2015
In the biennium 2014‒2015, the WPR will work with countries and areas to: monitor, analyse and disseminate information on regional trends, consequences and risk factors of suicide and mental disorders; develop national policy, legislation and programmes contributing to global targets and addressing unique challenges in countries and areas; support multidisciplinary and multisectoral programmes to improve the ability of health and social systems in countries and areas to prevent and manage suicide and mental disorders; and to strengthen regional and subregional networks and partnership. A special focus on high impact conditions such as depression is envisioned as a strategic entry point for raising mental health awareness and improving overall mental health services. A regional profile on alcohol prevention and control will be developed. Cross-cutting issues/linkages with other programmes and partners
The mental health programme will work with programmes under Category 4 to promote and support inclusion of mental health components in all work on strengthening of national health policies, strategies and plans; integrated people-centred health services; integrated life-course approach to primary health care including mental health, improvement of access to medicines and health technologies; and strengthening of health systems information and evidence. It is essential to collaborate with programmes under Category 3 to address population mental health needs at key life stages. Outputs to which WPR will contribute
2.2.1
Countries’ capacity to develop and implement national policies and plans in line with the 2013–2020 global mental health action plan strengthened Region’s accomplishments at the end of the 2014–2015 biennium
• 2.2.2
Four countries have developed or updated national mental health policies and plans
Mental health promotion, prevention, treatment and recovery services improved through advocacy, better guidance and tools on integrated mental health services Region’s accomplishments at the end of the 2014–2015 biennium
• 2.2.3
Four countries have functioning programmes for intersectoral mental health promotion and prevention
Expansion and strengthening of country strategies, systems and interventions for disorders due to alcohol and substance use enabled Region’s accomplishments at the end of the 2014–2015 biennium
•
Two countries have developed prevention and treatment strategies, systems and interventions for substance use disorders and associated conditions
Relevant Regional Committee Resolutions
WPR/RC52.R5 Regional Strategy for Mental Health WPR/RC57.R5 Regional Strategy to Reduce Alcohol Related Harm VIOLENCE AND INJURIES
With 1.2 million injuries and violent deaths each year, it is estimated that one person is killed every 30 seconds in the WPR. Road traffic crashes result in more than 337 000 fatalities, making it the leading cause of death in those aged 15–44. Motorcyclists, pedestrians and cyclists are particularly vulnerable and account for 69% of all those killed on the Region’s roads. The magnitude of road trauma is widely variable in the WPR with the risk of dying being 2.5 times higher in low- and middle-income countries
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CATEGORY 2. NONCOMMUNICABLE DISEASES
compared to high-income countries. The United Nations General Assembly (Resolution 64/255) proclaimed the period 2011‒2020 as the Decade of Action for Road Safety with a goal to stabilize and then reduce the forecast level of road traffic fatalities around the world by 2020, saving five million lives. With 27% of global road traffic fatalities, comprehensive action in the WPR will be crucial to achieving the objectives of the Decade of Action. Suicide, interpersonal violence, falls, drowning, burns and poisoning also are significant causes of death. For every person killed, many more are injured and suffer from a range of physical, sexual, reproductive and mental health problems. Priorities/focus for 2014–2015
In the biennium 2014–2015 WPR will focus its efforts on contributing to the implementation of the global plan for the Decade of Action, and a comprehensive, multisectoral systems approach to road safety in the Region, including the monitoring of actions and achievements against the objectives of the Decade. Emphasis also will be placed on building country capacity in the injury and violence prevention workforce for effective responses and preventive intervention. Finally advocacy and technical support will be provided for the development of national policies and programmes for the prevention of violence against women as well as injuries and maltreatment to children. Cross-cutting issues/linkages with other programmes and partners
The Violence and injuries programme (VIP) will work with partners in gender, human rights, and maternal, child and adolescent health to expand evidence-based programmes for the prevention and response to violence against women and children. With child health, the objective will be to align child injury prevention with the wider programme of child survival. In collaboration with health systems, the programme will scale-up technical support for the provision of pre-hospital and definitive trauma care to the injured. Working with the Health Information, Evidence and Research unit (IER), opportunities for strengthening quality of vital registration systems for reporting cases and causes of injury and violence death will be maximized. For road safety, VIP will continue to work closely with Headquarters as well as various partners in the United Nations Road Safety Collaboration. Outputs to which WPR will contribute
2.3.1
Development and implementation multisectoral plans and programmes to prevent injuries, with a focus on achieving the targets set under the Decade of Action for Road Safety (2011‒2020) Region’s accomplishments at the end of the 2014–2015 biennium
• 2.3.2
Three countries will have developed new road safety legislation comprehensively addressing one or more of the 5 key risk factors for road safety.
Countries and partners enabled to develop and implement programmes and plans to prevent child injuries Region’s accomplishments at the end of the 2014–2015 biennium
• 2.3.3
Six countries in WPR will have developed national or provincial policies or programmes to prevent leading cause of child injury.
Development and implementation of policies and programmes to address violence against women, youth and children facilitated Region’s accomplishments at the end of the 2014–2015 biennium
•
20 countries have submitted a complete assessment of national violence prevention status.
Relevant Regional Committee Resolutions
WPR/RC63.R3 Violence and Injury Prevention WPR/RC48.R9 Women, Health and Development
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CATEGORY 2. NONCOMMUNICABLE DISEASES
DISABILITIES AND REHABILITATIONS
Disabilities and Rehabilitation Quality data on disability is limited however evidence indicates that disability prevalence in the WPR is increasing as a result of NCD and ageing populations. WHO estimates that globally 15% of the population have a disability, this correlates to 270 million in the WPR. Disability prevalence is higher in low- and middle- income countries. While most countries in the Region have disability policies and many have ratified the Convention on the Rights of Persons with Disabilities few have developed health or rehabilitation policies that are in line with WHO recommendations or have strong national leadership to achieve this. The health outcomes for people with disability are less than the general population living without a disability, and service gaps and barriers exist for health, rehabilitation and assistive device provision. While health and disability service needs vary people with more significant disabilities often require ongoing services through health and community providers. Rehabilitation is a common part of health services in many countries; however it is often a low priority within the health sector. Rehabilitation sector jurisdiction and authority can be unclear as often responsibility lies across health, welfare and education ministries, while non-government organizations also play significant roles in many countries. This has resulted in limited rehabilitation sector leadership, strategic planning and coordination and makes this a key sectoral issue. Disability, unmet service needs and service effectiveness remain complex to measure, which is a pressing issue for advancement of the sector. While disability definitions and concepts have evolved, the lack of quality, comparable data and information about people with a disability and their service needs is a major deficiency. Even basic disability prevalence data can be unavailable, and where it exists it varies enormously depending upon measurement approaches used. Building better understandings of the situation of people with a disability in the Region and current service systems is a clear regional priority. Prevention of Blindness WHO estimates the number of people with visual impairment in the WPR to be over 90 million (76 million in China), with over 10 million blind (8 million in China) and 80 million having low vision (67 million in China). Those over the age of 50 are far more likely to be affected, because of the links between ageing and vision loss. Epidemiological survey data exists for some low- and middle-income countries in Asia such as Cambodia, China Malaysia, Mongolia, Philippines, and Viet Nam, , and Pacific island countries such as Fiji, Papua New Guinea, Tonga and Vanuatu. However, most surveys report prevalence of blindness and visual impairment for a particular region or district only, rather than providing reliable national data. Prevalence of blindness tends to differ substantially between provinces or districts of one country, and vary according to income levels, and rural or urban contexts. Globally, the principal causes of visual impairment are uncorrected refractive error and cataract, 43% and 33% respectively. For blindness, the key causes are cataract 51%, glaucoma 8%, and age-related macular degeneration 5%. Uncorrected refractive error is a major cause of visual impairment through Asia, and a very high prevalence of myopia (short sightedness) exists in China. Refraction personnel (such as optometrists), services and the provision of affordable spectacles and contact lenses are key to managing vision loss from refractive error. Cataract remains the primary cause of visual impairment and blindness in the Region, regardless of geography. Countries with an equipped workforce and facilities at the secondary and tertiary level are in the best position to treat cataract with surgery. Vision loss from diabetes is considered a new and growing epidemic in eye care. Diabetic retinopathy already ranks among the leading causes of vision impairment in Pacific island countries. While the prevalence of diabetes in most Asian countries is between 5 and 10% (9% in China), some Pacific island countries report prevalence as high as 30%, with patients in young age brackets rising.
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CATEGORY 2. NONCOMMUNICABLE DISEASES
The causes of visual impairment and blindness are closely related to social determinants and poverty and around 90% of the world’s blind and visual impaired live in developing countries. Within all countries, disadvantaged and vulnerable communities are the worst affected, which reflects strong linkages to poverty, education and access to housing, water and sanitation. An estimated 80% of blindness and visual impairment is avoidable, or can be treated or prevented. Yet, efforts to prevent blindness are complicated by varying capacity and readiness within national health systems, and economies at very different stages of development. A draft regional action plan for the prevention of avoidable visual impairment and blindness 2014-2019 was recently developed, in line with the global action plan covering the same time period. Main priorities are: the need for generating evidence on the magnitude and causes of visual impairment and eye care services and using it to advocate greater political and financial commitment; development and implementation of integrated national eye heath policies, plans and programmes to enhance universal eye health; and multisectoral engagement and effective partnerships to strengthen eye health. Priorities/focus for 2014–2015
Disabilities and Rehabilitation In 2014–2015 biennium, WPR will focus support on strengthening rehabilitation through building national leadership, sectoral analysis and development of national strategies and actions plans. Attention to assistive device provision and community-based rehabilitation will continue, particularly in the Pacific. Building understanding and initiatives to increase access and inclusion to health services for people with disability will increase. A regional profile on disability and rehabilitation will be developed. Prevention of Blindness In the biennium 2014–2015 WPR will focus its efforts on the provision of support to countries to develop, implement and monitor national eye health plans, including the integration with other health services, such as NCDs. The new regional action plan for the prevention of avoidable visual impairment and blindness 2014–2019 defines eye health indicators. Another priority will be to support countries to collect information on these indicators within national health information systems. Cross-cutting issues/linkages with other programmes and partners
Disability is a cross-cutting issue and multiple linkages are occurring with health systems, particularly in areas of health workforce, heath services, and in equity and rights issues. These are also being developed with key communicable diseases and with mental health and NCDs. An integrated life-course approach to primary health care will be an opportunity to highlight disability and rehabilitation at the community level. Eye health programmes should be well integrated within the health system at all levels, especially in resource poor settings. This refers to governance (national eye health plans integrated into national health plans), financing (eye health funds identified within health budgets), human resources (eye health staff trained in eye care), disease control (e.g. to ensure that all people with diabetes receive periodic eye examinations) and monitoring (eye health indicator data collected within health information systems). Collaborative efforts within the context of health promoting school will be pursued. Outputs to which WPR will contribute
2.4.1. Implementation of the recommendations of the World report on disability and the Highlevel Meeting of the General Assembly on Disability and Development Region’s accomplishments at the end of the 2014–2015 biennium
•
10 countries with rehabilitation action plans and strategies in line with WHO guidelines and the Convention on the Rights of Persons with Disabilities
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CATEGORY 2. NONCOMMUNICABLE DISEASES
2.4.2. Countries are able to strengthen the provision of services to reduce disability due to visual impairment and hearing loss through more effective policies and integrated services Region’s accomplishments at the end of the 2014–2015 biennium
•
15 countries in the Region implement eye health-promoting policies and services that are in line with WHO recommendations
Relevant Regional Committee Resolutions
WPR/RC31.R20 Regional Programme for Disability Prevention and Rehabilitation NUTRITION
The double burden of malnutrition (undernutrition and obesity) is one of the leading underlying causes of death and disability globally. Hunger, severe food and nutrition insecurity, unacceptably high levels of low-birth-weight, stunting and anaemia undermine health and development in many countries. In the WPR up to 20% of newborns are low-birth-weight, 45% of children under five years of age are stunted, 35% are underweight and nearly a quarter of pre-school children and 30.7% of pregnant women are anaemic. Only 29% of infants below six months are exclusively breastfeeding. While undernutrition remains high, obesity, especially in the Pacific island countries has surged to over 70% in among adults in some countries and to 20 % of children between 13 and 15. Infections among children, including helminthiasis can induce malnutrition, including anaemia and also lead to stunting and impaired childhood development. Recurrent sickness and diarrhoea among infants who are not breastfed result in malnutrition and eventually impacts on normal growth and development. Tuberculosis among young people and adults is linked to poor nutrition. On the other hand, dietary patterns are shifting from traditional diets to diets in which predominantly processed foods are consumed. These foods are nutrient-poor and rich in saturated fats, sugar and salt. As markets emerge, aggressive marketing of infant formula and unhealthy foods and beverages for children has increased. Legal and regulatory protections vary between countries and products within the Region. Even in countries with relevant legal and regulatory systems, enforcement is weak. Similarly, few countries have sufficient legislation and regulation to support food fortification. Knowledge gaps in optimal diets, including complementary feeding, and lack of national nutrition guidelines hamper evidence-based policy-making in many countries. Micronutrients are often not provided as government-funded commodities. Surveillance for key nutrition indicators is generally poor or nonexistent. Action has not been strategic, extensive and well-enough resourced to reach all sectors of society with these effective interventions. Priorities/focus for 2014–2015
In the biennium 2014–2015 WPR will focus on evidence-based interventions across the life-course to address the double burden including education of mothers, exclusive breastfeeding in the first six months, continued breastfeeding to at least two years, appropriate complementary feeding, micronutrient supplementation and food fortification and improvements in diet, supported through comprehensive policies to address issues related to sustainable food systems, rational land use, taxation of harmful food products among others are also needed. Countries need to engage and coordinate new stakeholders, combining multisectoral and intersectoral approaches, including engaging private sector to address the complexity of issues related to the reduction of the double burden of disease. Cross-cutting issues/linkages with other programmes and partners
The nutrition programme will work with programmes on reproductive, maternal, newborn and child health, health promotion and the other NCD programmes to expand nutrition services for women, pregnant women, mothers and children and to implement regional maternal, infant and young child nutrition strategies. In the context of climate change and food security, collaboration with environmental health and other international agencies will be sought. Joint efforts will be undertaken with the UNICEF, the Food and Agriculture Organization of the United Nations (FAO), World Food Programme (WFP), and other international organizations to support these efforts.
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CATEGORY 2. NONCOMMUNICABLE DISEASES
Outputs to which WPR will contribute
2.5.1. Countries enabled to develop, implement and monitor action plans based on the maternal, infant and young child nutrition comprehensive implementation plan Region’s accomplishments at the end of the 2014–2015 biennium
• •
Regional Action Plan (RAP) to reduce the double burden of malnutrition adapted by countries At least seven countries in the WPR have developed and monitor a national plan of action on maternal, infant and young child nutrition, consistent with the comprehensive implementation plan on maternal, infant and young child nutrition
2.5.2.
Norms and standards on maternal, infant and young child nutrition, population dietary goals, and breastfeeding updated, and policy options for effective nutrition actions for stunting, wasting and anaemia developed Region’s accomplishments at the end of the 2014–2015 biennium
•
At least seven countries have adopted guidelines on effective nutrition actions for stunting, wasting and anaemia.
Relevant Regional Committee Resolutions
WPR/RC63.R2 Scaling-Up Nutrition in the Western Pacific Region WPR/RC58.R2 Progress Towards Achieving the Millennium Development Goals WPR/RC50.R10 Infant and Young Child Nutrition and Implementation of the International Code of Marketing of Breast-Milk Substitutes WPR/RC48.R8 Infant and Young Child Nutrition and Implementation of the International Code of Marketing of Breast-Milk Substitutes WPR/RC46.R13 Infant and Young Child Nutrition WPR/RC44.R6 Nutrition in the Western Pacific Region Proposed budget allocation: Category 2. Noncommunicable diseases 2014–2015 (US$) Programme Projected Expenditure 2012–2013 Country Offices Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitations Nutrition Total 15 336 000 1 476 000 2 385 000 585 000 2 783 000 22 565 000 Regional Office 12 044 000 2 360 000 663 000 2 012 000 1 044 000 18 123 000 Total 27 380 000 3 836 000 3 048 000 2 597 000 3 827 000 40 688 000 Proposed PB 2014–2015 Country Offices 13 434 000 2 829 000 2 797 000 1 498 000 3 456 000 24 014 000 Regional Office 10 866 000 2 050 000 1 665 000 2 505 000 1 000 000 18 086 000 Total 24 300 000 4 879 000 4 462 000 4 003 000 4 456 000 42 100 000
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE Promoting good health at key stages of life, taking into account the need to address social determinants of health (the societal conditions in which people are born, grow, live, work and age) and gender, equity and human rights.
This category is by its nature cross-cutting. It addresses population health needs with a special focus on key stages in life bringing together strategies for promoting health and well-being from conception to old age. It is concerned with health as an outcome of all policies and with health in relation to the environment, and includes leadership and capacity-building on the social determinants of health, gender and human rights, and mainstreaming of these programme areas across the Organization. REPRODUCTIVE, MATERNAL, NEWBORN, CHILD AND ADOLESCENT HEALTH
There is a high-level commitment to work in this area as it contributes to the achievement of Millennium Development Goals 4 (Reduce child mortality) and 5 (Improve maternal health). The biennium 2014– 2015 is crucial for the achievement of those goals. In the WPR, approximately 12 000 women died from pregnancy- or childbirth-related events in 2010. In the same year, 384 000 children died before their fifth birthday, of those, 200 000 (54 % of children’s death under five years old) died during their first four weeks of life. It is equivalent to a newborn dying every two minutes in the Region. This is unacceptable on any terms, but doubly unacceptable when the knowledge and tools exist to save 45 000 of these newborns annually. Effective interventions exist for improving health and reducing maternal, neonatal and child mortality and morbidity. The challenges are to implement and expand those interventions, making them accessible for all during pregnancy, childbirth and the early years of life, and ensure the quality of care provided. For mothers and newborns, the first 24 hours are critical because half of maternal deaths, one third of newborn deaths and one third of stillbirths, as well as most of the complications that can lead to the death of the mother or the newborn, occur in the 24 hours around delivery. It also is within this same period that the most effective interventions to save the lives of mothers and newborns can be delivered: management of labour and delivery by skilled birth attendants (SBA), and early essential newborn care. In the Region, the Joint WHO/UNICEF Regional Child Survival Strategy (2006), the Joint WHO/UNICEF Action Plan Towards Healthy Newborn Infants in the Western Pacific (2014–2020), and the Regional Framework on Reproductive Health for the Western Pacific (2013) provide unified directions to guide countries in accelerating the scaling-up of effective interventions in reproductive, maternal, newborn health. These documents identified Cambodia, China, the Lao People’s Democratic Republic, the Pacific islands, Papua New Guinea, the Philippines, and Viet Nam as priority countries, as more than 95% of maternal and child deaths in the Region occur in these countries. Priorities/focus for 2014–2015
For women in pregnancy, childbirth, or postpartum, newborns and children SBA coverage is 91% in the Region; there are, however, major disparities between and within countries and areas. To improve equity between and within countries and areas, access to SBAs should be ensured. At the same time, the quality of intrapartum and postpartum care provided by SBAs needs to be improved. During the 2014–2015 biennium, the programme will continue to work on promoting effective interventions to reduce maternal, newborn and child mortality in priority countries, and to reduce disparities between the poorest and wealthiest women and children between and within countries and areas, with particular focus given to access to SBAs and the quality of intrapartum and postpartum care they provide.
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
For adolescents There are 270 million adolescents, young people between the ages of 10–19 years, in the Region which constitutes 15% of the Region’s total population (2010). Adolescence is a period when physical, biological and psychological changes occur. Adolescent girls are prone to anaemia and mental health problems. Experimentation leads to risky behaviours like pregnancy and substance abuse, including alcohol, tobacco and psychoactive drugs. Risk-taking leads to road traffic accidents and drowning which are the predominant causes of adolescent deaths in the Region. In some countries, reproductive health services including contraception exist for married couples, while the system excludes adolescents. In the Region, neither the reproductive health needs nor health risk behaviours among adolescents has been analysed thoroughly. Therefore, to improve adolescent health, work in the biennium 2014–2015 will focus on identifying effective interventions though comprehensive assessments of health-related policies and laws covering adolescents and adolescent risk behaviour. For women who need reproductive health services Family planning and safe abortion are critical health services to improve reproductive health and to reduce maternal mortality and morbidity. However, with regards to abortion, the quality of data and analysis is rarely sufficient or linked to policy/programmatic actions in the Region’s priority countries. With regards to family planning, the poor quality of counselling has been identified as a factor for discontinuation of modern contraceptive methods. Therefore, in the 2014–2015 biennium, work will focus on conducting assessments that will support policy/programmatic action and supporting countries to eliminate unsafe abortion and improving family planning counselling. Cross-cutting issues/linkages with other programmes and partners
The work in the maternal, newborn, child and adolescent health area has linkages with other WPR programmes, such as those on HIV/AIDS, nutrition, NCDs, vaccines, violence and injury. An integrated life-course approach to primary health care will be pursued to strengthen health planning at the primary level and link this to community resources. In continuing WHO’s convening role, the work of maternal, newborn, child and adolescent programme in the WPR will be undertaken in collaboration with academic and research institutions, development partners, civil society organizations (CSO), and other stakeholders at global, regional, and country levels in order to ensure complementarity and to accelerate regional actions in the final push towards achieving Millennium Development Goals (MDGs) 4 and 5. Within this context work will be undertaken in line with the following global initiatives and partnerships: The Secretary-General’s Global Strategy on Women's and Children's Health and its related commissions and groups (United Nations Commission on Information Accountability for Women’s and Children’s Health, United Nations Commission on Lifesaving Commodities for Women and Children; and Independent Expert Review Group); Every Newborn - An Action Plan to End Preventable Deaths; A Promise Renewed, and A Call to Action-Child Survival; and Health 4+ (UNAIDS, UNFPA, UNICEF, United Nations Women and the World Bank). Outputs to which WPR will contribute
3.1.1.
Further expansion enabled of access to and quality of effective interventions from prepregnancy to postpartum focusing on the 24-hour period around childbirth Region’s accomplishments at the end of the 2014–2015 biennium
• •
At least seven countries have adapted the Action Plan for Healthy Newborns into national plans. At least seven countries have adapted clinical guidelines and guidelines on monitoring, including maternal death surveillance and response, and perinatal death reviews; and improved information system for the intrapartum and postpartum period and provide support for their implementation in countries.
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
3.1.2
Countries’ capacity strengthened to expand high quality interventions to improve child health and early child development and end preventable child deaths, including from pneumonia and diarrhoea Region’s accomplishments at the end of the 2014–2015 biennium
•
• 3.1.3.
At least seven countries have reviewed their child health programmes and made adjustments to expand effective integrated interventions to improve child health and early child development and ending preventable child deaths facilitated; implementation and monitoring at regional and country level supported. Operational research in one country to improve monitoring, mentoring and supervision.
Countries enabled to implement and monitor effective interventions to cover the unmet needs in sexual and reproductive health and to reduce adolescent risk behaviour Region’s accomplishments at the end of the 2014–2015 biennium
• • • 3.1.4.
At least one country has conducted an assessment of unintended pregnancies and induced abortion. At least six countries have developed strategic priority setting and coordination of H4+. At least
Research undertaken, and evidence generated and synthesized to design key interventions in reproductive, maternal, newborn, child and adolescent health, and other conditions and issues linked to it Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Supported the strengthening of research capacity in three countries, including facilitating engagement and support from WHO collaborating centres and national institutions; regional research priorities identified and research supported Planned and facilitated the conduct, sharing and use of results, especially for multicountry research work; a regional database maintained and updated
Relevant Regional Committee Resolutions
WPR/RC58.R2 Progress Towards Achieving the Millennium Development Goals WPR/RC56.R5 Child Health WPR/RC54.R9 Child Health AGEING AND HEALTH
Population ageing is a key public health challenge confronting countries and areas in the WPR. This shift is the result of both declining fertility and longer life expectancy. Countries in the Region are at different stages of the demographic transition, ranging from Japan, the world's most "silver" society, to countries in which the majority of the population is young, such as Cambodia, Papua New Guinea and the Philippines. However, across the Region, the proportion of people aged 60 years and above is growing faster than any other age group. The increase is especially rapid in low- and middle-income countries. While population ageing is inevitable, its relative speed in low- and middle-income countries in the Region significantly narrows the window of time available for them to prepare to respond to its social, economic and public health implications. Longer life expectancies reflect successful public health and development policies, but they also pose challenges to societies and health systems as they struggle to maximize the health, functional capacity, social participation and security of older people.
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
There is no single way to deal with the health implications of population ageing. Policies and actions are needed on a range of issues. Ageing cuts across the different dimensions of health systems, with important policy implications for leadership and governance, service delivery, health financing, health workforce, essential medicine and technologies and health information. Strengthening health systems to provide older persons with equitable access to priority services is thus an important part of the universal coverage agenda in developed and developing countries. Countries need to be aware of different policy options, learn from each other and build on best practices on how to ensure healthy ageing across the life-course and respond to the health needs of older people. Priorities/focus for 2014–2015
The WHO Regional Office for the Western Pacific is strengthening its response to ageing and health. It has developed a regional framework for action on ageing and health, based on analysis of the health of older people and policies on ageing and health in selected countries in the Region. The framework is intended to form a basis for discussions in and among countries and areas on adequately responding to the health implications of population ageing in the WPR. In the biennium 2014–2015 WPR will focus its efforts on accelerating awareness, stimulating policy dialogue, providing technical support and strengthening partnerships on ageing and health. These activities will be focused around the four pillars of the regional framework for action, namely: foster an age-friendly environment through action across sectors; promote healthy ageing across the life-course and prevent functional decline and disease among older people; reorient health systems to respond to the needs of older people and strengthen the evidence-base on ageing and health. Cross-cutting issues/linkages with other programmes and partners
Work on ageing and health is expected to involve strong links with programmes on NCDs, health promotion, disabilities, mental health, and all health systems areas. A focus on equity, gender, human rights and the social determinants of health will be key to this work. Outputs to which WPR will contribute
3.2.1
Countries enabled to develop policies and strategies that foster healthy and active ageing, and improve access to, and coordination of, chronic, long-term and palliative care Region’s accomplishments at the end of the 2014–2015 biennium
•
• 3.2.2
At least four countries will have undertaken technical collaboration with WHO for the development of national policies to promote healthy ageing and reorient health systems to meet the health needs of older people At least two countries will have been supported to monitor trends on ageing and health, including through documentation and sharing of experiences
Technical guidance and innovations that identify and address the needs of older people for improved health care Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Input will have been provided into at least two technical guidelines and innovations by collating and sharing regional experiences, good practices and lessons learnt on addressing the health needs of older people At least one technical guideline will have been adapted for regional use to promote universal coverage through age-friendly health systems and meet the health needs of older people and their access to care ---
Relevant Regional Committee Resolutions
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
GENDER, EQUITY AND HUMAN RIGHTS MAINSTREAMING
Evidence suggests that the impressive health gains achieved over recent decades are unequally distributed and have largely failed to reach the poor and other marginalized or socially excluded groups. Persistent and growing inequalities in health are increasingly evident, both between and within countries. Effectively reducing health equities can ensure improved outcomes for public health programmes, while also promoting social justice and the human right to health. Reducing health inequities requires a range of strategies, tailored to the needs of the specific situation. Gender is a significant determinant of health. Because of their biological differences as well as their distinct gender roles and relations, significant gender-based differences exist between men and women with regard to health risks, access to services and outcomes. Although precise data are lacking, evidence suggests that gender-based violence against women, which violates women's human rights, imposes a significant health burden in several countries across the Region. Addressing gender inequalities can strengthen programme planning and implementation, reducing delay, improving diagnosis, and improving access to services, as well as adherence and treatment outcomes. Gender mainstreaming is a strategy for promoting gender equality. It involves changing policies and activities, as needed, to ensure that the goal of gender equality becomes central. The right to the highest attainable standard of physical and mental health, or the right to health, is enshrined in the WHO Constitution. Human rights violations can have serious health consequences. Depending on how they are designed or implemented, health policies and programmes can either promote or violate human rights. At the same time, taking steps to respect, protect and fulfil human rights can reduce ill-health or vulnerability to ill-health. WHO advocates a coherent approach to gender, equity and human rights mainstreaming in health, building on the links between the three areas. Mainstreaming involves two aspects: programmatic and institutional. Mainstreaming within the Organization will include effective integration of gender, equity and human rights in the analysis and actions of programmes, and putting in place institutional and accountability mechanisms to ensure sustainability. Institutional mainstreaming enable stronger progress in programmatic mainstreaming, and supports countries in their realization of gender equality, health equity and the right to health. Collaboration with countries and areas will also encompass these dimensions. Priorities/focus for 2014–2015
Capacity in countries and areas and technical programmes in these areas is still weak. WHO supports countries and areas and programmes in building their capacity to design and implement health policies and programmes that enhance health equity and integrate pro-poor, gender-responsive, and human rightsbased approaches. In the biennium 2014–2015 WPR will focus its efforts on improving the awareness, skills and capacity of technical programmes and countries on equity, gender and human rights issues in health and developing, disseminating and promoting the use of technical tools and resources to support this work. Implementation support will be provided to technical programmes and countries to address equity, gender and human rights in their policies, programmes and actions. Capacity will be strengthened on equity analysis, monitoring and measurement, as well as collection, analysis and use of health information that is disaggregated by relevant social stratifiers, through equity-focused analysis of selected national surveys and datasets and the documentation of good practices and lessons learnt on gender, equity and human rights-based approaches in health. Cross-cutting issues/linkages with other programmes and partners
Work on gender, equity and human rights is a cross-cutting area expected to involve strong links with programmes across the Organization. Strong alignment with the work on social determinants of health and other cross-cutting issues also will be important. Increasing interest and demand for support is observed across countries and areas and programmes. Linkages with these will be made using windows of opportunity as they arise.
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
Outputs to which WPR will contribute
3.3.1
Gender, equity and human rights are incorporated in routine strategic and operational planning and monitoring of WHO programmes Region’s accomplishments at the end of the 2014–2015 biennium
•
Technical collaboration will have been undertaken with at least four programmes or country offices to mainstream a focus on gender, equity and/or human rights into their work.
Outputs to which WPR will contribute
3.3.2
Countries’ capacity strengthened to integrate and monitor gender, equity and human rights in their health policies Region’s accomplishments at the end of the 2014–2015 biennium
•
At least four countries will have undertaken technical collaboration with WHO to mainstream a focus on gender, equity and/or human rights into their health policies, programmes or activities. --
Relevant Regional Committee Resolutions
SOCIAL DETERMINANTS OF HEALTH
The bulk of the global burden of disease and the major causes of health inequities arise from the social determinants of health, or the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The WHO Commission on Social Determinants of Health observed that, although health inequities are increasing both within and between countries, they are not inevitable, but rather the result of policy failures. The Commission made three main recommendations on ways to reduce health inequities by acting on the social determinants of health: improve daily living conditions; tackle the inequitable distribution of power, money and resources; and measure and understand the problem and assess the impact of action. The Rio Political Declaration on Social Determinants of Health emphasizes action around five key themes: adopt better governance for health and development; promote participation in policy-making and implementation; further reorient the health sector towards reducing health inequities; strengthen global governance and collaboration; and monitor progress and increase accountability. Regional trends such as the steady rise in the burden of NCDs, population ageing and globalization have increased the relevance of acting on the social determinants of health and reducing health inequities through a health-in-all-policies approach. In particular, increasing interest is seen in the Pacific under the healthy islands vision, following the declaration of a NCD crisis there. Priorities/focus for 2014–2015
The WHO Western Pacific Regional Office provides support to strengthen national capacities to address the social determinants of health, and to develop and implement policies and programmes – both within health and across other sectors – to reduce health inequities. In the biennium 2014‒2015, the Secretariat will continue its work to reduce health inequities through policies and action on the social health determinants of health, across the five themes of the Rio Political Declaration. It will develop and disseminate tools to support implementation of health-in-all-policies and strengthen capacity in countries and areas to act on the social determinants of health. Cross-cutting issues/linkages with other programmes and partners
Work on the social determinants of health potentially links with all WHO areas of work. In particular, there are increasing links with the work in health promotion (following the 8th Global Conference on Health Promotion, with the theme health-in-all-policies) as well as in noncommunicable diseases,
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
following the emphasis on developing multisectoral plans of action on NCD prevention and control, and in national health policies, strategies and plans. Windows of opportunity to link with other programmes will be used as they arise. Outputs to which WPR will contribute
3.4.1
Increased country capacity to implement a health-in-all-policies approach, intersectoral action and social participation to address the social determinants of health Region’s accomplishments at the end of the 2014–2015 biennium
•
• 3.4.2
At least three countries will have undertaken technical collaboration with WHO to act on the social determinants of health and reduce health inequities through a health-in-all-policies approach Capacity will have been strengthened in at least two countries to promote appropriate policies and strategies on the social determinants of health
Effective guidance to countries to mainstream social determinants of health in all WHO programmes Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Input will have been provided into at least two technical guidelines by documenting and disseminating regional experiences, good practices and lessons learnt on addressing the social determinants of health or implementing health-inall-policies approaches At least one technical guideline will have been adapted for regional use to promote action on the social determinants of health or implementation of healthin-all-policies approaches --
Relevant Regional Committee Resolutions
HEALTH AND THE ENVIRONMENT
Environmental determinants of health (which include occupational determinants) contribute significantly to the burden of disease in the Region. In 2006, an estimated 2.7 million deaths or one quarter of the total deaths were attributable to environmental and occupational health risks. Those mainly affected were poor women and children who live and work in polluted and fragile ecosystems and whose health is at risk from diverse factors such as chemicals, radiation, lack of safe water and sanitation, air pollution and climate change. Some of these environmental risks affect the health and safety of people beyond national borders, requiring regional cooperation among countries and areas in the Region. Many countries and areas, however, have limited resources and capacity in environmental and occupational health risk assessment and management to develop and implement national and local action plans and to provide input to international agreements on health and the environment. Also, in many countries and areas, multisectoral coordination to reduce environmental and occupational health risks is not always effective. Priorities/Focus for 2014–2015
Work in 2014‒2015 will aim to further increase the recognition of the interaction between human health and the environment. In particular, the emphasis will be on how public health is affected by policies in sectors outside health such as transport, energy, urban planning, food systems and labour (through occupational health) as these affect the physical environment. WHO will work with countries on tackling a broad range of risk factors and underlying drivers of environmental health. Within this context there will be a strong focus on strengthening capacities of countries to implement international environmental agreements, undertake environmental health risk assessment and communication, strengthen the capacity of national health authorities to engage with other sectors towards achievement of the goals of their national environmental health action plans.
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
Water and sanitation will be a top priority. Other specific technical areas include related to chemical safety (especially asbestos), indoor and outdoor air pollution, water safety and availability, waste and non-ionizing radiation through more effective and systematic intersectoral collaboration, in particular, between the health and environment sectors at the country level. Finally the programme will work to enhance intercountry cooperation to share solutions to common environmental health problems and to harmonize policies to address trans-boundary and global environmental health issues. High level advocacy will be pursued through the Regional Forum on Environment and Health as a platform for dialogue and priority setting for environmental health in Asia and the Pacific. The vision is for the Ministers of environment and health to strategically align their work in thematic areas such as energy, transportation, urban settings and food systems. Cross-cutting issues/linkages with other programmes and partners
The health and the environment programme will work programmes on maternal and children health to address environmental health risks that threaten children and mothers health, especially exposure to endocrine disrupting chemicals, air pollution and unsafe water and unhygienic environments. Working with food safety and nutrition action will be taken to address unsafe and contaminated foods and chemical substances; and to provide technical support in environmental and food-related emergencies during epidemics. In collaboration with the NCD programme efforts will be undertaken to address the environmental and occupational determinants of NCDs in particular cancer. Finally, linking with the communicable disease programme actions will be undertaken to improve infection control and the management of healthcare waste. The health and environment programme will maintain cooperation with specific partnerships and other organizations in the United Nations system, strengthening its collaboration with UNICEF on monitoring of water and sanitation as a member of United Nations Water; working with United Nations Habitat on urban environmental health issues and will continue to participate in the Inter-Organization Programme for the Sound Management of Chemicals and coordinate activities with other WHO programmes having chemical safety components, e.g. food safety, occupational health, control of tropical diseases, and with other specialist agencies such as the International Agency for Research on Cancer (IARC). The programme will represent health within the overall United Nation’s regional response to climate change under the United Nations Framework Convention on Climate Change. Outputs to which WPR will contribute:
3.5.1.
Country capacity strengthened to assess health risks, develop and implement policies, strategies or regulations for the prevention, mitigation and management of the health impacts of environmental risks Region’s accomplishments at the end of the 2014–2015 biennium
• • • •
Developed a draft regional strategy/action plan on environmental and occupational health. 12 countries would have introduced Water Safety Plans (WSP) to improve risk management of drinking water in urban and rural areas. At least 11 countries would have undertaken the Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS). All Member States in the WPR would have reviewed their progress in achieving Millennium Development Goal (MDG) 7 targets on drinking water and sanitation as reported in the Global Joint Monitoring Programme (JMP).
3.5.2.
Norms, standards and guidelines to define environmental and occupational health risks and benefits associated with air quality, chemicals, water and sanitation, radiation, nanotechnologies, and climate change Region’s accomplishments at the end of the 2014–2015 biennium
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CATEGORY 3. PROMOTING HEALTH THROUGH THE LIFE-COURSE
• •
•
A regional report on the status of air quality of Member States in WPR and a synthesis report on climate change and health are produced. At least one regional training and capacity-building on environmental and occupational health risks and benefits associated with air quality, or water and sanitation, or climate change will be conducted. At least two countries are supported to participate in regional training and capacity building programmes on environmental and sustainable urban transport (ESHUT), occupational health including elimination of asbestos related diseases and climate change.
3.5.3.
Public health issues incorporated in multilateral agreements and conventions on the environment and sustainable development Region’s accomplishments at the end of the 2014–2015 biennium
• •
Developed workplans and implemented activities of the Regional Forum on Environment and Health in South-East and East Asian Countries Publication of relevant regional reports on environmental health and the priority sectors in the Region.
Regional Committee Meeting Resolutions
WPR/RC56.R7 Environmental health WPR/RC59.R7 Protecting health from the effects of climate change Proposed budget allocation: Category 3. Promoting health through the life-course 2014–2015 (US$) Programme Projected Expenditure 2012–2013 Country Offices Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity and human rights mainstreaming Social determinants of health Health and the environment Total 7 599 000 244 000 113 000 330 000 6 754 000 15 040 000 Regional Office 2 937 000 52 000 107 000 1 185 000 1 848 000 6 129 000 Total 10 536 000 296 000 220 000 1 515 000 8 602 000 21 169 000 Proposed PB 2014–2015 Country Offices 9 900 000 115 000 535 000 53 000 5 600 000 16 203 000 Regional Office 2 200 000 100 000 100 000 897 000 2 100 000 5 397 000 Total 12 100 000 215 000 635 000 950 000 7 700 000 21 600 000
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CATEGORY 4. HEALTH SYSTEMS
CATEGORY 4. HEALTH SYSTEMS Health systems based on primary health care, supporting universal health coverage
This category covers the work on strengthening of national health policies, strategies and plans; integrated people-centred health services; improvement of access to medicines and health technologies; and strengthening of health systems information and evidence. NATIONAL HEALTH POLICIES, STRATEGIES AND PLANS
While significant economic progress has been made in many of the countries in the Region, this has not necessarily translated into improved health status of their populations. Several countries are not on track towards achieving the MDGs by 2015. Large population groups are still without quality services, are unable to afford services or becoming impoverished because of paying for health services; subnational inequities have been rising rapidly in most countries. Furthermore rapid demographic and ecological transitions are leading to an acceleration of NCDs for which most health systems are as yet not adequately prepared. Both human and financial resources are lacking, especially outside of the major urban areas. The private sector is rapidly developing albeit in the absence of appropriate regulatory and governance frameworks. Investment in health from public sources is still low in most countries. This results in private out-of-pocket payment for health contributing to a significant part of national health spending. In the meantime, available resources for health have not been used efficiently. Addressing those challenges, most countries have established the vision of universal health coverage. Policies, strategies and plans need to be developed, updated and operationalized to ensure that access to good quality health services is improved, while at the same time providing financial protection for all. Priorities/focus for 2014–2015
In the biennium 2014‒2015, the Secretariat will first and foremost support countries to facilitate policy dialogue towards the operationalization of universal health care, through integration of services across the continuum of care, based on the principles of primary health care and health equity. Countries will be assisted with the assessment, review and renewal of their national, and in a number of cases subnational, health sector plans for the period 2015–2020 and beyond, engaging the main players in health systems strengthening at the national level, as well as many stakeholders outside the health sector. Such plans will ensure the appropriate harmonization of the different health systems components systems (i.e. legislation and regulation, human resources, health information, health technologies, service delivery and health financing) with priority disease programmes as well as addressing the social determinants of health. Health systems strengthening and capacity-building will be key areas of technical support provided by the Secretariat; in a number of instances countries, such as the Lao People’s Democratic Republic and Mongolia, will receive intensive support from both the country and Regional Office for their health sector reform programmes. Furthermore, countries and areas will be supported to undertake detailed assessments and updating of their regulatory and legislative health sector frameworks. In addition, technical support will be provided for high-level policy dialogue and generation of evidence for policymaking on the governance and institutional arrangements of health financing, increasing public funding for health, and innovative ways of financing health. Rational resource allocation and streamlined provider payment mechanisms are crucial to improving efficiency and will be one of the key strategic directions, as well as assessing the impacts of hospital autonomy and financial management. Facilitating countries’ and areas’ monitoring and evaluating progress towards access to health services and financial risk protection remains a regional priority. Cross-cutting issues/linkages with other programmes and partners
Policy dialogue, sector planning, evidence generation and aid effectiveness will increasingly involve key stakeholders from donor agencies, global health initiatives, civil society, nongovernmental organizations and the private sector, and links to other sectors in order to ensure that the most important social determinants of health are tackled. This includes WHO’s cross-cutting work on gender, human rights, and equity, ensuring health is addressed in all policies. It also will involve the application of tools and policies to remove health system barriers that hinder access and utilization of health care, promote integrated service delivery, and facilitate accountability of resources used. Appropriate development and
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CATEGORY 4. HEALTH SYSTEMS
application of policies, strategies and plans will ensure that health systems are strengthened to provide core services for NCDs (Category 2) infant, child, adolescent, adult and older people’s health (Category 3), and HIV/AIDS, tuberculosis, malaria and other infectious diseases (Category 1). Health systems that are essential in the preparation for, respond to, or facilitate recovery from health emergencies of all types (Category 5) will be supported in those countries and areas prone to such unfortunate events. Outputs to which WPR will contribute
4.1.1 Advocacy and policy dialogue to support countries to develop comprehensive national health policies, strategies and plans Region’s accomplishments at the end of the 2014–2015 biennium
•
Five countries that conducted reviews of their national health strategy including the financing component during the biennium
4.1.2 Country capacity to develop and implement legislative, regulatory, and financial frameworks strengthened by generation and use of evidence, norms and standards, and robust monitoring and evaluation Region’s accomplishments at the end of the 2014–2015 biennium
•
Three countries that have institutionalized tracking of health resources
Relevant Regional Committee Resolutions
WPR/RC63.R6 Implementation of the International Health Regulation (2005) WPR/RC61.R2 Western Pacific regional strategy for Health Systems based on the values of Primary Health Care WPR/RC60.R3 Health financing strategy for the Asia Pacific Region 2010-2015 WPR/RC59.R4 Health Systems Strengthening and Primary Health Care WPR/RC58.R2 Programme towards achieving MDGs WPR/RC56.R6 Strategy on health care financing for countries of the Western Pacific and Southeast Asia Regions 2006-2010 WPR/RC53.R6 Ethical issues related to new developments in the Health Sector WPR/RC53.R3 The Global Fund for AIDS, Tuberculosis and Malaria INTEGRATED PEOPLE-CENTRED HEALTH SERVICES
As witnessed in current national health sector plans, many countries in the Region have adopted, and in some instances adapted, universal health coverage (UHC) as a guiding principle for developing and strengthening their health sector. Integration of services will be the main vehicle for achieving UHC. However, due to the double burden of demographic (ageing) and ecological (from communicable to NCDs) transitions, exacerbated by the scarcity of human and financial resources, many countries are experiencing difficulties in providing an integrated, comprehensive health service delivery system that caters for people through the life-course. Different demand and supply side barriers are impacting on the access and continuity of care such as: location and fragmentation of services; staff and medical supplies availability; high costs; poor quality of services; limited referral systems; and cultural inhibitions. There is an unbridled expansion of hospital-based curative services that absorbs significant amounts of public funding, to the detriment of the more efficient and cost-effective, promotive and preventive services. In addition, global health initiatives have skewed resources towards single disease programme implementation without strengthening mainstream health services. Necessary investments in human resource development have remained inadequate, and as a result, shortages of health workers, inadequate and imbalanced skill-mix and uneven geographical distribution of the health workforce continue to pose a major barrier to achieving better health outcomes. Moving towards UHC, the availability of appropriately skilled health workers will be critical in accessing health services. Health workforce requirements in terms of quantity, skill-mix and competencies are changing
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CATEGORY 4. HEALTH SYSTEMS
with an ageing population and increase of NCDs. Insufficient education capacities and mobility of the health workforce pose additional challenges in the region. Priorities/focus for 2014–2015
In the biennium 2014‒2015, the Secretariat will first and foremost support countries to operationalize UHC, through integration of services across the continuum of care, based on the principles of primary health care and health equity. Acknowledging the great diversity among countries in the Region in terms of health sector development and service delivery barriers, the Secretariat will work closely with countries and areas and other key stakeholders on: developing norms, tools, system strengthening and capacity-building approaches that address and integrate efficient country delivery systems for effective health interventions; and ensuring equitable access to quality services for their citizens, with an appropriate mix between prevention, promotion, treatment, rehabilitation, palliative and social care. With regards to human resources, the Secretariat will continue to provide technical cooperation with countries and areas to develop human resources for health (HRH) strategies and plans to address HRH challenges taking into account population needs and dynamics of the labour market. WHO will support building governance and financing capacity to implement HRH strategies. Effort will also be made to strengthen HRH information, as well as education capacities, quality and relevance. Cross-cutting issues/linkages with other programmes and partners
Integration of services across the spectrum of care, delivery levels and disease programmes will involve key stakeholders from government agencies, service providers, donor agencies, global health initiatives, civil society, nongovernmental organizations and the private sector. The Secretariat will facilitate or coordinate partnership models that will allow for equal representation and provide a platform for sharing of tools and policies to remove health system barriers that hinder access and utilization of health care, promote integrated service delivery, and facilitate accountability of resources. System development, including HRH development, as well as capacity-building will be coordinated and aligned with services for NCDs (Category 2) infant, child, adolescent, adult and older people’s health (Category 3), and HIV/AIDS, tuberculosis, malaria and other infectious diseases (Category 1) as well as with WHO’s cross-cutting work on social determinants, gender, human rights, and equity, ensuring health-in-allpolicies. Outputs to which WPR will contribute
4.2.1.
Policy options, tools and technical support to countries for equitable people-centred integrated service delivery and strengthening of public health approaches Region’s accomplishments at the end of the 2014–2015 biennium
• •
Five countries have integrated service delivery packages at different levels of their health system and reflected in their national health strategy Two countries routinely assess the costs and impact of different service delivery options and the related expenditures
4.2.2. Countries enabled to plan and implement strategies that are in line with WHO’s global strategy on HRH and the WHO Global Code of Practice on the International Recruitment of Health Personnel Region’s accomplishments at the end of the 2014–2015 biennium
•
All countries in the region facing health workforce crisis will have improved HRH information, updated HRH strategies and increased numbers of health workers in line with the strategies.
4.2.3. Guidelines, tools and technical support to countries for improved patient safety and quality of services, and for patient empowerment Region’s accomplishments at the end of the 2014–2015 biennium
•
Five countries have a comprehensive quality of care programme in different service delivery institutions 29
CATEGORY 4. HEALTH SYSTEMS
•
Three countries have official engagement in new patient safety and empowerment initiatives
Relevant Regional Committee resolutions
WPR/RC61.R2 Western Pacific regional strategy for Health Systems based on the values of Primary Health Care WPR/RC59.R4 Health Systems Strengthening and Primary Health Care WPR/RC58.R2 Programme towards achieving MDGs WPR/RC58.R4 People at the centre of care initiative WPR/RC57.R7 Regional strategy on Human Resources for Health 2006–2015 WPR/RC53.R3 the Global Fund for AIDS, TB and Malaria WPR/RCM 62 Human Resources for Health Action Framework ACCESS TO MEDICINES AND HEALTH TECHNOLOGIES AND STRENGTHENING REGULATORY CAPACITY
An estimated 30% of the world‘s population does not have regular access to essential medicines; in the WPR, millions lack access to life-saving medicines or suffer financial hardship in order to obtain essential medicines and medical products. Spending on medicines is often the highest portion of out-ofpocket payments in lower middle-incomes countries in the Region. In light of the rapidly increasing NCD burden in the Western Pacific, the lack of regular access to affordable medicines may lead to a heavy burden on the health system when dealing with complications and disabilities due to poorly controlled chronic diseases. Despite existence of national essential medicines or reimbursement lists in 78% of the countries of the region the availability of quality-assured products is often low and major inequities exist in access to affordable vaccines, diagnostics, medical and assistive devices, and other essential health technologies. Improving access these medical products is central to the achievement of UHC; improving efficiency and reducing wastage is an important component of health financing policy. There are significant differences in capacity of national regulatory authorities to ensure quality of medical products in their markets. The sale of substandard, spurious, falsely-labelled, falsified or counterfeit medical products due to poor regulatory enforcement is still a major problem and constitutes serious risks to patients. The sale of such products also can contribute to the emergence of antimicrobial resistance with critical public health implications, as exemplified by the emergence artemisinin resistant malaria. There are several elements to this programme area, including rational pricing policies, and appropriate prescribing that favours greater use of generic over originator brands; promoting research and development for the health technologies needed by low-income countries; strengthening national regulatory authorities and systems; diagnostics and vaccines available that benefit those in need; and comprehensive national policies on medical products, based on good governance principles. Priorities/focus for 2014–2015
In the biennium 2014‒2015, WHO in the WPR will continue to support the implementation of the global strategy and plan of action on public health, innovation and intellectual property. This work will focus on supporting the collection of national data on research and development and to identify priorities for innovation in the Region, and provide input to setting both regional and global agenda on research and development priorities. WHO Regional Office for the Western Pacific will support countries to make rational choices when selecting, procuring and reimbursing health technologies, and identify cost-effective and safe options using appropriate tools, including health technology assessment. Facilitating collaboration and capacitybuilding to effectively use results of health technology assessment and to develop policies and systems for financing of cost-efficient health technologies will be a priority.
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CATEGORY 4. HEALTH SYSTEMS
Promotion of policy interventions and enabling of multisectoral responses to reduce the emergence of antimicrobial resistance will be another priority in the Region. Capacity development for adequate national regulatory systems, to ensure that marketing of qualityassured health technologies and traditional medicine products and reduce the sale of substandard, spurious, falsely-labelled and falsified products, will be targeted as a major priority for WHO’s future work in the Region. This work will be advanced through facilitating better collaboration and harmonization of good regulatory practices in the Region. Cross-cutting issues/linkages with other programmes and partners
The essential medicines and health technologies programme of the WHO Regional Office for the Western Pacific will work with other programmes both within Category 4 and across other categories. Linkages are necessary to ensure availability of quality-assured, affordable health technologies inclusive of medicines and access to reliable laboratory and diagnostic services for communicable and NCDs as well as for programmes on reproductive, maternal, newborn and child health and for ageing populations. Reducing the risk of and strengthening response to the emergence of antimicrobial resistance will also require collaboration across several programmes as well as collaboration with other United Nations and international organizations. In collaboration with health financing programme action will be taken to ensure equitable access to essential health technologies through adequate financing mechanisms as part of efforts to move towards UHC and improve efficiency and reducing wastage. Outputs to which WPR will contribute
4.3.1
Countries enabled to develop or update, implement, monitor and evaluate national policies on better access to health technologies; and to strengthen evidence-based selection and rational use of health technologies Region’s accomplishments at the end of the 2014–2015 biennium
•
•
•
A regional collaboration and learning opportunities are supported for the development and implementation of medicine pricing and reimbursement policies that will increase access to essential medicines and health technologies as a key element of universal health coverage Technical support for national capacity development in health technology assessment(HTA) will be facilitated by WHO to promote the use of HTA as an evidence-informed tool for rational selection and prioritization of investments in health technologies Development of policies and implementation of appropriate multisectoral responses to the emerging threat of antimicrobial resistance(AMR) will be advocated and supported by WHO in the region
4.3.3.
Strengthening national regulatory authorities facilitated; norms, standards, guidelines for medical products developed; and quality, safety and efficacy of health technologies ensured through prequalification Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Adoption and implementation of WHO technical guidelines, norms and standards for quality assurance of health technologies, including traditional and complementary medicines are supported and priority countries assisted in their regulatory capacity development A subregional collaboration is facilitated for Mekong countries to strengthen the procurement and supply chain system and regulatory actions to ensure availability of quality-assured health technology for malaria as part of ongoing regional efforts to contain the emergence of artemisinin resistant malaria
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CATEGORY 4. HEALTH SYSTEMS
Relevant Regional Committee Resolutions
WPR/RC62.R3 Antimicrobial Resistance WPR/RC62.R4 Traditional Medicine WPR/RC60.R6 Asia Pacific Strategy for Strengthening Health Laboratory Services, 2010–2015 WPR/RC55.R4 Regional Strategy for Improving Access to Essential Medicines in the Western Pacific, 2005–2010 WPR/RC53.R5 Antimicrobial Resistance WPR/RC52.R4 Traditional Medicine HEALTH SYSTEMS INFORMATION AND EVIDENCE
Reliable and timely health information and evidence that is presented in a way that is easily interpreted are essential for public health policy, decision-making, resource allocation, performance monitoring and evaluation. Too often there is a gap between the producers of information and research and the policy makers. There is a key role for knowledge brokers, and for developing national capacity to produce, analyse, and use quality health information and health policy research. Achievement of UHC will require regular monitoring of population health status and health systems performance. Well-functioning health information systems (HIS), including civil registration and vital statistics (CRVS) systems, and effective use of e-health (information and communications technology to improve health) will be essential. However, national HIS are suboptimal and fragmented, and capacity in health research is limited in most of the countries and areas. For example, in the WPR, only in 17 of its 37 countries and areas and areas are births almost completely accounted for. In terms of death registration, only 16 of the countries and areas have attained at least 90% death coverage. In a third of countries and areas where civil registration systems are poorly functioning, 30% to 50% of deaths go unregistered. In the area of health research, countries and areas are demanding more capacity towards achieving UHC through knowledge networks that facilitate translation of evidence into effective policies and practices. Suboptimal governance and management systems for health research in many countries and areas are a major barrier towards unlocking the full potential of increasing investments in health research. Within the WHO Regional Office for the Western Pacific, the Ethics Review Committee is strengthening to ensure that all the health research supported by the Region and its country offices is in compliance with international ethical standards. Priorities/focus for 2014–2015
In the biennium 2014‒2015, WHO in the WPR will continue to support countries to have properly functioning CRVS systems indicative of increasing access, quality, and use of reliable health information and evidence to support policy and decision-making across the health sector. The WHO Regional Office for the Western Pacific will specifically support countries in strengthening their national HIS and CRVS systems with better access and use of health data standards to promote system interoperability that is sustainable and scalable. Technical support will be provided to countries and areas through peer networks of HIS, CRVS, and e-health professionals, which will contribute to knowledge learning and sharing, technical transfer, and monitoring health situation at regional, national and subnational levels. In addition, WPR will assist countries and areas in exploiting the tremendous potential of m-health (medical and public health practices supported by mobile devices) and e-health applications in improving health service delivery and quality of healthcare via development and implementation of coherent national ehealth strategies. In the area of health research, we will work with work with countries and areas to strengthen national health research governance system including system to ensure ethical conduct of health research. In the area of health systems and policy research, national health in transition reports will continue to be developed and comparative analyses will be presented in policy briefs, as well as national or subnational analyses, to provide high-value public good products to countries and areas. We will also
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CATEGORY 4. HEALTH SYSTEMS
work with national institutions and WHO collaborating centres to utilize the potential of these organizations to support global and regional public health work. Cross-cutting issues/linkages with other programmes and partners
The information, evidence and research programme of the Regional Office for the Western Pacific will work with other programmes both within Category 4 and across other categories. The programme is integrally linked with promotion and evidence-based decision-making of core services for NCDs (Category 2) infant, child, adolescent, adult and older people’s health (Category 3), and HIV/AIDS, tuberculosis, malaria and other infectious diseases (Category 1). The Regional Office will engage with regional development banks (Asian Development Bank) and other regional intercountry government organizations (UNICEF, United Nations Population Fund, Economic and Social Commission for Asia and the Pacific) as well government ministries of health and in other relevant sectors to ensure an inclusive and multisectoral approach. Regional approaches to derive country impacts in better health information and research quality and use will be facilitated through the Regional Office Secretariat, technical support, and participation in collaborative networks of partners and professionals, including the Asia eHealth Information Network (AeHIN), Pacific Health Information Network (PHIN), and the Asia Pacific Observatory on Health Systems and Policy (APO). Outputs to which WPR will contribute
4.4.1.
Comprehensive monitoring of the global, regional and country health situation, trends and determinants, using global standards, and leadership in the new data generation and analyses of health priorities Region’s accomplishments at the end of the 2014–2015 biennium
•
• •
Develop comprehensive, standards-based, interoperable HIS at the national and subnational level, and ensuring reliable information is used in decision-making and is available to the general public. CRVS policies, strategies, and plans developed and utilized in 20 countries/areas Build the knowledge and evidence base of health systems through operation and maintenance of the Health Information and Intelligence Platform (HIIP) for the Western Pacific, with access to nationally reported and global health estimates for countries and areas with analytical tools and software.
4.4.2. Countries enabled to plan, develop and implement an e-health strategy Region’s accomplishments at the end of the 2014–2015 biennium
• 4.4.3.
12 countries and areas will have developed, enhanced, or be implementing their national e-health or HIS strategy.
Knowledge management policies, tools, networks, assets and resources developed and fully utilized by WHO and countries to strengthen their capacity to generate, share and apply knowledge Region’s accomplishments at the end of the 2014–2015 biennium
•
AeHIN and PHIN supported to provide peer-to-peer assistance, training, knowledge sharing and learning, and adoption and implementation of health information standards and quality improvements.
4.4.4.
Policy options, tools and support provided to define and promote research priorities, and to address priority ethical issues related to public health and to research for health Region’s accomplishments at the end of the 2014–2015 biennium
•
Through the Asia Pacific Observatory of Health Systems and Policies, production of high quality and objective assessments of national health sector, in 10 countries completed and updates produced on 4 previously released Health in Transitions reviews, 2 multi-country case analysis produced (6 countries in each),
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CATEGORY 4. HEALTH SYSTEMS
• •
and 12 policy briefs developed and their dissemination through policy-dialogue events as well as innovative internet communication. National health research priority setting and public health data analysis capacity strengthened in five countries The Health Research Portal of the Regional Office for the Western Pacific is maintained, updated and expanded.
Relevant Regional Committee Resolutions
WPR/RC61.R2 Western Pacific Regional Strategy for Health Systems based on the Values of Primary Health Care WPR/RC58.R2 Progress Towards Achieving the Millennium Development Goals WPR/RC50.57 Development of Health Research Proposed budget allocation: Category 4. Health systems 2014–2015 (US$) Programme Projected Expenditure 2012–2013 Country Offices National health policies, strategies and plans Integrated people-centred health services Access to medicines and health technologies and strengthening regulatory capacity Health systems information and evidence Total 12 918 000 15 755 000 Regional Office 4 479 000 5 230 000 Total 17 397 000 20 985 000 Proposed PB 2014–2015 Country Offices 11 158 000 13 226 000 Regional Office 4 753 000 6 189 000 Total 15 911 000 19 415 000
4 571 000
3 384 000
7 955 000
7 202 000
3 860 000
11 062 000
1 839 000 35 083 000
3 829 000 16 922 000
5 668 000 52 005 000
3 372 000 34 958 000
4 440 000 19 242 000
7 812 000 54 200 000
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE Reducing mortality, morbidity and societal disruption resulting from epidemics, natural disasters, conflicts and environmental and food-related emergencies, through prevention, preparedness, response and recovery activities that build resilience and use a multisectoral approach.
This category focuses on strengthening countries’ capacities in prevention, preparedness, response and recovery for all types of hazards, risks and emergencies that pose a threat to human health. It includes those hazards and emergencies covered by the requirements of the International Health Regulations (2005). The category also covers the work in polio eradication and emergency risk management, building country and community resilience to disasters of all types. ALERT AND RESPONSE CAPACITIES
In the WPR, the Asia Pacific Strategy for Emerging Diseases 2010 (APSED) serves as a regional tool to help countries and areas meet core capacity requirements of the International Health Regulations 2005 (IHR). Annual results of the global IHR core capacity monitoring questionnaire have shown good overall progress in the Region. The countries in the Region have responded effectively to a number of emerging disease threats. In particular, China’s response to avian influenza A(H7N9) in early 2013 demonstrated the importance of investing in preparedness and response capacities, transparency and political commitment. Despite this progress, 14 countries requested and obtained two-year extensions, indicating that additional time and technical and financial resources are required to meet IHR core capacity requirements before the second deadline in 2014. In addition, countries that did not request extension will still be expected to sustain the core capacities using the APSED framework, and strengthen them further. Effective implementation of national APSED/IHR workplans has been critical for meeting and sustaining IHR core capacity requirements. Pacific island countries and areas face unique national and local capacity development challenges due to multiple factors including small population size, geographical isolation, and limited infrastructure and resources. Many national capacities can be strengthened and enhanced at the subregional Pacific level through collective effort and resource sharing by the Pacific island countries and areas. Priorities/focus for 2014–2015
APSED (2010) will continue to serve as a roadmap towards meeting IHR core capacity requirements. The need to develop and sustain IHR core capacities presents opportunities for developing and/or updating cohesive and feasible APSED/IHR implementation plans. These plans should be accompanied by robust arrangements for result-based monitoring and evaluation, and estimations of the financial and technical resources required to implement them. In 2014–2015 the focus will be on strengthening cross-cutting generic capacities including expansion of event-based surveillance, risk assessment for acute public health events, establishment and strengthening of emergency operations centres in ministries of health as a platform to enhance preparedness, response and operational readiness for public health emergencies, further strengthening of the regional alert and response capacities, as well as a stronger focus on integrated monitoring and evaluation system. Cross-cutting issues/linkages with other programmes and partners
APSED (2010) suggests a stepwise approach, where countries and areas first focus on building individual technical areas, then strengthening the linkages among these areas to reinforce the system as a whole. As part of moving towards an all-hazard approach, future efforts will seek to strengthen event-based surveillance and establish collaboration with other sectors for risk assessment and response to noninfectious public health events such as food, chemical and radiation emergencies as well as to the health impacts of climate change.
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
Outputs to which WPR will contribute
5.1.1.
Countries enabled to develop core capacities required under IHR (2005) Region’s accomplishments at the end of the 2014–2015 biennium
•
APSED/IHR implementation plans are developed and/or updated in order to develop and sustain IHR core capacity requirements.
5.1.2. WHO has the capacity to provide evidence-based and timely policy guidance, risk assessment, information management and communications for all acute public health emergencies. Region’s accomplishments at the end of the 2014–2015 biennium
•
WHO regional and country offices coordinate a common surveillance and assessment of public health emergencies of potential international and/or regional significance in line with the Emergency Response Framework.
Relevant Regional Committee Resolutions
WPR/RC63.R9 Implementation of the International Health Regulations (2005) WPR/RC61.R9 Asia Pacific Strategy for Emerging Diseases (2010) and the International Health Regulations (2005) WPR/RC58.R9 Avian and pandemic influenza, International Health Regulations (2005), and the Asia Pacific Strategy for Emerging Diseases WPR/RC57.R5 Asia Pacific Strategy for Emerging Diseases, including International Health Regulations (2005) and avian influenza WPR/RC56.R7 Asia Pacific Strategy for Emerging Diseases EPIDEMIC- AND PANDEMIC-PRONE DISEASES
The WPR continues to be a hotspot of epidemic- and pandemic-prone diseases, as represented by the emergence of avian influenza A(H7N9) virus in 2013, and continued reporting of avian influenza A(H5N1). Dengue continues its yearly resurgence in the Region and sporadic outbreaks of other regional priority diseases such as hand foot and mouth disease, chikungunya and cholera, continue to pose threats to health security of the region. The Asia Pacific Strategy for Emerging Diseases 2010 (APSED) serves as a regional tool to assist countries and areas in meeting core capacity requirements of the International Health Regulations 2005 (IHR), and to prepare for specific hazards including novel influenza. The Region has been an active player in the WHO Global Influenza Surveillance and Response System (GISRS)–with 21 national influenza centres in 15 WPR countries and three WHO Collaborating Centres for Reference and Research on Influenza: one each in Australia, China and Japan. In 2014–2015, GISRS in the WPR will further be sustained and enhanced to accommodate new threats, such as avian influenza A(H7N9), Middle East respiratory syndrome coronavirus (MERS-CoV) and other newly emerging diseases. Challenges remain for the control of these epidemic- and pandemic-prone diseases. The volatile nature of avian influenza and its persistence in the wild means countries must remain vigilant for subsequent recurrences and anticipate the emergence of new strains of the virus. It is imperative that countries individually and the Region as a whole be enabled to adequately face these challenges on several fronts, including strengthening the collaboration between animal- and human health sectors. The very nature of avian influenza and zoonoses means that no single sector can manage the risks alone. The APSED (2010) focuses on bringing together the numerous partners working together to prevent, detect and control emerging diseases. Priorities/focus for 2014–2015
In the 2014–2015 period, the WPR will focus on strengthening existing influenza detection and preparedness planning, to accommodate additional epidemic- and pandemic-prone diseases in a stepwise
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
manner. This will be done in line with the Pandemic Influenza Preparedness (PIP) Framework, for example strengthening surveillance capacity with a focus on the detection of cases and clusters of severe acute respiratory infections (SARI) and influenza-like illness (ILI). Under APSED (2010), functional coordination mechanism between animal-, human health and other sectors will be strengthened to control prioritized zoonotic diseases. Working collectively during outbreaks and on a routine basis will reduce the risk to human health associated with avian influenza and other emerging diseases. Cross-cutting issues/linkages with other programmes and partners
This programme area is closely linked to Category 5.1 Alert and Response Capacities. The future efforts will seek better integration in building regional and national capacities in preparedness and response to epidemic- and pandemic-prone diseases to meet IHR requirements through the implementation of APSED (2010). Outputs to which WPR will contribute
5.2.1.
Countries are enabled to develop and implement operational plans, in line with WHO recommendations on strengthening national resilience and preparedness covering pandemic influenza and epidemic and emerging diseases Region’s accomplishments at the end of the 2014–2015 biennium
•
Existing operational plans for the 2009 influenza pandemic are updated and expanded to cover other emerging infectious diseases beyond avian and pandemic influenza.
5.2.2.
Expert guidance and systems support in place for disease control, prevention, treatment, surveillance, risk assessment and risk communications Region’s accomplishments at the end of the 2014–2015 biennium
•
Routine and event-based surveillance in place at the national level for capturing and registering public health events from a variety of sources.
Relevant Regional Committee Resolutions
WPR/RC63.R9 Implementation of the International Health Regulations (2005) WPR/RC61.R9 Asia Pacific Strategy for Emerging Diseases (2010) and the International Health Regulations (2005) WPR/RC58.R9 Avian and pandemic influenza, International Health Regulations (2005), and the Asia Pacific Strategy for Emerging Diseases WPR/RC57.R5 Asia Pacific Strategy for Emerging Diseases, including International Health Regulations (2005) and avian influenza WPR/RC56.R7 Asia Pacific Strategy for Emerging Diseases EMERGENCY RISK AND CRISIS MANAGEMENT
The WPR is prone to emergencies and disasters that result in loss of life, human suffering and devastation of health systems. Over the last biennium encouraging steps were undertaken towards strengthening national health emergency risk and crisis management capacities. In August 2011, the First Regional Health Cluster Forum was convened in Kobe, Japan, to develop a regional, operational framework for health cluster coordination. In October 2011, the Sixty-second Session of the WHO Regional Committee for the Western Pacific reviewed the lessons learnt from recent disaster responses, and called for actions to strengthen national health emergency risk management (HERM) capacities for disasters. Since March 2012, a series of technical consultations were conducted to identify strategic directions and possible actions in various technical areas, including Hospitals Safe from Disasters, information and needs assessments, and health services preparedness. Building on the outcomes of
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
previous consultations and countries’ experiences, a Regional Framework of Action for Health Emergency Risk Management of Natural Hazards was developed. Despite these important initiatives, significant but not systematically documented gaps in health emergency risk and crisis management capacities of the countries and areas as well as the international community at large still remain. Key challenges in the Region include: recurrence of natural hazards and escalation of technological hazards that may cause emergencies and become disasters in vulnerable and inadequately prepared communities; insufficient preparedness for emergencies at provincial and community levels, aggravating the impacts of hazards on health and health services; weak capacity of health authorities for emergency management, leading to ineffective or inappropriate emergency support; lack of collaboration among partner agencies, leading to the inappropriate use of limited resources and hindering collective efforts; and shortages of systematic and reliable public health information on emergencies, making it difficult to measure their impact, develop sound policies or monitor activities. Priorities/focus for 2014–2015
In the biennium 2014–2015 the WPR will focus its efforts on further enhancing countries’ and areas’ capacities in managing public health risks associated with natural hazards through implementation of the Regional Framework of Action for Health Emergency Risk Management of Natural Hazards. This will include technical support to countries and areas for the integration of all-hazard emergency and disaster risk management for health into national health strategies, WHO country cooperation strategies and the United Nations Development Assistance Framework. Information and knowledge management for emergency risk and crisis management will be an important priority in 2014–2015. Strengthening WHO’s organizational readiness for emergencies and disasters to ensure implementation of the Emergency Response Framework will remain a priority in 2014–2015. The WPR will adopt regional standard operating procedures for emergencies, as required, and maintain regional on-call surge teams and invest in institutional capacity-building. Special attentions will be paid to the capacity-building in the Pacific island countries and areas vulnerable to the natural disasters related to climate change (e.g., cyclones, floods, droughts, heat waves). Cross-cutting issues/linkages with other programmes and partners
Future efforts will seek better coordination with building national capacities in prevention, preparedness, response and recovery that are relevant to all types of hazards affecting human health, including those specific to the requirements of the IHR and the decisions of Inter-Agency Standing Committee. The work on emergency risk and crisis management will be strongly linked with health systems, environmental health risk management, and various development partners united under the Hyogo Framework for Action 2005-2015: Building the Resilience of Nations and Communities to Disasters. Outputs to which WPR will contribute
5.3.1. Global Health Cluster and country health clusters reformed in line with the Inter-Agency Standing Committee’s Transformative Agenda Region’s accomplishments at the end of the 2014–2015 biennium • Countries with active health clusters have adapted the Cluster Performance Monitoring tool
5.3.2. Health established as a central component of global multisectoral frameworks for emergency and disaster risk management; national capacities strengthened for all-hazard emergency and disaster risk management for health (ERMH) Region’s accomplishments at the end of the 2014–2015 biennium
•
At least six countries have developed their capacity development plan or programme that is based on the results of a WHO-endorsed capacity assessment tool and process.
5.3.3. Organizational readiness to fully implement WHO’s Emergency Response Framework
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
Region’s accomplishments at the end of the 2014–2015 biennium
• 5.3.4.
WHO regional, subregional and country offices are ready for responding to emergencies to ensure implementation of the Emergency Response Framework
Health sector strategy and plan developed, implemented and reported on in all targeted protracted emergency countries by an in-country network of qualified and trained WHO emergency staff Region’s accomplishments at the end of the 2014–2015 biennium
•
Countries in protracted emergencies have health sector strategy and plan developed and implemented.
Relevant Regional Committee Resolutions
WPR/RC62.R13 Rev.1 Emergencies and disasters WPR/RC56.R15 Responding to health aspects of disasters FOOD SAFETY
Foodborne disease and food contamination continue to be significant public health issues across the WPR. More than 200 diseases, ranging from diarrhoeal diseases to various forms of cancer, spread through unsafe food. The Western Pacific Regional Food Safety Strategy (2011–2015) was endorsed at the Regional Committee Meeting in 2011 to provide guidance on strategic directions and actions to strengthen national food control systems and improve regional collaboration among partners. There are seven themes addressed in the Strategy: (1) Improved food control and coordination throughout the food chain continuum; (2) Risk-based regulatory frameworks; (3) Improved availability of food safety data to better guide policy and risk analysis; (4) Food inspection services; (5) Food safety training and education; (6) Capacity to detect, assess and manage food safety incidents and emergencies; (7) Enhanced cooperative planning, partnerships and collaboration. While all Member States are in the process of strengthening their national food safety control systems, level of progress and achievements against indicators in the Western Pacific Regional Food Safety Strategy (2011–2015) varies significantly across countries and areas. Overall, notable efforts were made during the 2012–2013 biennium to establish food control coordination mechanisms, develop risk-based regulatory frameworks and strengthen food inspection services. However, foodborne disease surveillance, food safety training and public awareness and management of food safety incidents were highlighted as requiring significant investment in most countries and areas. Priorities/focus for 2014–2015 The Western Pacific Regional Food Safety Strategy (2011–2015) will continue to serve as a roadmap for reducing the health and social burden of foodborne diseases in the region. Although the safety of food has been improving overall, progress is uneven, with some countries still lacking core capacities required to ensure food safety. Stronger focus on individual country needs will be required considering that each country and area is at different stage as well as stakeholders’ collaboration at country and regional levels towards achieving the regional strategy's goal and objectives. Cross-cutting issues/linkages with other programmes and partners The future efforts will seek better coordination with building national capacities in prevention, preparedness and response that are relevant to all types of hazards affecting human health, including food safety and those specific to the requirements of the International Health Regulations. Food safety as an essential part of food security needs to be recognized and further strengthened. This involves the availability of adequate safe and nutritious food for all; hence, linkages should be strengthened with programmes addressing noncommunicable diseases, nutrition, maternal and child health, zoonosis and environmental health.
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
Outputs to which WPR will contribute 5.4.1. Support the work of the Codex Alimentarius Commission to develop, and for countries to implement, food safety standards, guidelines and recommendations Region’s accomplishments at the end of the 2014–2015 biennium • All high priority requests for international guidance, standards or recommendations on food safety dealt with in line with the Codex work
5.4.2. Multisectoral collaboration to reduce foodborne public health risks, including those arising at animal-human interface Region’s accomplishments at the end of the 2014–2015 bienniums • Action plan for strengthening INFOSAN in the WPR including communication mechanisms for the interactive exchange of information on food safety incidents and emergencies is developed and implemented Two priority countries have developed and implemented a national plan for strengthening food control systems in line with the IHR core capacity and other requirements
•
5.4.3 Adequate national capacity to establish and maintain risk-based regulatory frameworks to prevent, monitor, assess and manage foodborne and zoonotic diseases and hazards Region’s accomplishments at the end of the 2014–2015 bienniums • At least six countries have strengthened national food control systems to meet IHR core capacity requirements
Relevant Regional Committee Resolutions
WPR/RC62/7
Western Pacific Regional Food Safety Strategy (2011–2015)
WPR/RC55.R6 Food safety WPR/RC52.R2 Food Safety POLIO ERADICATION
Polio is a crippling and potentially fatal infectious disease. There is no cure, but there are safe and effective vaccines. The strategy to eradicate polio is therefore based on preventing infection by immunizing every child until transmission stops and the world is polio-free. The completion of the eradication of polio has been declared a programmatic emergency for global public health. The immediate objective is the complete eradication of wild poliovirus. Thereafter, internationally agreed surveillance, containment and outbreak response protocols are needed for the endgame period of polio eradication; regional consensus is required on the phased cessation of the use of oral polio vaccine from routine immunization programmes; and international consensus must be achieved on the goal and process for securing the public health legacy of polio eradication. Priorities/focus for 2014–2015
In the 2014–2015 biennium, the focus will be on implementing and monitoring the relevant components of the global Polio Eradication and Endgame Strategic Plan. For the polio endgame, support to countries will be intensified to strengthen surveillance, introduce inactivated polio vaccine (IPV) in all countries and replace trivalent oral polio vaccine (OPV) with bivalent OPV. Cross-cutting issues/linkages with other programmes and partners
Polio eradication is strongly linked with Category 1 and the reduction of the burden of communicable diseases. WHO will continue to be a leading partner in the Global Polio Eradication Initiative in order to ensure that the objectives of the polio eradication and endgame strategy are achieved and that the polio endgame is initiated.
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
Outputs to which WPR will contribute
5.5.1.
Direct support to raise population immunity against polio to the required threshold levels in affected and high-risk areas Region’s accomplishments at the end of the 2014–2015 biennium
• 5.5.2.
Two high-risk countries supported to conduct polio vaccination campaigns and surveillance
International consensus established on the cessation of the use of oral polio vaccine type 2 in routine immunization programmes globally Region’s accomplishments at the end of the 2014–2015 biennium
• 5.5.3.
Six countries (among the 17 countries and areas using OPV) have an agreed timeline for cessation of use of oral polio vaccine type 2 in routine immunization
Processes established for long-term poliovirus risk management, including containment of all residual polioviruses, and the certification of polio eradication globally Region’s accomplishments at the end of the 2014–2015 biennium
• 5.5.4.
Fully functional regional certification process for polio eradication maintained and supported
Establishment of the polio legacy plan Region’s accomplishments at the end of the 2014–2015 biennium
•
Regional consensus on priorities for the legacy of the polio eradication programme developed
Relevant Regional Committee Resolutions
WPR/RC61.R7 Vaccine-Preventable Diseases: Measles Elimination, Hepatitis B Control, and Poliomyelitis Eradication WPR/RC56.R8 Measles Elimination, Hepatitis B Control and Poliomyelitis Eradication OUTBREAK AND CRISIS RESPONSE
The WPR has been a hotspot for outbreaks, large-scale emergencies and disasters over recent years, which continuously threaten the health security of the Region. Epidemic-prone emerging diseases such as dengue and cholera continue to burden the Region, while others such as chikungunya and hand, foot and mouth disease have resurged or increased in intensity. Newly emerging infectious threats continue to surface, as evidenced by the emergence of avian influenza A (H7N9) virus in 2013. Moreover, disasters due to natural hazards also pose ongoing public health concerns; during the past two decades, among those affected by natural disasters globally, more than half are from the Region. In addition to large-scale typhoons and floods, technological hazards such as the radio-nuclear event in Japan have raised new concerns for the Region. Food safety concerns, ranging from localized diarrheal outbreaks to widespread distribution of unsafe foods associated with various hazards, are posing considerable threats for this rapidly developing and increasingly interconnected region. As mandated by the United Nations Inter-Agency Standing Committee (IASC) Transformative Agenda and the IHR (2005), and guided by the regional strategies such as the Asia Pacific Strategy for Emerging Diseases (APSED 2010), WHO has been playing an increasingly important role in outbreak and crisis response to acute events including public health and humanitarian emergencies in the region. WHO’s response capacities have been reflected in the recent responses to the public health and humanitarian emergencies including the outbreaks of avian influenza A(H7N9) in China, severe hand, foot and mouth disease in Cambodia, dengue in Solomon Islands and Lao People’s Democratic Republic, typhoon Bopha in the Philippines and earthquake in Solomon Islands.
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CATEGORY 5. PREPAREDNESS, SURVEILLANCE AND RESPONSE
Priorities/focus for 2014–2015
Effective responses will be implemented, through rapid needs and risk assessments, deployment of trained technical and coordinating staff, adequate information management and resource mobilization. This follows the overall role of WHO in emergency setting and implements WHO’s Emergency Response Framework. The Regional Office, the subregional and country offices will implement emergency response procedures and ensure the application of the tool for tracking performance against the Emergency Response Framework in all graded emergencies. Cross-cutting issues/linkages with other programmes and partners
The Regional Office and subregional offices will seek support from different technical programmes across the Organization and health cluster partners. Outputs to which WPR will contribute 5.6.1. Implementation of the WHO’s Emergency Response Framework in acute emergencies with public health consequences Region’s accomplishments at the end of the 2014–2015 biennium • Implementation of the Emergency Response Framework in emergencies from any hazards with public health consequences at regional and country offices Relevant Regional Committee Resolutions
WPR/RC63.R9 Implementation of the International Health Regulations (2005) WPR/RC62.R13 Rev.1 Emergencies and disasters WPR/RC62.R7 Western Pacific Regional Food Safety Strategy (2011–2015) WPR/RC61.R9 Asia Pacific Strategy for Emerging Diseases (2010) and the International Health Regulations (2005) WPR/RC58.R9 Avian and pandemic influenza, International Health Regulations (2005), and the Asia Pacific Strategy for Emerging Diseases WPR/RC57.R5 Asia Pacific Strategy for Emerging Diseases, including International Health Regulations (2005) and avian influenza WPR/RC56.R7 Asia Pacific Strategy for Emerging Diseases WPR/RC56.R15 Responding to health aspects of disasters WPR/RC55.R6 Importance of multisectoral collaboration and sharing food safety information among countries and areas Proposed budget allocation: Category 5. Preparedness, surveillance and response 2014–2015 (US$) Programme Projected Expenditure 2012–2013 Country Offices Alert and response capacities Epidemic- and pandemicprone diseases Emergency risk and crisis management Food safety Total 7 020 000 7 618 000 1 772 000 980 000 17 390 000 Regional Office 4 483 000 4 589 000 1 126 000 982 000 11 180 000 Total 11 503 000 12 207 000 2 898 000 1 962 000 28 570 000 Proposed PB 2014–2015 Country Offices 9 800 000 4 300 000 2 200 000 1 100 000 17 400 000 Regional Office 5 300 000 3 700 000 1 800 000 1 200 000 12 000 000 Total 15 100 000 8 000 000 4 000 000 2 300 000 29 400 000
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CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
CATEGORY 6. CORPORATE SERVICES/ENABLING FUNCTIONS This cross-cutting category includes work on strengthening WHO’s leadership and governance, and activities to foster improved transparency, accountability and risk management within the Organization. It also covers the work performed to enhance strategic planning, resource coordination and reporting, management and administration and strategic communications. LEADERSHIP AND GOVERNANCE
The work in this area aims to achieve greater coherence in global and regional health, continue reform efforts to strengthen the oversight role of governing bodies, and strengthen the leadership role WHO plays in coordination with the health sector and other health actors at country and regional levels. WHO endeavours to strengthen its leadership at country and regional levels in the Western Pacific Region to better respond to country health priorities and to support national authorities in setting the broader health agenda with partners. WHO will strategically strengthen its convening role in relation to cross-border and multisectoral issues relevant to groups of countries and the Region as a whole. In the biennium 2014–2015, the WHO offices throughout the Western Pacific Region will make concerted efforts perform their functions more effectively, particularly exercising strong leadership at the country level. Playing a leadership role in country health development requires strong technical capacity and well-managed WHO country offices equipped with appropriate skills and competencies, and the Regional Office working synergistically with the country office to deliver better results at the country level. WHO Western Pacific Region needs to collaborate with countries to identify sets of priorities for effective and results-based collaboration at the country level. To ensure this, there is a need for more robust WHO country cooperation strategies that clearly define the priorities of WHO's work in and with countries through inclusive consultation with countries and partners. Following effective strategies will guarantee that WHO's work is better aligned with the priorities of Member States and better harmonized with the work of other development partners. The current WHO mechanisms will be further enhanced to ensure greater coordination between the work of country and regional offices in line with countries’ priorities. In order for WHO to achieve better results at the country level, the oversight role of WHO governing bodies should be strengthened through active participation in the Regional Committee, World Health Assembly and Executive Board by Member States. In harmonization of the work of the World Health Assembly, Executive Board and Regional Committee, their resolutions and decisions would be closely coordinated for effective implementation. The Western Pacific Region will further identify effective means for assisting preparing governing bodies in discharging their oversight responsibilities, and continue provide timely briefings and where possible, face to face discussion between members of country delegations and Executive Board and WHO representatives, assisting them in preparation of their participation and following up on implementation of governing body decisions and resolutions. The Western Pacific Region will continue to strengthen advance consultation with member states on Regional Committee agendas to address the most important policy and strategic issues confronting the Region; to align the Organization’s programmes and budget with countries and the Region’s priorities, monitor their implementation, and evaluate if the expected results are achieved. Furthermore, in pursuing the Organization’s reform agenda and in ensuring accountability, the Western Pacific Region's work in the strengthening evaluation of its performance at country and regional levels should continue to better inform the strategic direction-setting and oversight of the work of WHO. The Western Pacific Region will strengthen country- and regional-level mechanisms for engaging with other sectors, civil society and other non-state actors on a common health agenda. Efforts also will be undertaken to enhance WHO coordination with the United Nations system at the country level and more effectively engage regional United Nations partners to advocate and collaborate on country and regional health priorities. Finally, during the 2014–2015 biennium, the WHO Western Pacific Region will continue to pursue reform towards improving the Organization’s overall programme delivery, governance and management. Enhancements of the WHO reform at regional and country levels will further address priority-setting,
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CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
resource mobilization, partnerships and human resources as a core part of the work of all WHO offices in the Region. The reform effort will be guided and strengthened by a systematic and independent evaluation of the country- and regional-level work. Outputs to which Western Pacific Region will contribute
6.1.1.
Effective WHO leadership and management in place Region’s accomplishments at the end of the 2014–2015 biennium
• • • • 6.1.2.
WHO leadership roles are strengthened in technical collaboration with Member States in key programme areas identified by WHO governing bodies All updated country cooperation strategies or plans have defined priorities that are aligned with national health priorities All WHO heads of offices in the Western Pacific Region have undergone leadership training or executive coaching Effective management in WHO is ascertained through evaluation and auditing process validated by WHO governing bodies.
Effective engagement with other stakeholders in building a common health agenda that responds to countries and areas’ priorities Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Broader partnerships with ASEAN, the United Nations, donor countries, academia, professional bodies and civil society are strengthened to address countries and areas' priorities for technical collaboration at the country level In all countries with a WHO presence, the Organization partners with the ministry of health, other government sectors, the United Nations and other partner agencies in leading sector-wide coordination for health
6.1.3.
WHO governance strengthened with effective oversight of the sessions of the governing bodies, and efficient, aligned agendas Region’s accomplishments at the end of the 2014–2015 biennium
•
Regional Committee increases oversight role of WHO’s performance through consultative strategic agenda-setting, better coordination of work of the World Health Assembly, Executive Board and Regional Committee, timely and comprehensive briefings with Member States, strengthening review and evaluation of effectiveness and evidence-based results of WHO programme delivery, particularly at the country level
6.1.4.
Integration of WHO reform into the work of the Organization Region’s accomplishments at the end of the 2014–2015 biennium
•
WHO reform activities have a positive impact on the Organization's performance at the country level
TRANSPARENCY, ACCOUNTABILITY AND RISK MANAGEMENT
Work in the area of managerial accountability, transparency and risk management is a key aspect of the WHO reform agenda. The work aims to foster a culture of evaluation that conforms to best practices, norms and standards of the United Nations Evaluation Group and complies with the Executive Boardapproved evaluation policy. Managerial accountability and internal oversight will be strengthened through broader audit coverage, an increased focus on standards of ethical behaviour by staff and increased monitoring of potential conflicts of interest through financial disclosures. In addressing the programme’s focus, there has been increased oversight of Programme Budget monitoring and evaluation of financial implementation at the regional level by the Programme Committee (PC), and Award Oversight Group (AOG) and at the country level by the Senior Management
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CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
Groups (SMGs) and through regular Programme Management meetings. Efforts to inculcate an evaluation culture have included self-assessments of all the Region’s country offices and external country assessments for Cambodia, Papua New Guinea and Solomon Islands with piloting of country proposals for addressing areas for improvement identified by external assessments. Additional mechanisms have been put in place to improve transparency, accountability and risk management, such as the monitoring of open audit recommendations to ensure they are closed in a timely manner, instituting travel quality reviews of all travel requests, the creation and monitoring of an administration risk register, the regular review of the Region’s human resources plan for funding and organizational vulnerability. In 2014–2015, the Western Pacific Region will maintain effective and efficient internal control mechanisms, including a comprehensive risk management framework. The corporate risk register will be rolled out to technical areas. An internal control framework with an accountability structure will be fully implemented across all offices in the Region. Country and Regional Office evaluations will be conducted in line with the WHO policy on evaluation and methodologies, with Regional Office support for countries carrying out their evaluations. The Western Pacific Region will continue to support the activities of the regional Board of Appeal, Ombudsperson and the Staff Association’s related work on the internal justice system in the country and regional offices. Outputs to which Western Pacific Region will contribute
6.2.1.
Accountability ensured though strengthened corporate risk management and evaluation at all levels of the Organization Region’s accomplishments at the end of the 2014–2015 biennium
• •
The Organization-wide risk management framework is implemented in the Western Pacific Region country and regional offices Accountability is enhanced through the utilization of the global control framework
6.2.2. Implementation of WHO’s evaluation policy across the Organization Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Regional evaluation plan developed and implemented effectively including WHO performance assessment at regional and country levels, and annual and biennium WHO programme assessment and evaluation Evaluation of selected programmes conducted according to established policies with follow-up actions initiated within six months from the date of the final recommendations
6.2.3. Ethical behaviour, decent conduct and fairness promoted across the Organization Region’s accomplishments at the end of the 2014–2015 biennium
•
All complaints and allegations reported are assessed within six months of registration.
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CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
STRATEGIC PLANNING, RESOURCE COORDINATION AND REPORTING
Strategic planning, resource coordination and reporting is concerned with financing and the alignment of resources with the priorities and health needs of the countries and areas within a results-based management framework. It encompasses strategic planning, operational planning, budget management, performance assessment, resource mobilization and reporting at country and regional levels. Key features of this work are: sequenced planning to enable country needs to be better reflected in the development of the regional and Organization-wide Programme Budget; and a realistic Programme Budget that highlights the results delivered at all levels of the Organization. In addressing the programme’s concerns, there is continuous and close coordination between the country offices and the Regional Office. Regular meetings are held with country focal points through the Programme Management Officers Network, with information dissemination in terms of policy updates and guidance. These meetings have been instrumental in ensuring that strategic and operational planning, budget management, performance assessment, and reporting processes are effectively implemented. Additional mechanisms have been put in place to further improve programme management, such as the regional Awards Oversight Group, regional programme and WHO country office programme committee/groups. These groups meet regularly to communicate management decisions and to review the budgetary situation, award management, human resources management, programme implementation and monitoring, resource mobilization and donor reporting. In line with changes in the results-based management framework, financing and management reforms, the Region must continue to find ways to further improve the knowledge and skills of staff to fully support the planned improvements in programme management. Likewise, the Region must continue to find ways to regularly review and improve planning, implementation, resource mobilization, budget management, and performance assessment. In the biennium 2014–2015, efforts will focus on strengthening operational planning at country and Regional Office levels, ensuring alignment of country and Regional Office operational plans and human resources with agreed priorities. Emphasis also will be placed on further enhancing the coordinated monitoring and assessment of country and regional outputs and deliverables, as well as the provision of related performance, budget and implementation analysis and reporting. Finally, country and Regional Office resource mobilization efforts will be aligned and capacity will be built in all offices for effective and coordinated donor and partner engagement. Outputs to which the Western Pacific Region will contribute
6.3.1.
Results-based management framework in place including an accountability system for WHO’s corporate performance assessment Region’s accomplishments at the end of the 2014–2015 biennium
•
•
All country and Regional Office workplans developed in conformity with results-based management framework and aligned with agreed county and regional priorities Regional input to Organization’s Programme Budget 2016–2017 and related performance assessment and analyses on Programme Budget 2014–2015 implementation for the Regional Committee provided
6.3.2.
Alignment of WHO financing with agreed priorities, facilitated through strengthened resource mobilization, coordination and management Region’s accomplishments at the end of the 2014–2015 biennium
•
•
Strategic resource management strengthened to ensure that a larger part of Programme Budget 2014–2015 for the Region by category and budget centre is funded by end of the 2014–2015 biennium Resource mobilization efforts coordinated at country and Regional Office levels
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CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
• •
Allocation of resources to country and regional workplans in alignment with agreed priorities Reporting on all grants and agreements are timely and accurate
M ANAGEMENT AND ADMINISTRATION
The programme area addresses the core administrative services that underpin WHO’s effective and efficient operation: finance, human resources, information technology and operations support. Specifically the programme ensures the effective implementation of a financial control framework under which expenditure is properly authorized and recorded, account record keeping is accurate, the Organization’s assets are safeguarded and liabilities correctly quantified, and financial reporting is accurate and timely. Within the area of human resources, the programme focuses on maintaining a flexible and mobile workforce, providing staff learning and development opportunities, further improving performance assessment, and ensuring administration of justice in term of staff issues. With respect to information technology, the programme provides the necessary computing and network infrastructure with a range of corporate systems and applications uniquely suited to WHO’s technical programmes and supportive of its corporate services and enabling functions. In the area of operations support, efforts are focused on providing logistic support, procurement, infrastructure maintenance and security services for staff and the Organization’ property In line with the programme’s focus on finance, the Western Pacific Region continues to provide timely financial and budgetary support services to all budget centres; maintains regular monitoring of implementation of all sources of funds and submission of financial reports to senior management for information and decision-making; and ensures that audit requirements are met through a robust internal control framework in all offices in the Region. Systems have been implemented to more effectively manage imprest accounts enhancing compliance and quality assurance of transactions across the Region and ensuring timely monthly closing of imprest accounts. In line with the Organization’s adoption of the International Public Sector Accounting Standards (IPSAS), the Region successfully implemented IPSAS and provides timely and accurate financial data as part of the Organization’s overall financial reporting. Mechanisms have been put in place to strengthen human resources management, including: the creation and utilization of generic post descriptions; revising and streamlining the selection and recruitment process, which includes a requirement that all positions include at least one female candidate; standardizing the induction process, which includes regular senior management interaction with new staff; initiating an executive coaching programme for the senior management; active monitoring and follow-up of staff performance assessment/staff development (PMDS) compliance; and the implementation and evaluation of the regional mobility policy for professional staff. Major initiatives have been undertaken in the information and technology area with enhancements made in computing environment including upgrading computers and software, deploying a new server infrastructure, upgrading network bandwidth and email services throughout the Region with enhanced connectivity in several country offices, and providing staff remote connectivity to the Regional Office. Technical support has been provided in the development and implementation of several health projects, including the regional Health Information Intelligence Platform (HIIP). During the 2014–2015 biennium, the Region will implement the WHO control framework and ensure compliance with WHO’s administrative policies and regulations at country and Regional Office levels, manage imprest and local payments, and manage accounts, expenditure tracking and financial reporting to ensure accuracy. The Region will facilitate human resources planning to align staff resources with relevant priorities, and implement human resource policies, specifically those addressing recruitment and sourcing, rotation, mobility and reassignment, including policies to move closer to gender balance in the Organization. The Region also will continue to monitor staffing to ensure timely creation of positions, the availability of a qualified and motivated workforce, implement mechanisms for more effective staff performance management and promoting greater staff accountability, advise staff on benefits and entitlements, facilitate staff development and learning, and implement health-promoting occupational policies. In addition the Region will focus on implementing regional information and communications technology (ICT) strategies and policies, overseeing regional governance, managing ICT at country and 47
CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
regional levels, including networks, applications, the hosting environment, event support, emergency support and training in information and communication technology at the regional level. Finally, the Region will manage and administer building and maintenance, procurement of goods and services, transport and meeting services, administer asset and inventory control and reporting, records and archives, and coordinate with the United Nations on ensuring staff security and implementing related cost-sharing mechanisms at the country and regional levels. Outputs to which the Western Pacific Region will contribute
6.4.1. Sound financial practices managed through an adequate control framework, accurate accounting, expenditure tracking and the timely recording of income Region’s accomplishments at the end of the 2014–2015 biennium
•
Positive contribution leading to issuance of unqualified audit opinions by external auditors; timely closure of all audit recommendations; continued improvement in mitigating control risks in all offices.
6.4.2.
Effective and efficient human resources management in place to recruit and support a motivated, experienced and competent workforce in an environment conducive to learning and excellence Region’s accomplishments at the end of the 2014–2015 biennium
•
Ninety per cent of recruitment processes will be completed within 180 days
6.4.3. Efficient and effective computing infrastructure, network and communications services, corporate and health-related systems and applications, and end-user support and training service provided Region’s accomplishments at the end of the 2014–2015 biennium
• 6.4.4.
Ninety per cent of requests for service are fulfilled within one day.
Provision of operational and logistics support, procurement, infrastructure maintenance and asset management, and of a secure environment for WHO’s staff and property (in compliance with United Nations Minimum Operating Security Standards [MOSS] and Minimum Operating Residential Security Standards [MORS]) Region’s accomplishments at the end of the 2014–2015 biennium
•
Ninety-five per cent of WHO facilities in the Region are MOSS/MORS compliant
STRATEGIC COMMUNICATIONS
The strategic communications programme focuses on two interrelated aspects: providing the public with timely and accurate health information, including during emergencies; and better communicating the work of WHO and its impact to increase visibility. With the increasingly complex global health architecture, a changing media environment, the rise of social media and growing demands from donors, politicians and the public for WHO to clearly demonstrate the impact of its work, rapid, effective and well-coordinated communication across platforms is essential. Towards this end, the Western Pacific Region finalized and is implementing a seven-year regional communications strategy (2013–2019). The Regional Office has also invigorated the country/regional office network of communications focal points and strengthened its strategic communications capacity, including training communications focal points in country offices, providing additional funding to support country office communications staff in four countries, launching three new country web sites and upgrading the Regional Office web site. In addition, steps have been taken to better target messages to stakeholders, including revising the format and graphic presentation of the report of the Regional Director to the Regional Committee, to more effectively communicate the work of WHO in the Region, preparing biennial WHO representative reports for two countries, improving the quality of donor reporting through more effective
48
CATEGORY 6. CORPORATE SERVICE/ENABLING FUNCTIONS
communication of results, better editing and layout, making available quality photographs from projects, preparing well-written success stories from the field and undertaking a donor/partners mapping exercise to identify “players in health” for targeted messages. In the biennium 2014–2015, the Region will continue: to implement the regional communications strategy at the country level and standard operating procedures for communication during emergencies; to provide surge capacity to country offices where it is needed; and to create strategic networks and partnerships with communications, media and other practitioners at the regional level, and link them with country offices to support communication needs. In addition, the Region will: strengthen strategic communication, media relations and marketing of WHO at the country level and for the Region as a whole; increase the visibility of WHO’s work through advocacy, managing media relations, news releases, public health campaigns and other communication platforms at country and regional levels; and work in collaboration with communications focal points at WHO headquarters to develop and implement modernized media outreach and education. Outputs to which the Western Pacific Region will contribute
6.5.1.
Improved communication by WHO staff leading to a better understanding of the Organization’s actions and impact Region’s accomplishments at the end of the 2014–2015 biennium
•
•
WHO offices in the Western Pacific Region complete the communications capacity-building programme and are assessed to be effective communicators of the Organization's work WHO offices in the Western Pacific Region have their own web sites
6.5.2. Development and efficient maintenance of innovative communication platforms Region’s accomplishments at the end of the 2014–2015 biennium
• •
WHO representatives receive advanced training in how to be effective spokespeople for WHO A corporate video is developed
Proposed budget allocation: Category 6. Corporate services/enabling functions 2014–2015 (US$) Programme Leadership and governance Transparency, accountability and risk management Strategic planning, resource coordination and reporting Management and administration Strategic communications Total Projected Expenditure 2012–2013 14 674 000 70 000 6 511 000 21 889 000 3 210 000 46 354 000 Proposed PB 2014–2015 14 400 000 100 000 6 400 000 20 500 000 2 900 000 44 300 000
49
EMERGENCIES
EMERGENCIES Polio Eradication and Outbreak and Crisis Response, although related to Category 5 (Preparedness, surveillance and response) and contributing to results within that category, from a budget perspective will be treated under the emergencies component, in order to allow a more flexible approach to managing the budgets. Polio eradication is currently considered a programmatic emergency for global public health, which illustrates the need for flexibility for budget increases on short notice in order to accommodate programmatic needs. Proposed budget allocation: Emergencies 2014–2015 (US$) Programme Projected Expenditure 2012– 2013 Country Offices Polio eradication Outbreak and crisis response Total 988 000 4 905 000 5 893 000 Regional Office 913 000 95 000 1 008 000 Total 1 901 000 5 000 000 6 901 000 Proposed PB 2014–2015 Country Offices 1 000 000 4 900 000 5 900 000 Regional Office 900 000 100 000 1 000 000 Total 1 900 000 5 000 000 6 900 000
50
2014–2015 PROPOSED PROGRAMME BUDGET BY COUNTRIES AND AREAS
PROPOSED PROGRAMME BUDGET 2014–2015 BY COUNTRIES AND AREAS The Western Pacific Region, one of the six regions of the World Health Organization, is home to approximately 1.8 billion people, more than one quarter of the world's population. The Region stretches over a vast area, from China and Mongolia in the north and west, to New Zealand in the south, and French Polynesia in the east. One of the most diverse of the WHO regions, the Western Pacific constitutes some of the world's least-developed countries and areas as well some of the most rapidly emerging economies. There are 37 countries and areas in the Region, 29 of which will receive WHO-funded technical cooperation in 2014–2015. Of the remaining eight, two are Overseas Territories—the Pitcairn Islands (the United Kingdom of Great Britain and Northern Ireland) and Wallis and Futuna (France)—and six have foregone WHO funding for 2014–2015: Australia, Hong Kong (China), Macao (China), New Caledonia, the Republic of Korea and New Zealand. Country and area overviews of expected WHO technical cooperation in 2014–2015 are provided in the following pages. The technical support provided by the WHO Representative/South Pacific/Director, Pacific Technical Support, the Regional Office and WHO headquarters is not reflected in the country budget figures provided in the overviews. The country budget figures shown are those proposed as of 15 August 2013 and will be finalized prior to the commencement of the biennium, following an Organization-wide review.
51
2014–2015 PROPOSED PROGRAMME BUDGET – AMERICAN SAMOA
AMERICAN SAMOA American Samoa situated in the South Pacific about midway between Hawaii and New Zealand consists of a group of islands: the main island is Tutuila, a small neighbouring island Aunu’u, the three Manu’a islands, Swain’s island, and the uninhabited Rose Atoll. American Samoa is a territory of the United States of America with a population of 65 869 people. Thirty-five per cent of the population is under the age of 15; life expectancy at birth is 69 years for males and 75 years for females. The most serious health issues are related to an increase in chronic and NCDs, with their roots in improper nutrition and inadequate physical activity. Significant increases have been seen in obesity, hypertension, cardiovascular diseases, cerebrovascular diseases and diabetes mellitus. Increasing health system capacity, workforce development, surveillance and health information system also are high priorities for the territory. WHO programmes of technical assistance are managed through the country office in Apia, Samoa, which is responsible for American Samoa, Cook Islands, Niue, Samoa and Tokelau. Technical cooperation between the American Samoa Government and WHO focuses mainly on HRH, communicable and NCD prevention and control, and health promotion and protection. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Subtotal County/area total 67 000 --67 000 67 000 --60 000 60 000 69 000 ----9 000 9 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
52
2014–2015 PROPOSED PROGRAMME BUDGET – BRUNEI DARUSSALAM
BRUNEI DARUSSALAM Brunei Darussalam is located on the north coast of Borneo, in Southeast Asia. It is an independent sovereign Sultanate, with a total land area of 5765 square kilometres (2226 square miles). The total population of Brunei Darussalam is estimated to be 393 162 (2011) with the majority located in the capital Bandar Seri Begawan. The economy encompasses a mixture of foreign and domestic entrepreneurship, government regulation, welfare measures, and village tradition. Because of its oil-based economy, the country is wealthy and the majority of people enjoy a relatively high standard of living for Southeast Asia. Crude oil and natural gas production account for nearly half of the gross domestic product (GDP). Per capita GDP (US$ 41 542 in 2011) is far above most other developing countries. The Government provides for all medical services and subsidizes rice and housing. Brunei Darussalam has achieved good health status, although its core capacity in health has to be further developed due to its small size and lack of human resources. The demographic structure is essentially that of a young population; with around 25.2% of the population below 15 years of age. In 2011, the crude birth rate was 17.1 per 1000 population and the crude death rate was 3.1 per 1000 population. The total fertility rate has remained around 1.7 children per woman of reproductive age since 2007. The life expectancy at birth was 78.5 years for males and 79.3 years for females in 2011. Brunei is almost entirely free of major communicable diseases. The leading causes of mortality in 2010 were: cancer, heart disease, diabetes mellitus, cerebrovascular disease and septicaemia. The most common types of cancers are trachea, bronchus and lung, liver and intrahepatic bile ducts, cervix uteri, colon and stomach while the common type of heart disease is ischaemic heart disease. Brunei is turning its attention towards chronic NCDs and has embarked on a health promotion initiative with strategies to promote a healthy lifestyle for the prevention and control of chronic lifestyle diseases. WHO collaborative programmes are managed by a country office located in Kuala Lumpur which also covers Malaysia and Singapore. In 2012–2013, WHO technical cooperation with the Government is focused on support in NCD management including health promotion, pharmaceuticals and medical technologies. The WHO collaborative programme also includes specific areas of communicable diseases such as support for implementation of core capacities under the International Health Regulations (IHR) 2005. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Subtotal County/area total 7 000 7 000 36 000 5 000 5 000 36 000 13 000 ----13 000 --8 000 9 000 17 000 16 000 16 000 14 000 14 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
53
2014–2015 PROPOSED PROGRAMME BUDGET – CAMBODIA
CAMBODIA Cambodia, with a per capita GDP of US$ 2100 (2010), is seeing rapid economic progress. Poverty has been reduced from 47% in 1993 to 22.8% in 2012. Cambodia experienced an average GDP growth of around 10% in the decade leading up to 2008, largely driven by the garment sector, tourism and construction. Agriculture, however, remains a major sector of the economy accounting for 40% of the GDP and employing more than 70% of the workforce. In the past decade the prevalence of communicable diseases such as tuberculosis, HIV and malaria has declined dramatically. Cambodia is moving towards an AIDS-free generation and is on track to eliminate the transmission of HIV by 2020. Maternal, infant and under-five mortality fell by more than 50% during the decade 2000 to 2010, however nutrition indicators for children and pregnant women are still lagging. With NCDs on the rise as a result of smoking, unhealthy diet, harmful use of alcohol, and physical inactivity, Cambodia still faces challenges in further improving the health of its people. WHO’s technical cooperation is managed through the country office with professional staff in a range of areas, including: support to health sector development; control, surveillance of and response to communicable and NCDs; maternal and child health; nutrition and environmental health; and emergency and humanitarian assistance. WHO is the lead facilitator among partners in health working to increase harmonization and alignment of external support and improve sector-wide management. WHO’s Country Cooperation Strategy (2009–2015) is in line with, and supports the National Health Strategy Plan for 2008–2015. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening 1 601 000 1 698 000 97 000 1 139 000 1 385 000 470 000 1 329 000 --485 000 1 814 000 1 800 000 400 000 950 000 3 150 000 1 620 000 ------320 000 1 940 000 1 000 000 40 000 400 000 700 000 675 000 2 815 000 1 038 000 1 581 000 1 678 000 --1 940 000 6 237 000 1 150 000 1 850 000 2 000 000 628 000 1 371 000 6 999 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
54
2014–2015 PROPOSED PROGRAMME BUDGET – CAMBODIA
Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total
--3 396 000
250 000 3 244 000
2 421 000 --4 000 --2 425 000
1 255 000 1 000 000 100 000 60 000 2 415 000
----15 812 000
100 000 100 000 18 723 000
55
2014–2015 PROPOSED PROGRAMME BUDGET – CHINA
CHINA China is the third largest country in the world in terms of land size, and the largest in population, with over 1.3 billion people. It joined the upper middle-income country group in 2010, with per capita GDP of US$ 4433, yet in many respects remains a developing country. In the past 50 years, there has been a significant demographic change, including a decreasing fertility rate, an ageing population and an increased number of migrant workers. The China 12th Five-Year Plan for Health Sector Development (2011–2015) set up health development goals for 2015, which include: (1) the establishment of a basic medical and health system that covers urban and rural residents; (2) universal availability of basic medical insurance and basic public health services; (3) increased accessibility, quality and efficiency of medical and health services as well as patient satisfaction; (4) reduction in out-of-pocket payments; (5) a continuing narrowing in the cross-regional gap in health resource allocation and the gap of health status among populations; (6) increased average life expectancy by one year compared with 2010. China, as one of the Brazil, China, India and Russia (BRIC) countries, plays an increasingly important role in global health, including fulfilling international commitments and providing health cooperation to other developing countries. China and WHO have jointly developed a country cooperation strategy for the period 2013–2015. The Country cooperation strategy (CCS) has four strategic priorities for collaboration, including: strengthening health systems towards UHC; reducing morbidity and mortality from major diseases of public health importance and from risks to health and health security; reducing inequities in health in the western region of China through subnational public health action; and contributing to strengthening global health through supporting the collaboration of China in the global health arena. WHO cooperates with the Government both at the national and subnational levels. WHO’s work with government partners also includes close coordination with United Nations agencies, bilateral organizations and national and international nongovernmental organizations. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Social determinants of health Health and environment Subtotal 708 000 --456 000 1 164 000 800 000 8 000 400 000 1 208 000 3 756 000 97 000 97 000 124 000 679 000 4 753 000 2 800 000 300 000 960 000 --350 000 4 410 000 1 679 000 1 767 000 631 000 291 000 1 647 000 6 015 000 1 300 000 1 400 000 600 000 --3 054 000 6 354 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
56
2014–2015 PROPOSED PROGRAMME BUDGET – CHINA
Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio eradication Outbreak and crisis response Subtotal County/area total ------18 334 000 40 000 100 000 140 000 18 231 000 1 027 000 331 000 388 000 --1 746 000 1 200 000 200 000 150 000 50 000 1 600 000 2 377 000 2 095 000 184 000 --4 656 000 1 490 000 1 081 000 1 496 000 452 000 4 519 000
57
2014–2015 PROPOSED PROGRAMME BUDGET – COOK ISLANDS
COOK ISLANDS Cook Islands is located in the South Pacific, about 3500 kilometres north-east of New Zealand. The country is made up of 15 islands, 13 of which are inhabited. Cook Islands has a population of 23 300, with the majority residing on the main island of Rarotonga (73.6%). There is a significant Cook Island population living in New Zealand and Australia (more than 50 000 people). The Cook Islands’ health profile is largely favourable with adequate health services coverage. No maternal deaths have been recorded since 2001, which can be attributed to 100% of births being attended by a skilled health professional. NCDs and their associated risk factors are a growing health problem, and are the main cause of mortality and account for significant portion of morbidity. Strengthening health system infrastructure, governance, and capacity are high priorities for the country. WHO programmes of technical assistance are managed through the country office in Apia, Samoa, which is responsible for American Samoa, Cook Islands, Niue, Samoa and Tokelau. Technical cooperation between the Cook Islands and WHO focuses mainly on HRH, communicable and NCD prevention and control, improving health system, health promotion, nutrition, mental and oral health, and tobacco control. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Epidemic – and pandemic – prone diseases Subtotal County/area total ----419 000 15 000 15 000 432 000 152 000 ----152 000 50 000 150 000 10 000 210 000 103 000 --103 000 15 000 12 000 27 000 164 000 ------164 000 100 000 30 000 20 000 10 000 160 000 ------10 000 10 000 20 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
58
2014–2015 PROPOSED PROGRAMME BUDGET – FIJI
FIJI Fiji is comprised of 332 islands of which approximately 110 are inhabited, is scattered over 18 000 square kilometres in the Pacific Ocean. The 2010 estimated population of 854 000 is 50.7% male and 49.3% female. Inter-census population growth rate (1996–2007) averaged 0.7% with a total fertility rate of 2.7 equating to about 19 000 births annually. Life expectancy at birth is high for both women (72 years) and men (68 years). Fiji is governed as a parliamentary republic by a military-appointed President, a Prime Minister and Cabinet. Elections are planned to be held in September 2014. Major revenue sources include tourism, sugar, mining, fishing, forestry, clothing/consumable goods and remittances. In 2011, Fiji's human development index was 0.688 (rank of 100 out of 187 countries) and per capita GDP was FJ$ 6608 (US$ 3671). The level of government expenditure on health is comparatively low in comparison with other countries at a similar level of development - total health expenditure was 4.8% of GDP in 2010 (US$ 183 per person) or about 8.9% of government budget. However, Fiji has achieved good health outcomes. Between 1990 and 2010, there were significant reductions in mortality rates – infant mortality by 40%; under-five mortality by 46%; and maternal mortality ratio by 37% - and levels of health care services are generally good. Fiji has a well-developed health system based on the primary health care concept, free universal health care with a small but growing private sector. The main health issues and challenges include: a triple burden of communicable and NCDs and injuries; and health systems pressures such as increasing population demands, especially for more specialized and quality care and universal access to services, while health resources are limited. In 2010, the leading causes of death were diseases of the circulatory system (44%), endocrine, nutritional, or metabolic diseases (13%), and neoplasms (10%), with circulatory and respiratory systems’ diseases and certain infectious and parasitic diseases being the leading causes of morbidity. The major priorities of the Fiji Ministry of Health Strategic Plan 2011–2015 include: NCDs and their risk factors; emerging and reemerging communicable diseases; maternal, adolescent and child health; mental health; and environmental health issues affecting the health and well-being of the community. The strategic plan’s goals include: providing adequate primary and preventive services; accessible clinical and rehabilitative services; and health systems strengthening at all levels. There is a strong drive towards “Wellness” as a more holistic approach to health and empowering individuals to take more responsibility for their health and well-being. Fiji falls under the responsibility of the WHO Representative's Office in the South Pacific/Division of Pacific Technical Support. The WHO Country Cooperation Strategy for Fiji 2013–2017 provides a framework for WHO collaboration with the Fiji Government. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Disabilities and rehabilitation Subtotal 320 000 19 000 --339 000 200 000 100 000 25 000 325 000 78 000 263 000 14 000 49 000 404 000 70 000 231 000 65 000 50 000 416 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
59
2014–2015 PROPOSED PROGRAMME BUDGET – FIJI
Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, Surveillance and Response Alert and response capacities Food safety Subtotal County/area total 39 000 39 000 78 000 1 694 000 20 000 40 000 60 000 1 546 000 --251 000 25 000 15 000 291 000 20 000 220 000 100 000 20 000 360 000 73 000 --509 000 582 000 75 000 10 000 300 000 385 000
60
2014–2015 PROPOSED PROGRAMME BUDGET – FRENCH POLYNESIA
FRENCH POLYNESIA French Polynesia is comprised of five archipelagos spread out over a very extensive area in the Pacific Ocean. Its population estimated at 268 000 (2010) is unevenly distributed with over 80% living on the island of Tahiti. The population is ageing and becoming increasingly urbanized. French Polynesia has experienced a declining population growth rate since 2002. French Polynesia’s status is that of an overseas country within the French Republic with the French Government retaining responsibility for police and justice, monetary policy, tertiary education, migration, and defense and foreign affairs. After enjoying consistent economic growth in the late 1990’s, the country began experiencing structural difficulties that have affected its economy; difficulties exacerbated by the global recession and political instability. Unemployment is on the rise due to job cuts and a shrinking labour market. Major economic activities in French Polynesia include tourism, pearl farming and agricultural processing. French Polynesia spends about 13% of its GDP on health (2008). NCD prevalence is increasing and is second only to respiratory infection as the leading cause of morbidity. In 2007, the leading causes of mortality were neoplasm, followed by diseases of the circulatory system, and injuries and external causes. The five major areas of focus for WHO support for achieving French Polynesia’s Health Blueprint include: NCD prevention and control; health policy development; increasing health management, monitoring and evaluation capacities; strengthening surveillance and health data; information and communications technology. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 4 – Health systems National health policies, strategies and plans Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Subtotal County/area total 36 000 36 000 36 000 ----36 000 ----36 000 36 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
61
2014–2015 PROPOSED PROGRAMME BUDGET – GUAM
GUAM Guam is an island of 549 square kilometres in the North Pacific Ocean, about three quarters of the way from Hawaii to the Philippines. The population of Guam was estimated at 180 692 in 2010. Guam is faced with the challenge of maintaining a health care system that will adequately meet the needs of a predominantly young and growing population. At the same time, it is also faced with the added challenge of addressing the problems of the rapidly increasing number of older people, which is estimated to have increased from 3.9% of the total population in 1990 to 7.5% in 2010. In 2010, average life expectancy at birth was 79.4 years with life expectancy for men 77 years and women 82.1 years. Based on inpatient data, the leading causes of morbidity in 2007 were diseases of pregnancy, childbirth and the puerperium; other forms of heart disease; diabetes mellitus; ischaemic heart disease; influenza and pneumonia; certain infectious and parasitic diseases; malignant neoplasms; cerebrovascular diseases; asthma; and other chronic obstructive pulmonary diseases. The five leading causes of death in 2003 were cardiovascular diseases (119.4 per 100 000 population), malignant neoplasms (68.4), cerebrovascular diseases (31.2), accidents (17.4) and bacterial diseases such as septicaemia (16.2). Although the health status of Guam’s population continues to improve, lifestyle-related diseases remain a concern. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 4 – Health systems Integrated people-centred health services County/area total 36 000 36 000 36 000 36 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
62
2014–2015 PROPOSED PROGRAMME BUDGET – JAPAN
JAPAN Japan with an estimated population of 127.3 million in 2013 has the third largest economy in the world in terms of GDP, after the United States of America and China. The health situation in Japan remains one of the best in the Region and the majority of health-related statistics, such as life expectancy and the under-five mortality rate continue to improve. The health disparities within the country are also relatively small compared with those in other industrialized nations. The average life expectancy remains among the highest in the world and in 2011; it was 85.9 years for women and 79.4 years for men. The infant mortality was 2.4 per 1000 live births and the maternal mortality ratio was 5.0 per 100 000 live births in 2010 With the ageing population, disease patterns have shifted to lifestyle-related diseases, such as cancer, heart disease, cerebrovascular disease and diabetes. These diseases account for 60% of mortality and this trend is expected to continue. Tuberculosis, infectious and difficult-to-treat diseases, such as HIV infection, and new types of influenza are becoming serious threats to public health in Japan. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services County/area total --34 000 34 000 34 000 --34 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
63
2014–2015 PROPOSED PROGRAMME BUDGET – KIRIBATI
KIRIBATI The Republic of Kiribati consists of 33 islands all but one low-lying atolls in three groups–Gilbert, Phoenix and Line Islands–located both sides of the equator and the (classic) date line. Twenty-one of which are permanently inhabited. Though the country extends over 3.5 million square kilometres of ocean, the total land area is only 811 square kilometres. With a maximum elevation of only three to four metres above sea level, the island atolls are highly vulnerable to the potential impact of rising sea level due to climate change. Fortunately, Kiribati generally escapes the major climate change-related threat of cyclones due to its specific geographic location. Kiribati population has a population of 103 058 (National census 2010) with 36% of the total population under 15 years of age, 58% between 15 and 59 and the remaining 5%, 60 years and older. The marginal annual growth rate is 2.2% and urban growth rate is 4.4%. Life expectancy at birth was 63.2 years, under-five mortality was 59 deaths per 1000 live births, the crude birth rate was 31.1 and the crude death rate 7.8 per 1000 population. Infant mortality rate was calculated at 45 per 1000 live births. Kiribati’ society is moving away from traditional subsistence living to a cash economy, with increased reliance on imported, processed foods and motorised transport. This transition has seen significant urban drift to the capital of Tarawa, where approximately 54.1% of Kiribati’s estimated total population now lives. Kiribati ranked 122 on the Human Development Index (2012) faces significant challenges to achieve sustainable development. The country remains vulnerable to wider economic constraints including global economic downturns as well as an increasing population causing general reduction in GDP per capita. Kiribati development is constrained by its small size, remoteness and geographical fragmentation, infertile soil, limited exploitable resources and rapid population growth. There has been a steady improvement in health indicators over the last decade, but the people of Kiribati face the typical double burden of disease of a developing country and are experiencing a shorter lifespan than those observed in most other Pacific islands. Infant and child mortality rates though decreasing remain particularly high. There are high rates of infectious diseases, including respiratory infections, diarrhoeal diseases, skin diseases and hepatitis A and B. The prevalence of tuberculosis is among highest in the Region. Lifestyle diseases are on the rise especially diabetes associated with unhealthy diet and lack of physical activity, cancers and STI. The secondary prevention of cancer for women is in its infancy. The Ministry of Health and Medical Service’s Strategic Plan (2012–2015) focuses areas: comprehensive family planning; maternal, newborn and child health; communicable diseases; risk factors for NCDs; gaps in health service delivery; and health care services for victims of gender-based violence and services that specifically address the needs of youth. WHO’s programme of technical collaboration is managed through a Country Liaison Office supported by technical staff from the WHO Representative's Office in the South Pacific/Pacific Technical Support Division in Suva, Fiji, and focuses on health systems strengthening and health service management, improving health service delivery and public health functions. It also puts a special emphasis on reaching elimination status for Leprosy and Lymphatic Filariasis (“unfinished business”). In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases Neglected tropical diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Disabilities and rehabilitation 155 000 19 000 10 000 150 000 --30 000 68 000 68 000 70 000 70 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
64
2014–2015 PROPOSED PROGRAMME BUDGET –KIRIBATI
Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total
184 000
180 000
55 000 ----19 000 74 000
50 000 5 000 5 000 20 000 80 000
83 000 19 000 65 000 19 000 186 000
80 000 50 000 60 000 20 000 210 000
---------
10 000 10 000 15 000 35 000
----512 000
100 000 100 000 675 000
65
2014–2015 PROPOSED PROGRAMME BUDGET – LAO PEOPLE’S DEMOCRATIC REPUBLIC
LAO PEOPLE'S DEMOCRATIC REPUBLIC The Lao People’s Democratic Republic is surrounded by five other countries in the Greater Mekong Region: China, Cambodia, Myanmar, Thailand and Viet Nam. Lao People’s Democratic Republic has an estimated population of 6.3 million, 32% of which live in urban areas. The total fertility rate is 3.7 children per woman, the estimated population growth is 2.2%, and life expectancy at birth is 65 years. While the Lao People’s Democratic Republic is a low-income country, the economy has been growing steadily with a GDP growth rate at around 8% over the last five years. It ranked 138th out of 187 countries on the Human Development Index in 2012. WHO’s programme in the country is guided by the second WHO Country Cooperation Strategy for the Lao People’s Democratic Republic (2012–2015), which was jointly developed with the Ministry of Health in consultation with other development partners. The country cooperation strategy is in line with the Lao People’s Democratic Republic’s 7th National Socioeconomic Development Plan (2011–2015) and the United Nations Development Assistance Framework for 2012–2015. The country cooperation strategy defined four strategic priorities for technical cooperation: increasing access to primary health care and reducing health inequities by strengthening the health system and improving aid effectiveness; contributing to the achievement of health-related MDGs; preventing and controlling infectious diseases and public health events; and addressing health risk factors to reduce noncommunicable diseases, mental illness and disabilities. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity and human rights mainstreaming Social determinants of health Health and environment Subtotal 1 940 000 146 000 --176 000 1 037 000 3 299 000 1 800 000 5 000 5 000 5 000 550 000 2 365 000 350 000 59 000 107 000 9 000 156 000 681 000 360 000 61 000 100 000 180 000 695 000 1 396 000 388 000 485 000 776 000 388 000 1 261 000 3 298 000 672 000 157 000 585 000 366 000 1 937 000 3 717 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
66
2014–2015 PROPOSED PROGRAMME BUDGET – LAO PEOPLE’S DEMOCRATIC REPUBLIC
Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----13 073 000 100 000 100 000 14 401 000 305 000 3 792 000 146 000 388 000 4 631 000 2 700 000 1 700 000 200 000 200 000 4 800 000 221 000 572 000 167 000 204 000 1 164 000 869 000 816 000 159 000 179 000 2 023 000
67
2014–2015 PROPOSED PROGRAMME BUDGET – MALAYSIA
MALAYSIA Malaysia is comprised of Peninsular Malaysia and the states of Sabah and Sarawak on the island of Borneo with a total land area of 330 289 square kilometres. It is a multi-ethnic country with a population consisting of Malays, Chinese, Indian and other ethnic groups. In 2011, the population of Malaysia was estimated to be 28 964 300. Malaysia is an upper middle-income country with good financial and technical capacity. There has been sustained political and economic stability, and political commitment and financial investment in social sectors. Malaysia has a broad-based and diversified economy. In 2011, its GDP stood at US$ 287.9 billion, with per capita GDP of US$ 9977. As a result, a relatively strong health care system has evolved and there is good improvement in health outcomes. Malaysia has achieved a comparatively good standard of health with a relatively low total health expenditure of 4.96% of GDP (2009). In 2010, the life expectancy at birth had increased to 71.9 years for males and 77.0 years for females. The crude death rate was 4.8 per 1000 population, crude birth rate was 17.5 per 1000 population and the average annual population growth rate was 1.8%. The infant mortality rate was 6.8 per 1000 live births, under-five mortality rate was 8.5 per 1000 live births and the maternal mortality rate was 27.3 per 100 000 live births. Malaysia has achieved good health indicators with a primary care led and generally accessible health system. Both communicable and NCDs remain a burden to Malaysia. In 2011, the top five principal causes of death in Ministry of Health hospitals were diseases of the circulatory system (25.64%), diseases of the respiratory system (19.48%), certain infectious and parasitic diseases (17.02%), neoplasms (11.12%) and diseases of the digestive system (5.18%). Some communicable diseases persist; dengue, HIV/AIDS, foodborne diseases and tuberculosis are among the leading contributors to the communicable disease burden. WHO collaborative programmes managed by the country office have focused on selective priority areas, namely communicable disease outbreak management, NCD, health care financing, primary care and research. The country office will continue to provide technical support in NCDs (including mental health and disability), access to medicines and health technologies, health system information, environmental health as well as assistance in the development of national health policy and enhancement of health system delivery focusing on priority areas for longer term strategic collaboration. The WHO country office also coordinates Malaysia's contribution to the work of WHO through hosting of a number of WHO regional and global meetings, providing expert support to WHO programmes and receiving a number of foreign fellows. The collaborative programme for the coming years will reflect the increasing role played by Malaysia lending experts to other countries within the Region. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases Malaria Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Disabilities and rehabilitation Subtotal Category 3 – Promoting health throughout the life-course Health and environment Subtotal 98 000 98 000 45 000 45 000 227 000 ----227 000 161 000 50 000 26 000 237 000 73 000 73 000 -----
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
68
2014–2015 PROPOSED PROGRAMME BUDGET –MALAYSIA
Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----814 000 100 000 100 000 939 000 57 000 ----57 000 60 000 ----60 000 359 000 ------359 000 150 000 217 000 65 000 65 000 497 000
69
2014–2015 PROPOSED PROGRAMME BUDGET – MARSHALL ISLANDS
MARSHALL ISLANDS The Marshall Islands covers an area of 181 square kilometres in the Pacific Ocean and is comprised of 29 atolls and 5 major islands. The estimated population of the Marshall Islands in 2010 was 54 400 with 28% of the population under 15 years of age. Major economic activities in the Marshall Islands include agriculture, copra production, tuna processing and tourism. The United States Government provides direct aid to the Marshall Islands, such assistance is the mainstay of the economy. Current surveys and socioeconomic indicators suggest that poverty and hardship are on the rise. The Marshall Islands falls under the responsibility of the new WHO Country Liaison Office for Northern Micronesia located in Pohnpei, Federated States of Micronesia. Diabetes-related diseases and cancer are now leading causes of death. The leading causes of morbidity include child birth-related conditions, pneumonia and diabetes. Sepsis, malnutrition, pneumonia, drowning, and prematurity were the major causes of infant mortality, while severe malnutrition, bacterial meningitis, gastroenteritis, and pneumonia accounted for most childhood mortality. The strategic priorities for collaboration between the Marshall Islands Ministry of Health and WHO are based on the Ministry of Health National Strategic Plan (NSP) for 2012–2014 and includes: addressing the prevention and control of NCDs, strengthening surveillance for vaccine-preventable diseases; strengthening maternal, child and reproductive health; strengthening the pharmaceutical sector; and scaling-up HRH. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 3 – Promoting health throughout the life-course Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Emergency risk and crisis management Food safety Subtotal County/area total 8 000 ----8 000 284 000 --10 000 15 000 25 000 293 000 --213 000 ----213 000 20 000 111 000 30 000 20 000 181 000 ----20 000 20 000 46 000 46 000 47 000 47 000 ------17 000 17 000 5 000 5 000 5 000 5 000 20 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
70
2014–2015 PROPOSED PROGRAMME BUDGET – MICRONESIA, FEDERATED STATES OF
MICRONESIA, FEDERATED STATES OF The Federated States of Micronesia is comprised of four main island groups with over 600 volcanic Islands and atolls scattered over 1.5 million square kilometres of the Pacific Ocean. The population in 2012 was estimated at 102 600 with 35.7% the under 15 years of age. Approximately 49% of the population lives in Chuuk, 32% in Pohnpei, 11% in Yap and 8% in Kosrae; with almost 23% living in urban areas. Federated States of Micronesia which entered into a Compact of in Free Association with the United States of America is a constitutional federation of four states: Chuuk, Pohnpei, Yap and Kosrae. Major economic activities include tourism, construction and fish processing. There has been slow growth of the private sector with geographical isolation and a poorly developed infrastructure remains major impediments to long-term growth. In 2006, the leading causes of death were due to endocrine- and nutrition-related diseases, metabolic diseases (e.g. diabetes mellitus), diseases of the respiratory system (e.g. chronic obstructive pulmonary disease), and diseases of the circulatory system. The leading causes of morbidity include diseases of the respiratory system, diseases of the circulatory system, and infectious and parasitic diseases. The Federated States of Micronesia falls under the responsibility of the new WHO Country Liaison Office for Northern Micronesia, located in Pohnpei. Based on the Federated States of Micronesia Strategic Development Plan (2004–2023), areas of focus for the collaboration with WHO include: prevention and control of NCDs; improving capacity for addressing communicable diseases including vaccine-preventable diseases; strengthening environmental health capacity including water and sanitation, food safety and climate change; and strengthening the capacity of HRH. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Neglected tropical diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Disabilities and rehabilitation Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Subtotal 34 000 34 000 40 000 40 000 238 000 --141 000 379 000 10 000 325 000 20 000 355 000 --13 000 13 000 50 000 --50 000 68 000 ----68 000 52 000 12 000 25 000 89 000 ----64 000 64 000 20 000 40 000 --60 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
71
2014–2015 PROPOSED PROGRAMME BUDGET – MICRONESIA, FEDERATED STATES OF
Emergencies Outbreak and crisis response Subtotal County/area total ----558 000 100 000 100 000 694 000
72
2014–2015 PROPOSED PROGRAMME BUDGET – MONGOLIA
MONGOLIA Landlocked between the Russian Federation and China, Mongolia is the world’s 19th largest country. It is a democratic state with a parliamentary system, and has an estimated population of 2.81 million (2011) with 67.1% classified as urban. A very low population density (1.81 persons per square kilometre) and harsh climate poses a great challenge to the delivery of health services, especially in rural areas. Mongolia underwent a rapid transition from a centrally planned economy to a market based economy in the early 1990s. The initial period of transition was difficult; however, since about 2000, Mongolia has experienced steady economic growth. In spite of this recovery, poverty and unemployment continue to be major challenges. The main pillar of the domestic economy, particularly for the rural population, is herding and agricultural activities. Mining holds the most significant economic development potential overall. It already accounts for over 67% of exports and is expected to become the main contributor to GDP by 2020. Mongolia is included among countries in the medium human development index (0.675 in 2012) group. Its epidemiological projection is consistent with other countries that have undergone rapid economic transitions. Infectious diseases have given way to noncommunicable diseases. The main causes of morbidity and mortality are diseases of the circulatory system and cancers. The Government has initiated a health sector reform programme (2013–2016) which establishes public health care and service at a primary level of health system as a priority in addition to strengthening secondary, tertiary level service delivery. Within the health sector reform framework, the Ministry of Health has an explicit interest to enhance coordination and partnerships between national and international health partners and other stakeholders particularly around activities aimed strengthening health systems at the subnational level. WHO’s programme of technical collaboration is managed through the country office with professional staff in the areas of programme management, health systems development, environmental health, NCDs, EPI and communicable diseases surveillance and response. The country cooperation strategy was updated in 2010 identifies five strategic priorities for 2010–2015: health systems strengthening through primary health care approach; scaling-up prevention and control of NCDs, injuries, violence and their determinants; sustaining and accelerating the achievement of health-related MDGs; strengthening health security including control of communicable and vaccine-preventable diseases and strengthening environmental health management. These areas of collaboration with a focus on subnational health system strengthening will be reflected in the country workplans for the 2014–2015 biennium. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal 591 000 --534 000 --331 000 1 456 000 733 000 100 000 70 000 50 000 47 000 1 000 000 143 000 147 000 --679 000 969 000 150 000 150 000 50 000 750 000 1 100 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
73
2014–2015 PROPOSED PROGRAMME BUDGET – MONGOLIA
Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----4 755 000 100 000 100 000 5 502 000 203 000 --428 000 --631 000 500 000 100 000 200 000 200 000 1 000 000 --650 000 78 000 --728 000 902 000 465 000 130 000 80 000 1 577 000 49 000 49 000 --873 000 971 000 250 000 --25 000 450 000 725 000
74
2014–2015 PROPOSED PROGRAMME BUDGET –NAURU
NAURU Nauru, the world’s smallest republic, is an island nation located 40 kilometres south of the equator in the South Pacific Ocean. The estimated population in 2011 was 9700, with 35.6% of the population under 15 years of age and 1.3% 65 years and above. The major economic activity in Nauru is phosphate mining, but reserves are declining. From 2001 to 2007, the Australian Government supported a policy of transporting asylum seekers to detention centres in the Pacific including Nauru. The policy was reinstated in 2012 providing the country additional revenue. Coconut, banana and papaya are the main fruit crops and small quantities of vegetables are also grown. However, most food and water in Nauru is imported from Australia and other countries, such as China. Nauru has been without banking services since 1998. Nauru falls under the responsibility of the WHO Representative’s Office in the South Pacific/Division of Pacific Technical Support. NCDs, such as diabetes, hypertension and obesity have become the leading causes of morbidity and mortality in Nauru. The four overarching areas of health focus of the Nauru National Sustainable Development Strategy 2005–2025 for which WHO provides support include: progressing and achieving the MDGs; NCD prevention and control; adhering to conventions of the United Nations such as Framework Convention on Tobacco Control (FCTC); and improving health information, human resource development, and medical products and equipment management systems. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases Tuberculosis Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Health and environment Subtotal Category 4 – Health systems Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Emergency risk and crisis management Subtotal County/area total 3 000 3 000 98 000 5 000 5 000 101 000 28 000 ----28 000 33 000 14 000 23 000 70 000 23 000 --23 000 10 000 11 000 21 000 44 000 44 000 --------5 000 5 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
75
2014–2015 PROPOSED PROGRAMME BUDGET –NIUE
NIUE Niue is a small, isolated island in the South Pacific Ocean, situated between Tonga and Rarotonga (Cook Islands). This large raised coral atoll, with a land area of 259 square kilometres has a population of 1 496, which has dropped significantly in since 1966. Many factors have influenced overseas migration, particularly to New Zealand where Niueans hold citizenship, such as lack of natural resources, isolation, and insufficient social and economic development. Health indicators in general are good. Infant mortality is low and no maternal deaths have been recorded since 1999. The average life expectancy for men is 67 years and 76 years for women. Common childhood diseases and traditional communicable diseases have been substantially contained. Immunization coverage is 100%. Lifestyle-related health problems are increasing and the prevalence of chronic disease risk factors s is high. WHO programmes of technical assistance are managed through the country office in Apia, Samoa, which is responsible for American Samoa, Cook Islands, Niue, Samoa and Tokelau. Technical cooperation between the Niue Government and WHO focuses mainly on HRH, communicable and NCD prevention and control, health promotion, nutrition, mental health, alcohol and tobacco control. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Subtotal County/area total ------93 000 --5 000 5 000 96 000 --41 000 41 000 10 000 40 000 50 000 ------5 000 5 000 10 000 17 000 --4 000 21 000 15 000 5 000 --20 000 --31 000 31 000 5 000 6 000 11 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
76
2014–2015 PROPOSED PROGRAMME BUDGET –NORTHERN MARIANA ISLANDS, COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS, COMMONWEALTH OF THE The Commonwealth of the Northern Mariana Islands comprises 14 islands with a total land area of 457 square kilometres, spread over 683 760 square kilometres in the Northern Pacific Ocean. The multiethnic population was estimated at 63 100 in 2010 with just over 26% under 15 years of age. The Northern Mariana Islands is a commonwealth in political union with the United States of America. The major economic activities in the Commonwealth of the Northern Mariana Islands are construction, fishing, garment manufacturing, tourism and handicrafts. The Commonwealth of the Northern Mariana Islands falls under the responsibility of the WHO Representative’s Office in the South Pacific/Division of Pacific Technical Support. It further receives informal support from the WHO Country Liaison Office for Northern Micronesia, located in Pohnpei, Federated States of Micronesia. The leading causes of death in the Commonwealth of the Northern Mariana Islands are cancer, stroke, respiratory and heart disease. Infectious diseases such as tuberculosis, enteric foodborne illnesses, vaccine-preventable diseases, HIV and other STI are still a public health concern. The four overarching areas of focus for which WHO provides technical assistance and support include: prevention and control of noncommunicable diseases; maternal, adolescent, and child health programmes; and health systems strengthening through building capacity of HRH as well as health care financing. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Subtotal County/area total ----37 000 10 000 10 000 37 000 37 000 37 000 27 000 27 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
77
2014–2015 PROPOSED PROGRAMME BUDGET –PACIFIC ISLAND COUNTRIES
PACIFIC ISLAND COUNTRIES Pacific island countries (PICs) budget has been established in November 2009. This budget centre is managed by the WR/South Pacific/Director, Pacific Technical Support and represents costs and activities of 21 Pacific island countries and areas, i.e. American Samoa; Cook Islands; Fiji; Guam; Kiribati; Marshall Islands; Micronesia, Federated States of; Northern Mariana Islands, the Commonwealth of the; New Caledonia, New Zealand; Niue; Nauru; Papua New Guinea, Palau; French Polynesia; Samoa; Tokelau; Tonga; Tuvalu, Vanuatu; and Wallis and Futuna. This is in addition to the individual budgets for the countries and areas mentioned. In 2014–2015, WHO technical cooperation with the governments is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity and human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal 679 000 1 143 000 --409 000 2 231 000 1 000 000 600 000 150 000 250 000 2 000 000 1 723 000 1 817 000 1 213 000 970 000 5 723 000 1 304 000 3 166 000 1 429 000 707 000 6 606 000 291 000 ------873 000 1 164 000 500 000 10 000 10 000 10 000 800 000 1 330 000 2 462 000 785 000 439 000 437 000 728 000 4 851 000 3 121 000 1 500 000 10 000 180 000 430 000 5 241 000 654 000 806 000 523 000 873 000 733 000 3 589 000 700 000 972 000 --1 100 000 1 183 000 3 955 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
78
2014–2015 PROPOSED PROGRAMME BUDGET – PACIFIC ISLAND COUNTRIES
Emergencies Outbreak and crisis response Subtotal County/area total ----17 558 000 100 000 100 000 19 232 000
79
2014–2015 PROPOSED PROGRAMME BUDGET –PALAU
PALAU Palau is a democratic republic that consists of many small islands in the Western Pacific. Palau is divided into 16 states, with 79% of the population residing in the greater Koror urban area. The estimated population of Palau in 2010 was 20 500 with 20.5% under 15 years of age. Palau is in a Compact of Free Association with the United States of America. Major economic activities in Palau include tourism, handicrafts, subsistence agriculture, construction and fishing. Like many developing nations, Palau has recently undergone an epidemiological transition from malnutrition and communicable diseases to an increasing burden of NCDs such as diabetes, heart disease, obesity and kidney failure. In 2009, the leading causes of death included cardio/cerebrovascular disease, cancer and respiratory disease. Palau falls under the responsibility of the new WHO Country Liaison Office for Northern Micronesia located in Pohnpei, Federated States of Micronesia. Based on the Ministry of Health’s Strategic Plan, areas of focus for the collaboration between Palau and WHO include: the prevention and control of NCDs; injury, violence, and mental health; strengthening surveillance of vaccine-preventable diseases; developing health information systems; supporting the response to climate change; and scaling-up HRH. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services County/area total --116 000 116 000 50 000 70 000 120 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
80
2014–2015 PROPOSED PROGRAMME BUDGET –PAPUA NEW GUINEA
PAPUA NEW GUINEA Papua New Guinea (PNG) is a lower middle-income country and one of the world’s most ethnically diverse countries, with over 850 indigenous languages each language group having a distinct culture. According to the preliminary results of the 2011 population census, Papua New Guinea has an estimated population of 7.06 million; the population grew by 2.83% between 2000 and 2011. Forty per cent (1.5 million) of the population is under 15 years of age. Approximately 87.5% of the population lives in rural areas where access to social services is often poor, difficult and expensive. Health services are provided by the Government and church medical services. Services are financed primarily by public funds which are complemented by contributions from development partners. Over the years rural health services have deteriorated significantly mainly as a result declining infrastructure, frequent shortages of essential medicines, scarce and inefficiently deployed HRH and weak supervision and support systems. With high rates of infant mortality, under-five mortality, maternal mortality and an estimated 40% of the population living on less than US$ 1 per day, Papua New Guinea is unlikely to meet the MDGs by 2015. Communicable diseases, including malaria and tuberculosis remain major causes of morbidity and mortality in all age groups. Papua New Guinea has a low prevalence (0.8 %) generalized HIV/AIDS epidemic. Noncommunicable diseases are a significant contributor to the burden of disease in Papua New Guinea. The strategic directions for WHO’s work in Papua New Guinea is outlined in the Country Cooperation Strategy 2011–2015, which is aligned with both Papua New Guinea’s National Health Plan 2011–2020 and the Medium Term Development Plan 2011–2015. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal 3 638 000 4 802 000 1 251 000 --9 691 000 1 113 000 2 150 000 1 920 000 225 000 5 408 000 1 115 000 25 000 218 000 1 358 000 1 500 000 45 000 590 000 2 135 000 1 067 000 --97 000 --1 164 000 637 000 50 000 --441 000 1 128 000 544 000 897 000 1 164 000 291 000 1 940 000 4 836 000 1 000 000 1 810 000 1 000 000 1 000 000 1 763 000 6 573 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
81
2014–2015 PROPOSED PROGRAMME BUDGET – PAPUA NEW GUINEA
Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----18 504 000 100 000 100 000 16 764 000 1 455 000 ------1 455 000 800 000 300 000 225 000 95 000 1 420 000
82
2014–2015 PROPOSED PROGRAMME BUDGET –PHILIPPINES
PHILIPPINES The Philippines is a lower middle-income country whose economic growth in the past has been modest compared to Asian countries. However, with the current administration’s platform focusing on good governance, the country saw a rise in its GDP growth in recent years reaching 6.6% in 2012. The challenge is for this new found economic growth to be felt by all. The latest poverty data showed that the lives of poor Filipinos had not improved in the past seven years. In response the Government aims to enrol 4.6 million families in a Conditional Cash Transfer programme with a focus on improving access to education and health services by 2015. Significant increases in government expenditure is supporting the Aquino Agenda for Health which aims to ensure universal health care through the expansion of national health insurance, improvements in health facilities and investment in health care services. Gains have been seen in public health with the passage of the Mandatory Basic Immunization Services for Infants and Children Act, the Sin Tax Law, the Responsible Parenthood and Reproductive Health Law and the Food Safety Act. Tuberculosis and malaria incidence have fallen. But challenges remain. Maternal mortality targets of the MDGs will most likely not be achieved, the reduction in newborn death rate has stagnated, and HIV incidence is rising. In addition, there is an increasing burden of chronic and degenerative diseases and the Philippines is highly vulnerable to natural disasters that can have devastating impact on health and development. Improvements in health status in the country have occurred but remain uneven. Continued implementation of the universal health care agenda to achieve better health outcomes, sustained health financing and responsive health systems continues to be supported by institutionalized health partners’ collaboration. WHO’s programme of collaboration in the country is guided by its country cooperation strategy in line with government priorities In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health 269 000 631 000 267 000 319 000 531 000 274 000 428 000 154 000 873 000 1 455 000 1 470 000 --350 000 1 820 000 825 000 146 000 ----971 000 1 400 000 --100 000 170 000 1 670 000 1 164 000 1 455 000 1 601 000 858 000 742 000 5 820 000 370 000 1 600 000 700 000 540 000 1 500 000 4 710 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
83
2014–2015 PROPOSED PROGRAMME BUDGET – PHILIPPINES
technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio eradication Outbreak and crisis response Subtotal County/area total ------11 449 000 204 000 500 000 704 000 11 298 000 174 000 1 601 000 166 000 --1 941 000 500 000 100 000 500 000 50 000 1 150 000 95 000 1 262 000 120 000 1 244 000
84
2014–2015 PROPOSED PROGRAMME BUDGET –SAMOA
SAMOA The Independent State of Samoa consists of a small group of islands in the South Pacific Ocean, situated halfway between Hawaii and New Zealand, and measuring about 2935 square kilometres. It is comprised of two main islands, Upolu and Savaii, plus several smaller islands. Samoa has a land area of about 2842 square kilometres, with a population of 180 741. Village communities and extended families continue to play a major role in Samoan society. The extended family, or aiga, is the foundation of the fa’a-samoa, or traditional way of life in Samoa. NCDs are among the leading causes of morbidity and mortality, along with injuries and wounds. The increased prevalence of NCDs has been linked to changing diets, increased use of tobacco and alcohol, and limited public understanding of the associated risks. There also are concerns about emerging and reemerging diseases and the capacity to protect the population from these public health threats, particularly in context of climate change and vulnerability to natural disasters. WHO programmes of technical cooperation are managed through the country office in Apia, which is responsible for American Samoa, Cook Islands, Niue, Samoa and Tokelau. The Country Cooperation Strategy 2013–2017 identifies four strategic priority areas for cooperation between WHO and the Government: contributing to health systems strengthening; preventing and controlling NCDs, including mental health, injuries, disabilities and their risk factors; accelerating achievement of the MDGs; and building capacities in responding to and mitigating public health threats and risks posed by emergencies and disasters. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal 99 000 447 000 ----546 000 106 000 356 000 155 000 105 000 722 000 38 000 33 000 71 000 40 000 30 000 70 000 518 000 ------27 000 545 000 500 000 96 000 92 000 82 000 103 000 873 000 174 000 ------174 000 63 000 13 000 13 000 22 000 111 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
85
2014–2015 PROPOSED PROGRAMME BUDGET – SAMOA
Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----1 336 000 100 000 100 000 1 946 000 ----------20 000 10 000 20 000 20 000 70 000
86
2014–2015 PROPOSED PROGRAMME BUDGET –SINGAPORE
SINGAPORE The Republic of Singapore is an independent island republic located at the southern tip of the Malay Peninsula, in Southeast Asia. It has a total land area of 715.8 square kilometres, with a total population of about 5 312 400 in 2012. Singapore is a parliamentary republic and its legal system is based on English common law. Singapore is characterized by a highly developed and successful free-market economy. In 2012, its GDP stood at US$ 276.5 billion, with per capita GDP of US$ 52 051. Singapore has one of the most successful healthcare systems in the world, in terms of both efficiency and the results achieved in community health outcomes. Rising standards of living, high standards of education, good housing, safe water supply and sanitation, high quality medical services and the active promotion of preventive medicine, have all helped boost the health of Singaporeans. The leading causes of mortality are major NCDs such as cancer (30.0%), ischaemic heart disease (16.4%), cerebrovascular disease, including stroke (9.0%) and diabetes mellitus (1.7%). In 2012, the crude birth rate for Singapore was 10.1 per 1000 population and the crude death rate was 4.5 per 1000 population. The total fertility rate has shown a slight increase to 1.29 children per woman of reproductive age period (total fertility rates were 1.15 in 2010 and 1.20 in 2011). The infant mortality rate was 1.8 per 1000 live births. Life expectancy at birth was 79.6 years for males and 84.3 years for females in 2012. The WHO collaborative programme, being managed by the country office based in Kuala Lumpur, in 2012–2013 has focused on supporting capacity-building for emergency preparedness, in particular horizon scanning and risk assessment, as well as for the field epidemiology training programme (FETP) and for policy and experience reviews related to strengthening the health workforce and collaborating on emerging infectious diseases. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases Tuberculosis Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 4 – Health systems National health policies, strategies and plans Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic- and pandemic-prone diseases Subtotal County/area total 18 000 --18 000 35 000 --10 000 10 000 37 000 17 000 17 000 --------15 000 15 000 ------7 000 5 000 12 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
87
2014–2015 PROPOSED PROGRAMME BUDGET –SOLOMON ISLANDS
SOLOMON ISLANDS Solomon Islands form a Pacific archipelago of 922 islands, 347 of which are inhabited. Its land area of 28 900 square kilometres is scattered over 1.3 million square kilometres. The population is estimated to be 584 578 (July 2012 estimate). The Solomon Islands is classified as a lower middle-income country by the World Bank (2012). The Islands are rich in undeveloped mineral resources such as lead, zinc, nickel, and gold. However, more than 75% of its labour force is engaged in subsistence and fishing. Most manufactured goods and petroleum products must be imported. The Ministry of Health and Medical Services’ National Health Strategic Plan 2011–2015, shifts the focus from medically-oriented interventions towards more intersectoral efforts to tackle the social determinants of health and reduce the risk factors, mostly related to unhealthy lifestyle, which lie at the root of the disease burden. The plan envisages as well a major effort to increase efficiency in the way human and financial resources are managed; infrastructure is planned, used and preserved; and calls upon the provincial governments to play a more substantial role in the management of all aspects of health care delivery to their respective populations. In August 2012 the WHO Office was upgraded to full status as a WHO Representative Office to keep pace with evolving public health challenges in Solomon Islands. WHO’s programme of technical cooperation includes: strengthening health systems; renewal of primary health care and UHC; strengthening surveillance and control of communicable and NCDs, emergency and disasters preparedness and response and HRH. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal --795 000 534 000 --1 329 000 730 000 410 000 150 000 372 000 1 662 000 829 000 5 000 400 000 1 234 000 360 000 15 000 75 000 450 000 476 000 --------476 000 250 000 150 000 25 000 70 000 25 000 520 000 543 000 815 000 97 000 486 000 1 941 000 606 000 813 000 300 000 271 000 1 990 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
88
2014–2015 PROPOSED PROGRAMME BUDGET – SOLOMON ISLANDS
Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----5 039 000 100 000 100 000 5 272 000 36 000 ----23 000 59 000 150 000 80 000 270 000 50 000 550 000
89
2014–2015 PROPOSED PROGRAMME BUDGET –TOKELAU
TOKELAU Tokelau is a self-governing territory administered by New Zealand. It consists of three small atolls (Fakaofo, Nukunonu, and Atafu), with a total area of approximately 12.2 square kilometres. Each atoll is approximately 200 metres wide and no more than five metres above sea level, which makes the territory highly vulnerable to cyclones and climate change. Tokelau has a population of less than 1500 people. There are fewer Tokelauans living in Tokelau than in New Zealand, where most migrate for education, employment, and development opportunities. Human resources for health is a major challenge facing Tokelau with cases beyond local treatment capacity currently being evacuated by sea to Apia, Samoa which can take over 30 hours. Funding for health programmes, especially training, and noncommunicable (NCDs) diseases remains a priority for the health sector. WHO programmes of technical assistance are managed through the country office in Apia, which is responsible for American Samoa, Cook Islands, Niue, Samoa and Tokelau. Technical cooperation between the Government and WHO focuses mainly on HRH, communicable and NCD prevention and control, tobacco control, mental health, and health promotion and protection. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Subtotal Category 5 - Preparedness, surveillance and response Alert and response capacities Subtotal County/area total ----95 000 5 000 5 000 98 000 ------10 000 38 000 48 000 ------5 000 5 000 10 000 81 000 81 000 30 000 30 000 --14 000 14 000 5 000 5 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
90
2014–2015 PROPOSED PROGRAMME BUDGET –TONGA
TONGA Kingdom of Tonga is an upper middle-income country covering over 740 square kilometres in the Pacific Ocean with a population of 103 036 (2011), of which about 73% live on the main island Tongatapu and 27% are distributed on the outer islands. The economy is based on agriculture, tourism and to a lesser degree, fishing. The public-funded health system provides service free of charge and the formal private sector remains small. WHO’s programme of technical collaboration is managed by the Country Liaison Office based in the Ministry of Health. The dominant health problem is the high prevalence and burden of NCDs and their risk factors, of which the very high prevalence of overweight and obesity, hypertension, daily tobacco use and raised blood cholesterol are most prominent. WHO’s technical assistance from 2013–2017 will focus on fighting NCDs, strengthening the health information system, contributing to the advancement of the education and training of health workers, health sector reform, and enhancing infrastructure capacity. NCD prevention and control will be address through high-level multisectoral concrete collaboration at national level and community partnership at local level. Environmental health, emergencies and disasters preparedness also will be supported. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----908 000 100 000 100 000 1 012 000 --433 000 20 000 96 000 549 000 54 000 378 000 21 000 99 000 552 000 18 000 --94 000 112 000 19 000 5 000 75 000 99 000 189 000 ----53 000 242 000 120 000 10 000 10 000 110 000 250 000 ----5 000 5 000 5 000 3 000 3 000 11 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
91
2014–2015 PROPOSED PROGRAMME BUDGET –TUVALU
TUVALU Tuvalu, one of the world’s smallest independent countries, is comprised of nine atolls situated over 25.6 square kilometres of land in the South Pacific Ocean. The country with an estimated population of 11 150 (2010) has a high population density. Tuvalu has a relatively young population with 32% under the age of 15. Tuvalu’s extremely arid and sandy soil is not suitable for agriculture and there is no industry, including tourism. The major sources of income are the sale of copra and fishing rights, and remittances. The Government and the population are conscious of the potential long-term negative impact of global warming on the country’s landmass. In response to this threat New Zealand has established a migratory scheme with Tuvalu. NCDs remain the leading cause of morbidity and mortality in Tuvalu with cardiac diseases accounting for the majority of deaths. Communicable diseases are also a major cause of morbidity, with alarming numbers of acute respiratory infections, eye infections and skin infections. Tuvalu falls under the responsibility of the WHO Representative’s Office in the South Pacific/Pacific Technical Support Division. The areas of work, selected based on ability to contribute towards the achievement of the Tuvalu Strategic Health Plan (2009–2019), include: prevention and control of NCDs with a focus on primary health care; expansion of syndromic surveillance; communicable disease prevention (including immunization); increasing the capacity and quality of laboratory services and availability and quality of medical products; climate change and associated issues; health information systems data quality improvement; and human resource policy development. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases Tuberculosis Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Food safety Subtotal 11 000 ----11 000 --10 000 5 000 15 000 89 000 ----89 000 10 000 60 000 20 000 90 000 2 000 --2 000 --2 000 2 000 11 000 11 000 11 000 11 000 --6 000 6 000 5 000 1 000 6 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
92
2014–2015 PROPOSED PROGRAMME BUDGET – TUVALU
Emergencies Outbreak and crisis response Subtotal County/area total ----119 000 ----124 000
93
2014–2015 PROPOSED PROGRAMME BUDGET –VANUATU
VANUATU Vanuatu, a Melanesian archipelago of 83 islands and more than 100 languages, has a land mass of 12 189 square kilometres. It is situated in a geographic zone at high-risk for natural disasters. Volcanic activity, floods, earthquakes, and a small tsunami have occurred during the last two years. Vanuatu has a population of 234 023 (2009) and an annual population growth rate of 2.3%. Nearly 39% of the population are below 15 years of age. Life expectancy is 69 years for men and 72 years for women. The crude birth rate is 30.1 per 1000 population and the estimated crude death rate is 5.5. The infant mortality rate has dropped by about half to 25 per 1000 live births over the last 20 years while the maternal mortality ratio has remained constant at 86 per 100 000 live births. Most of the population are engaged in either subsistence agriculture or cash crop farming. Urban migration is increasing at an alarming rate (the urban population is currently 24.4%) particularly from rural islands to the urban towns of Port Vila and Luganville, as people seek opportunities for employment and education. Opportunities for paid employment are limited and can only be sourced through government departments, private companies and other small business enterprises. The Government’s Priorities and Action Agenda for 2006–2015 (PAA) defines the main development agenda for the country as follows: expanding the productive sector (agriculture, tourism); maintaining a macroeconomic balance; raising public service performance; cutting costs associated with transport and utilities; and improving access to basic services for health and education. WHO's programme of technical cooperation supports the Government's commitment to provide equitable and affordable health care. WHO will continue to support many components of the Health Sector Strategy 2010–2016 specifically: health systems strengthening; support for health service delivery through primary health care; health information; surveillance and control of communicable and NCDs; emergencies and disaster preparedness and responses; maternal and child health and HRH development. The Vanuatu Government is now engaged in an ambitious programme to eliminate malaria, yaws and filariasis. WHO actively collaborates with other development partners especially with Australian Government's Overseas Aid Programme (AusAID) and UNICEF to lead and coordinate health partnership in the spirit of the Paris Declaration and Accra Commitment. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Gender, equity and human rights mainstreaming Health and environment Subtotal 16 000 21 000 10 000 47 000 32 000 --60 000 92 000 259 000 12 000 --5 000 276 000 282 000 25 000 10 000 30 000 347 000 5 000 948 000 --308 000 1 261 000 781 000 10 000 371 000 400 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
94
2014–2015 PROPOSED PROGRAMME BUDGET – VANUATU
Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----2 240 000 100 000 100 000 2 410 000 55 000 6 000 13 000 74 000 35 000 20 000 --55 000 363 000 204 000 15 000 --582 000 616 000 114 000 --305 000 1 035 000
95
2014–2015 PROPOSED PROGRAMME BUDGET –VIET NAM
VIET NAM Situated some 3260 kilometres along the Indo-Chinese peninsula, Viet Nam forms an area of 332 600 square kilometres. It has a total population of 87.4 million with an average population density of 254 persons per square kilometre with the highest concentration in the Red River Delta region. Most of the population (70%) lives in rural areas, but urbanization has been growing at a rate of 3.2% per annum from 2005–2010. Viet Nam continues to be one of the fast growing economies in the Region, registering a GDP per capita of US$ 1596 and 5.03% growth rate in 2012. In general, Viet Nam’s health status has improved over the past decade with average life expectancy reaching 73 years in 2011. The achievement of most of the health-related MDGs is on track. Viet Nam has more than halved the under-five mortality rate from 58.1% in 1990 to 23.3% in 2011 with the goal to reduce the rate to 19.3% in 2015. It has also achieved a substantial reduction of maternal mortality, reducing the mortality rate ratio from 233 per 100 000 live births in 1990 to 67 per 100 000 live births in 2011. Despite these achievements, the important disparities between regions, provinces and population groups highlights the considerable challenges that still remain. WHO’s technical collaboration programme is managed through the country office. The Viet Nam–WHO collaborative programme for 2014–2015 is focused on the guiding objectives of the ongoing WHO reform agenda and aligned with the priorities included in Viet Nam’s Five-Year Health Plan 2011–2015. Among the national health priorities are: acceleration in the attainment of the health MDGs, namely maternal and child health, child immunization, tuberculosis, malaria and HIV/AIDS and addressing the corresponding equity issues involved; and health systems strengthening to attain UHC. While tackling these priorities, Viet Nam also needs to prepare and strengthen its capacity to deal with future public health issues: injury prevention and traffic safety; prevention and management of NCDs including tobacco control and mental health; ageing; environmental and occupational health. The work of the WHO country office will focus on three areas: technical assistance on national health priorities; strengthening the country’s capacity to deal with new and future public health issues; and health security. Under health security the country office will support national efforts to address effectively persistent health threats, such as influenza, hand foot and mouth disease and dengue that call for strengthened preparedness, prevention, control, response and recovery. Country office support and resources will be broadly allocated to those areas in following proportions: 60% to national health priorities; 30% to future public health issues; and 10% to health security. In 2014–2015, WHO technical cooperation with the Government is expected to focus on the following WHO categories and programmes: Category/Programme Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and 582 000 1 109 000 2 037 000 485 000 965 000 485 000 3 972 000 1 400 000 300 000 1 100 000 400 000 3 200 000 1 455 000 1 135 000 2 619 000 --3 589 000 8 798 000 1 466 000 1 200 000 2 700 000 500 000 2 500 000 8 366 000
Projected Expenditure 2012–2013 (US$)
Proposed PB 2014–2015 (US$)
96
2014–2015 PROPOSED PROGRAMME BUDGET – VIET NAM
adolescent health Ageing and health Gender, equity and human rights mainstreaming Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Outbreak and crisis response Subtotal County/area total ----19 368 000 100 000 100 000 19 781 000 462 000 751 000 631 000 97 000 1 941 000 1 500 000 160 000 350 000 50 000 2 060 000 1 374 000 873 000 655 000 299 000 3 201 000 2 000 000 956 000 700 000 300 000 3 956 000 49 000 49 000 776 000 1 456 000 100 000 40 000 850 000 2 099 000
97
2014–2015 PROPOSED PROGRAMME BUDGET – VIET NAM
98
2014–2015 PROPOSED PROGRAMME BUDGET –BUDGET TABLES
ANNEX - PROPOSED PROGRAMME BUDGET: BY CATEGORY/PROGRAMME AND OFFICE PROJECTED EXPENDITURE 2012–2013 AND PROPOSED PROGRAMME BUDGET 2014–2015
99
2014–2015 PROPOSED PROGRAMME BUDGET –BUDGET TABLES
100
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Proposed Programme Budget 2014–2015 of the Western Pacific Region by category /programme in relation to estimated expenditures 2012–2013 (US$ thousands) Regional Regional Countries Office Total Countries Office Total Projected Expenditure Category/Programme Proposed PB 2014–2015 2012–2013 1 - Communicable disease HIV/AIDS 7 001 3 200 10 201 7 322 2 568 9 890 Tuberculosis 10 051 3 800 13 851 9 093 4 579 13 672 Malaria 8 769 4 239 13 008 10 828 4 177 15 005 Neglected tropical diseases 5 040 2 669 7 709 2 944 3 454 6 398 Vaccine-preventable diseases 14 431 12 300 26 731 13 433 10 509 23 942 Subtotal 45 292 26 208 71 500 43 620 25 287 68 907 2 - Noncommunicable disease Noncommunicable diseases 13 434 10 866 24 300 15 336 12 044 27 380 Mental health and substance abuse 2 829 2 050 4 879 1 476 2 360 3 836 Violence and injuries 2 797 1 665 4 462 2 385 663 3 048 Disabilities and rehabilitation 1 498 2 505 4 003 585 2 012 2 597 Nutrition 3 456 1 000 4 456 2 783 1 044 3 827 Subtotal 24 014 18 086 42 100 22 565 18 123 40 688 3 - Promoting health through the lifecourse Reproductive, maternal, newborn, child and adolescent health 9 900 2 200 12 100 7 599 2 937 10 536 Ageing and health 115 100 215 244 52 296 Gender, equity and human rights mainstreaming 535 100 635 113 107 220 Social determinants of health 53 897 950 330 1 185 1 515 Health and the environment 5 600 2 100 7 700 6 754 1 848 8 602 Subtotal 16 203 5 397 21 600 15 040 6 129 21 169 4 - Health systems National health policies, strategies and plans 11 158 4 753 15 911 12 918 4 479 17 397 Integrated people-centred health services 13 226 6 189 19 415 15 755 5 230 20 985 Access to medicines and health technologies and strengthening regulatory capacity 7 202 3 860 11 062 4 571 3 384 7 955 Health system information and evidence 3 372 4 440 7 812 1 839 3 829 5 668 Subtotal 34 958 19 242 54 200 35 083 16 922 52 005 5 - Preparedness, surveillance and response Alert and response capacities 9 800 5 300 15 100 7 020 4 483 11 503 Epidemic- and pandemic-prone diseases 4 300 3 700 8 000 7 618 4 589 12 207 Emergency risk and crisis management 2 200 1 800 4 000 1 772 1 126 2 898 Food safety 1 100 1 200 2 300 980 982 1 962 Subtotal 17 400 12 000 29 400 17 390 11 180 28 570 6 - Corporate services / enabling functions Leadership and governance 8 500 5 900 14 400 8 747 5 927 14 674 Transparency, accountability and risk management 0 100 100 70 70 Strategic planning, resource coordination and reporting 2 500 3 900 6 400 2 800 3 711 6 511 Management and administration 11 900 8 600 20 500 12 553 9 336 21 889 Strategic communications 200 2 700 2 900 247 2 963 3 210 Subtotal 23 100 21 200 44 300 24 347 22 007 46 354 Emergencies Polio eradication 1 000 900 1 900 988 913 1 901 Outbreak and crisis response 4 900 100 5 000 4 905 95 5 000 Subtotal 5 900 1 000 6 900 5 893 1 008 6 901 Total 166 867 103 133 270 000 163 938 100 656 264 594 Share between COs/RO 62% 38%
101
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Summary of Budget Allocation by Countries/Areas (US$ thousands) Projected expenditure 2012–2013 67 36 15 812 18 334 419 1 694 36 36 34 512 13 073 814 284 558 4 755 98 93 37 116 18 504 11 449 1 336 35 5 039 95 908 119 2 240 19 368 17 558 Proposed Programme Budget 2014–2015 69 36 18 723 18 231 432 1 546 36 36 34 675 14 401 939 293 694 5 502 101 96 37 120 16 764 11 298 1 946 37 5 272 98 1 012 124 2 410 19 781 19 232
Countries/areas American Samoa Brunei Darussalam Cambodia China Cook Islands Fiji French Polynesia Guam Japan Kiribati Lao People's Democratic Republic Malaysia Marshall Islands Micronesia, Federated States of Mongolia Nauru Niue Northern Mariana Islands, the Commonwealth of the Palau Papua New Guinea Philippines Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Pacific island countries
102
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total
ASM 2012–13 ------------------------2014–15 ------------9 --------9 2012–13 ------------16 --------16
BRN 2014–15 ------------14 --------14 2012–13
CHN 2014–15 1 300 1 400 600 -3 054 6 354 2 800 300 960 2012–13
COK 2014–15 10 ------10 20 100 30 20 --10 160
1 679 1 767 631 291 1 647 6 015 3 756 97 97 124 679 4 753
------------164 -------
350 4 410
--164
------------67 ------67
--------------60 ----60
------------13 ------13
--------------8 9 --17
708 ------456 1 164 2 377 2 095 184 --4 656
800 ----8 400 1 208 1 490 1 081 1 496 452 4 519
103 --------103 152 ------152
15 ------12 27 50 150 --10 210
----------------67
----------------69
7 ------7 ------36
5 ------5 ------36
1 027 331 388 --1 746 ------18 334
1 200 200 150 50 1 600 40 100 140 18 231
----------------419
--15 ----15 ------432
103
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------1 694 ------1 546 ------558 --100 100 694 ------36 ------36 ------34 ------34 39 ----39 78 20 ----40 60 34 ------34 40 ------40 ------------------------------------------251 25 15 291 20 220 100 20 360 238 ----141 379 10 325 --20 355 --36 ----36 --36 ----36 --34 ----34 34 ------34 73 ------509 582 300 385 75 --10 ----13 ----13 50 --------50 ------------------------------------------------320 19 ------339 200 100 --25 --325 68 --------68 52 12 --25 --89 ------------------------------------------------78 263 --14 49 404 70 231 --65 50 416 ------64 --64 20 40 ------60 ------------------------------------------------FJI 2012–13 2014–15 2012–13 FSM 2014–15 GUM 2012–13 2014–15 2012–13 JPN 2014–15
104
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------15 812 --100 100 18 723 ------512 --100 100 675 ------13 073 --100 100 14 401 ------284 ------293 2 421 --4 --2 425 1 255 1 000 100 60 2 415 ----------10 10 --15 35 305 3 792 146 388 4 631 2 700 1 700 200 200 4 800 8 ------8 ----10 15 25 1 601 1 698 97 --3 396 1 139 1 385 470 250 3 244 83 19 65 19 186 80 50 60 20 210 221 572 167 204 1 164 869 816 159 179 2 023 --213 ----213 20 111 30 20 181 1 329 ------485 1 814 1 800 --400 --950 3 150 55 ------19 74 50 --5 5 20 80 1 940 146 --176 1 037 3 299 1 800 5 5 5 550 2 365 --------------------20 20 1 620 ------320 1 940 1 000 40 400 700 675 2 815 155 19 --10 --184 150 ----30 --180 350 59 107 9 156 681 360 61 100 180 695 1 396 46 --------46 47 --------47 1 038 1 581 1 678 --1 940 6 237 1 150 1 850 2 000 628 1 371 6 999 ------68 --68 ------70 --70 388 485 776 388 1 261 3 298 672 157 585 366 1 937 3 717 --------17 17 5 5 --5 5 20 KHM 2012–13 2014–15 2012–13 KIR 2014–15 2012–13 LAO 2014–15 2012–13 MHL 2014–15
105
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------4 755 --100 100 5 502 ------37 ------37 ------814 --100 100 939 ------93 ------96 203 --428 --631 500 100 200 200 1 000 --------------------57 ------57 60 ------60 ------------5 ----5 --650 78 --728 902 465 130 80 1 577 --------------------359 ------359 150 217 65 65 497 --41 ----41 10 40 ----50 49 49 ----873 971 250 ----25 450 725 ------------10 --------10 --------98 98 --------45 45 ------------5 ------5 10 591 --534 --331 1 456 733 100 70 50 47 1 000 37 --------37 27 --------27 227 --------227 237 161 50 --26 17 ------4 21 15 5 ------20 143 147 ----679 969 150 150 --50 750 1 100 ----------------------------73 ----73 --------------------31 31 5 ------6 11 MNG 2012–13 2014–15 2012–13 MNP 2014–15 2012–13 MYS 2014–15 2012–13 NIU 2014–15
106
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------98 ------101 ------11 449 204 500 704 11 298 ------17 558 --100 100 19 232 ------116 ------120 ----3 --3 ----5 --5 174 1 601 166 --1 941 500 100 500 50 1 150 679 1 143 --409 2 231 1 000 600 150 250 2 000 ----------------------28 ----28 --33 14 23 70 269 631 267 95 1 262 319 531 274 120 1 244 1 723 1 817 1 213 970 5 723 1 304 3 166 1 429 707 6 606 ----116 --116 50 70 ----120 23 --------23 10 ------11 21 428 ----154 873 1 455 1 470 ------350 1 820 291 ------873 1 164 500 10 10 10 800 1 330 ------------------------44 --------44 ------------825 --146 ----971 1 400 ----100 170 1 670 2 462 785 439 437 728 4 851 3 121 1 500 10 180 430 5 241 --------------------------------------5 ------5 1 164 1 455 1 601 858 742 5 820 370 1 600 700 540 1 500 4 710 654 806 523 873 733 3 589 1 100 1 183 3 955 700 972 ------------------------NRU 2012–13 2014–15 2012–13 PHL 2014–15 2012–13 PIC 2014–15 2012–13 PLW 2014–15
107
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------18 504 --100 100 16 764 ------36 ------36 ------35 ------37 ------5 039 --100 100 5 272 1 455 ------1 455 800 300 225 95 1 420 36 ------36 ----------18 ------18 --10 ----10 36 ----23 59 150 80 270 50 550 3 638 4 802 1 251 --9 691 1 113 2 150 1 920 225 5 408 ----------36 ------36 17 ------17 ------------795 534 --1 329 730 410 150 372 1 662 1 115 --25 --218 1 358 590 2 135 1 500 --45 ------------------------------------------------829 --5 --400 1 234 360 --15 --75 450 1 067 --97 ----1 164 637 50 ----441 1 128 ------------------------------------15 --------15 476 --------476 250 150 25 70 25 520 544 897 1 164 291 1 940 4 836 1 000 1 810 1 000 1 000 1 763 6 573 --------------------------------------7 ----5 12 --543 815 97 486 1 941 --606 813 300 271 1 990 PNG 2012–13 2014–15 2012–13 PYF 2014–15 2012–13 SGP 2014–15 2012–13 SLB 2014–15
108
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------95 ------98 ------908 --100 100 1 012 ------119 ------124 ------19 368 --100 100 19 781 ----------5 ------5 --------------------11 ------11 --10 --5 15 462 751 631 97 1 941 1 500 160 350 50 2 060 ----------10 38 ----48 --433 20 96 549 54 378 21 99 552 89 ------89 10 60 20 --90 1 374 873 655 299 3 201 2 000 956 700 300 3 956 ------------5 ------5 10 18 ------94 112 19 --5 --75 99 2 --------2 --------2 2 582 49 49 --776 1 456 1 109 100 40 --850 2 099 81 --------81 30 --------30 189 ------53 242 120 10 10 --110 250 11 --------11 11 --------11 2 037 485 965 --485 3 972 1 400 300 1 100 --400 3 200 --14 ------14 5 --------5 --------5 5 5 ----3 3 11 --------6 6 --5 ----1 6 1 455 1 135 2 619 --3 589 8 798 1 466 1 200 2 700 500 2 500 8 366 TKL 2012–13 2014–15 2012–13 TON 2014–15 2012–13 TUV 2014–15 VNM 2012–13 2014–15
109
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total ------2 240 --100 100 2 410 ------1 336 --100 100 1 946 55 --6 13 74 35 --20 --55 ----------20 10 20 20 70 363 204 15 --582 616 114 --305 1 035 99 447 ----546 106 356 155 105 722 16 --21 --10 47 32 ------60 92 38 ------33 71 40 ------30 70 5 --276 259 12 282 25 10 30 --347 518 ------27 545 500 96 92 82 103 873 5 --948 --308 1 261 10 --371 400 --781 174 --------174 13 22 111 63 13 VUT 2012–13 2014–15 2012–13 WSM 2014–15
110
2014–2015 PROPOSED PROGRAMME BUDGET – BUDGET TABLES
Annex - Proposed Programme Budget: By Category/Programme and Office Projected Expenditure 2012–2013 and Proposed PB 2014–2015 (US$ thousands) Budget Centre (Country/Area and Regional Office) Category 1 – Communicable diseases HIV/AIDS Tuberculosis Malaria Neglected tropical diseases Vaccine-preventable diseases Subtotal Category 2 – Noncommunicable diseases Noncommunicable diseases Mental health and substance abuse Violence and injuries Disabilities and rehabilitation Nutrition Subtotal Category 3 – Promoting health throughout the life-course Reproductive, maternal, newborn, child and adolescent health Ageing and health Gender, equity, human rights mainstreaming Social determinants of health Health and environment Subtotal Category 4 – Health systems National health policies, strategies and plans Integrated people-centred health services Access to medical products and health technologies strengthening Health systems information and evidence Subtotal Category 5 – Preparedness, surveillance and response Alert and response capacities Epidemic – and pandemic – prone diseases Emergency risk and crisis management Food safety Subtotal Category 6 - Corporate services/enabling functions Leadership and governance Transparency, accountability, risk management Strategic planning, resource coordination and reporting Management and administration Strategic communications Subtotal Emergencies Polio Outbreak and crisis response Subtotal Total 988 4 905 5 893 163 938 1 000 4 900 5 900 166 867 913 95 1 008 100 656 900 100 1 000 103 133 1 901 5 000 6 901 264 594 1 900 5 000 6 900 270 000 8 747 --2 800 1 2 553 247 24 347 8 500 --2 500 11 900 200 23 100 5 927 70 3 711 9 336 2 963 22 007 5 900 100 3 900 8 600 2 700 21 200 14 674 70 6 511 21 889 3 210 46 354 14 400 100 6 400 20 500 2 900 44 300 7 020 7 618 1 772 980 17 390 9 800 4 300 2 200 1 100 17 400 4 483 4 589 1 126 982 11 180 5 300 3 700 1 800 1 200 12 000 11 503 12 207 2 898 1 962 28 570 15 100 8 000 4 000 2 300 29 400 12 918 15 755 4 571 1 839 35 083 11 158 13 226 7 202 3 372 34 958 4 479 5 230 3 384 3 829 16 922 4 753 6 189 3 860 4 440 19 242 17 397 20 985 7 955 5 668 52 005 15 911 19 415 11 062 7 812 54 200 7 599 244 113 330 6 754 15 040 9 900 115 535 53 5 600 16 203 2 937 52 107 1 185 1 848 6 129 2 200 100 100 897 2 100 5 397 10 536 296 220 1 515 8 602 21 169 12 100 215 635 950 7700 21 600 15 336 1 476 2 385 585 2 783 22 565 13 434 2 829 2 797 1 498 3 456 24 014 12 044 2 360 663 2 012 1 044 18 123 10 866 2 050 1 665 2 505 1 000 18 086 27 380 3 836 3 048 2 597 3 827 40 688 24 300 4 879 4 462 4 003 4 456 42 100 7 322 9 093 10 828 2 944 13 433 43 620 7 001 10 051 8 769 5 040 14 431 45 292 2 568 4 579 4 177 3 454 10 509 25 287 3 200 3 800 4 239 2 669 12 300 26 208 9 890 13 672 15 005 6 398 23 942 68 907 10 201 13 851 13 008 7 709 26 731 71 500 COUNTRY TOTAL 2012–13 2014–15 REGIONAL OFFICE TOTAL 2012–13 2014–15 GRAND TOTAL 2012–13 2014–15
111