REGIONAL COMMITTEE
Provisional Agenda item 3.1
Sixty-fourth Session Jaipur, Rajasthan, India 6–9 September 2011
SEA/RC64/3 Rev.1 19 July 2011
Future of financing and programme of reform for WHO The rapidly changing environment in which WHO works requires changes in terms of new ways of working and improved clarity on Organization’s role in relation to other global players. Three fundamental problems drive the need for reform. (1) WHO’s role in relation to other actors in international health needs to be defined with greater clarity;
(2) (3)
WHO is widely perceived to be over-extended; trying to do too much compromising effectiveness and efficiency; Faced with new challenges and a rapidly changing environment, WHO is unable to respond with sufficient speed and agility.
The current financial crisis adds urgency to the need to address these problems. The expected objectives of these reforms are to:
achieve greater coherence in global health, with WHO playing a leading role in enabling the many different actors to play an active and effective role in contributing to the health of all peoples; improve health outcomes, with WHO meeting the expectations of its Member States and partners in addressing agreed global health priorities, focused on the actions and areas where the Organization has a unique function or comparative advantage, and financed in a way that facilitates this focus; ensure that the Organization pursues excellence; and being one that is effective, efficient, responsive, objective, transparent and accountable.
Five core business areas for WHO’s future work and six elements of reform have been presented to the Sixty-fourth World Health Assembly, which has been endorsed. Further, 129th Session of the Executive Board requested the Director-General of WHO to prepare three concept papers on “Governance of WHO”; “independent evaluation of WHO”, and “World Health Forum” to be presented to Member States.
The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 27 to 30 June 2011 reviewed the working paper and made the following recommendations: Actions by Member States (1) Member States are urged to examine the WHO reform-related concept papers and other documents, and provide timely feedback to WHO in order to ensure country inputs into the reform process. Member States are urged to raise regional concerns and participate effectively in discussions on WHO reform agenda during the forthcoming sessions of the Executive Board, as well as the next World Health Assembly.
(2)
Actions by WHO-SEARO (1) WHO should share concept papers on: Governance of WHO; Independent Evaluation of WHO; and the World Health Forum and other documents related to proposed reforms among Member States once they are finalized. The Regional Office should develop a strategic plan/action plan in consultation with Member States to ensure that reforms are systematically implemented in the SEA Region once the Governing Bodies have taken final decisions in this matter. WHO should establish a forum at country level to identify its country-specific roles and responsibilities through a multi-stakeholder mechanism. The Regional Office should increase efforts to mobilize more flexible Voluntary Contributions.
(2)
(3) (4)
Considerable progress has been made in following up on the Sixty-fourth World Health Assembly resolution and the decisions of the 129th Session of the Executive Board on WHO Reform. The concept papers on Governance of WHO, Independent Evaluation of WHO and the World Health Forum have been distributed to Member States and are available on website for a web-based consultation. The consultation will continue for four months, leading up to the special session of the Executive Board, which has been scheduled for 1-3 November 2011. The revised working paper and the HLP meeting recommendations based on it are submitted to the Sixty-fourth Session of the Regional Committee for its consideration.
Contents
Page Background ................................................................................................................... 1 Objectives...................................................................................................................... 2 Core business areas of WHO.......................................................................................... 2 Annex Expected Outcomes and outputs of reform agenda ........................................................ 6
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Background 1. WHO continues to play a critical role as the world’s leading technical authority on health. Its constitutional functions, including convening of experts, normative and standard-setting work, and technical cooperation with countries, have continued to meet health needs of Member States and form the backbone of its work. In a rapidly changing world, the need for authoritative, accessible, evidence-based and strategic guidance on all matters that affect peoples' health is more acute, and more complex, than it was when WHO was established more than 60 years ago. 2. However, over the years, WHO has acquired a rigid administrative and managerial structure which is sometimes criticized as outdated and which impairs WHO’s ability to adapt to changing needs and respond to the shifting, complex web of international efforts to improve public health with agility. The rapidly evolving environment in which WHO works requires changes in terms of new ways of working, and further clarity on WHO’s role in relation to other global actors. 3. The commitments, opportunities, innovations, successes, setbacks, surprises, and new realities unprecedented in the history of public health experienced during the first decade of 21st century has forced the Organization to re-examine its strengths and weaknesses, opportunities and threats. This re-examination has led to the Organization to find itself to be overcommitted, overextended, and in need of specific reforms. 4. It has been found that priority-setting for the Organization is neither sufficiently selective nor strategically focused. Given the large number of agencies now involved actively in health, duplication of effort and fragmented responses abound, creating a never-before need for greater coherence and more effective coordination. 5. Financial support for WHO does not always give priority to areas where WHO is best positioned to bring about major improvements in health. Preparation of programme budgets is cumbersome and often poorly aligned with implementation capacity or in the context of the emerging scenario of financial austerity. Procedures for staff recruitment, retention and career development follow a staffing model established decades ago, adding to the rigidity that impairs rapid adaptation to increasingly complex challenges. 6. This package of changes, referred to as the programme of reform, is the result of a series of activities that took place from January 2010 onwards which was tabled for discussion at the 128th Session of the Executive Board and subsequently submitted to the Sixty-fourth World Health Assembly for consideration.
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Objectives 7. The objectives of these reforms will be: (1) Ensuring greater coherence in global health, with WHO playing a leading role in enabling the many different actors to play an active and effective role in contributing to the health of all peoples. Improved health outcomes, with WHO meeting the expectations of Member States and partners in addressing agreed global health priorities, focussing on the actions and areas where the Organization has a unique function or comparative advantage, and financing the same in a manner that facilitates this focus. Making WHO an organization which pursues excellence; one that is effective, efficient, responsive, objective, transparent and accountable.
(2)
(3)
Core business areas of WHO 8. Five areas of core business have been identified which correspond closely to and are interlinked to WHO’s Core Functions whose purpose would be to provide a framework for examining future roles, directions and priorities. They are:
Convening for better health: WHO's role as a convener underpins all the other areas. It is central to the Organization's role in global health governance and health diplomacy. Generating evidence on health trends and determinants: Collection, collation, analysis and dissemination of health data from all counties to monitor and keep track of progress against internationally agreed goals, such as the Millennium Development Goals. Providing health advice for development: WHO is the key source of authoritative advice on health through the development of norms, standards and guidelines. Coordinating health security: Health security requires the strengthening of national and international capacity to reduce peoples' vulnerability to public health risks and to implement appropriate action when they do occur. Strengthening health systems and institutions: Providing strategic advice based on international experience and evidence.
9. While the programme of reform prepares WHO for the future, it is being initiated at a time when the Organization has to adjust to a new and more constrained financial reality. The need for immediate measures to ensure that WHO can live within its means has highlighted areas in which managerial reforms will be essential, and has added a sense of urgency to the overall process.
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10. The reform agenda consists of the following six elements: (1) (2) (3) (4) (5) (6) Increasing organizational effectiveness, including corporate decisions, decentralized implementation; Improving results-based management and accountability; A dynamic approach to human resource policy, planning and management; Strengthening financing, resource mobilization and strategic communication; Increasing WHO’s effectiveness at the country level; Strengthening WHO’s role in global health governance.
11. The expected outcomes and draft outputs of the reform agenda are shown in Annex. 12. A draft development plan has been laid out by WHO headquarters in relation to the information on reform presented in the Director-General’s Report on Reforms for a Healthy Future. It provides an indication of the expected outcomes and outputs from the areas of reform that support WHO’s five areas of core business. 13. During the robust discussions that took place during Sixty-fourth World Health Assembly on the proposed programme of WHO reform, the Member States stressed their desire to be kept informed and involved especially on reforms related to global health governance. 14. WHA resolution WHA 64.2 was adopted which requested the Director-General to present a detailed concept paper on the November 2012 World Health Forum. It was further decided that in consultation with the member states, an approach to carry out an independent evaluation of the ‘work of WHO’ to be developed, and the first report of the independent evaluation be presented to the Sixty-fifth World Health Assembly in May 2012. 15. When this item came up for discussion in 129th Session of the Executive Board, the Board decided to establish a transparent, Member-State driven, inclusive consultative process on WHO reform. The Board requested the Director-General to prepare by end of June, three concept papers on the following issues: the governance of WHO, an independent evaluation of WHO, and the World Health Forum, as outlined in resolution WHA 64.2. 16. Considerable progress has been made by WHO headquarters in following up on the Sixtyfourth World Health Assembly resolution and the decisions of the 129th Session of the Executive Board on WHO Reform. 17. Three concept papers on Governance of WHO, Independent Evaluation of WHO and the World Health Forum were distributed to Member States in late June as requested by the Executive Board and have been posted on a password-protected website for consultation. The consultation will continue for four months, leading up to the special session of the Executive Board, which has been scheduled for 1-3 November.
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18. A mission briefing was organized on 1 July 2011 inviting representatives of Geneva-based missions to seek initial views on the three concept papers. During the mission briefing, several countries have emphasized the need for an accelerated timeline for the Independent Evaluation, and have proposed that the Bureau of the Executive Board provide oversight for the evaluation. This would enable outcome of the evaluation to be used to influence the reform process. 19. As requested by the Member States during the mission briefing, an overview of the work on WHO reform is being developed by WHO in time for the Regional Committee meetings. 20. The First Task Force meeting on WHO Reforms was held from 28-30 June. The Task Force will continue to further develop a series of papers on organizational alignment and effectiveness, results-based management and accountability, financing and resource mobilization, and human resources. 21. A series of subgroups will continue their work in distant mode, by email and with teleconferencing, leading up to the second meeting of the Task Force, which will be held from 28-30 September 2011. This meeting will lead to finalization of the paper on managerial reform. 22. The outcome of the consultative process on the three papers and draft proposals being prepared by the Secretariat or proposed by Member States on other aspects of the reforms will be discussed at the Special Session of the Executive Board open to all Member States, scheduled to be held in November 2011. 23. WHO is committed to involve Member States in the designing of the reform agenda and is taking utmost caution to provide adequate opportunities for Member States and other partners to provide their views to further finetune the reform agenda. 24. The details are being developed through an inclusive process involving Member States, staff and partners. WHO staff with expertise in the relevant areas, drawn from headquarters, and regional and country offices will develop the different elements of the agenda for reform, supported by consultants providing inputs and reviewing outputs. Oversight is being provided by the Director-General and the Global Policy Group. The Director-General will report regularly to the Executive Board and the World Health Assembly on the progress made in the development and implementation of reforms. 25. The reform agenda will be implemented in two phases.
The preparatory phase: This phase has already been initiated and is expected to continue until May 2012. During the period from now until May 2012, detailed plans for each of the specific elements of WHO reforms will be developed and presented to the Executive Board at its 130th Session in January 2012, and the Sixty-fifth World Health Assembly in May 2012. Furthermore, a report of an independent formative evaluation of the work of WHO will be developed while the ways of working of the WHO governing bodies will be reviewed for presentation to the Sixty-fifth World Health Assembly.
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The implementation phase: Implementation of the elements of the programme of reform will follow different timelines. Initial steps to improve efficiency and effectiveness and promote greater accountability and transparency are already being introduced. Elements relating to the revised results-based management framework and accountability will be implemented in the next round of medium-term and Programme Budget planning cycles.
26. More specifically, the first World Health Forum will be held in November 2012 while a revised results-based management and accountability framework, including a priority setting framework, will be introduced in 2012 for strategic and programmatic planning. A revised resource mobilization and financing model (possibly based on replenishment) will be introduced from 2013. A revised staffing model for Headquarters and regional and country offices supported by performance management and mobility and rotation mechanisms will be introduced from May 2012.
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Annex
Expected Outcomes and outputs of reform agenda 1. Increasing Organizational effectiveness: corporate decisions, decentralized implementation Expected outcome Expected outcomes: Output
clear description of roles, responsibilities, synergies and resource allocation at each level of the Organization in the five areas of core business;
defined roles, responsibilities, division of labour and operating procedures, with organizational structures aligned to functions at headquarters, regional, sub-regional, and country levels;
specific measures to enhance the normative role of the Organization (including measures to standardize and harmonize processes for the generation of norms, standards, policies and data based on best practice; to accelerate and align procedures for medicines, vaccines and diagnostics and technologies; and to ensure the robust evaluation of the dissemination and impact of information;
excellence in performing normative functions.
standard operating and communication procedures in response to health crises. 2. Improving results-based management and accountability Expected outcomes Outputs
an effective, efficient, responsive, objective, transparent and accountable Organization.
results-based planning and accountability framework, encompassing short-, medium- and long-term planning;
a decision tree to guide resource allocation; an independent formative evaluation of WHO; a mechanism for independent biennial assessment of performance;
a mechanism for routine monitoring of organizational performance;
additional measures to improve accountability and increase transparency.
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3. A dynamic approach to human resource policy, planning and management Expected outcomes Outputs
a flexible staffing model, aligned to organizational needs;
a staffing model, comprising a cadre of core staff, supplemented by project staff;
recruitment and retention of experienced, competent and highly performing staff.
a human resource strategy, including: strategic workforce planning, performance assessment,
career development, and efficient recruitment; proposals for changes to staff rules. 4. Strengthening financing, resource mobilization and strategic communication Expected outcomes Outputs
at least 40% of income will be fully flexible.
a corporate resource mobilization strategy; a proposal for a replenishment model; an expanded resource base, including a mechanism to pool funds from private entities;
a strategic communications strategy. 5. Increasing WHO’s effectiveness at the country level Expected outcomes Outputs
the profile of WHO country presence aligned with country needs and priorities;
an enhanced recruitment and assessment mechanism for Heads of WHO country offices.
enhanced leadership, quality and autonomy of country office staff. 6. Strengthening WHO’s role in global health governance Expected outcomes Outputs
greater coherence in global health; different actors in global health playing an active and effective role in contributing to the
a multi-stakeholder World Health Forum; a charter (or similar mechanism) defining rules of engagement in global health;
health of all peoples; increased effectiveness of the functioning of governing bodies.
proposals for strengthening the work of the WHO governing bodies.
REGIONAL COMMITTEE
Provisional Agenda item 3.1
Sixty-fourth Session Jaipur, Rajasthan, India 6–9 September 2011
SEA/RC64/3 Inf. Doc.1 30 August 2011
Future of financing and programme of reform for WHO WHO-HQ developed an overview paper titled “WHO Reform for a Healthy Future: An Overview”. This information document is submitted to the Sixty-fourth Session of the Regional Committee for its review and information.
SEA/RC64/3 Inf. Doc.1
WHO Reform for a Healthy Future: An Overview Introduction 1. This paper is an overview of the WHO reform agenda that is now in development1. Its purpose is to explain the rationale and components of the reform and to show how they fit together. It also describes the timeframe and process of consultation with Member States and staff, leading to the special session of the Executive Board to be held 1-3 November 2011.
Rationale of the reform 2. WHO plays a critical role as the world’s leading technical authority on health. Addressing the increasingly complex challenges of the health of populations in the 21st century—from persisting problems to new and emerging public health threats— requires the Organization to make changes. Continuous process improvement is a vital component of organizational excellence. 3. In taking on more and more of these challenges, WHO has, like many other organizations, become overcommitted At a time of financial crisis, it is underfunded and overstretched. Priority-setting has not been sufficiently strategic. The Organization’s financing does not always match well with its priorities and plans. 4. Further, despite several innovations put in place over the past few years, some of the Organization’s ways of working are outdated. The kind of comprehensive reform that is now proposed is critical to a renewed Organization that works efficiently, effectively, and transparently. A transformed WHO will also be more flexible, responsive, and accountable. 5. Finally, the global health community has greatly expanded, such that there are now a large number of players with overlapping roles and responsibilities. In 1948 WHO was the only global health organization; now it is one of many. This proliferation of initiatives has led to a lack of coherence in global health.
Expected outcomes of the reform 6. Refocusing core business to address the 21st century health challenges facing countries and the world. WHO will narrow the scope of its work to what it can do best, working on priority issues identified by Member States, with adequate financing for these areas of focus. These areas of core business are: (1) health systems and institutions; (2) health and development; (3) health security; (4) evidence on health trends and determinants; and (5) convening for better health. 1
WHA 64/4 World Health Organization: reforms for a healthy future
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7. Reforming the financing and management of WHO to address health challenges more effectively. These reforms will result in: increased organizational effectiveness; clearly differentiated roles and responsibilities among headquarters, regional and country offices; improved results-based management and accountability; flexible, predictable and sustainable financing, and strengthened resource mobilization and strategic communication; and a new, flexible human resources model that emphasizes the recruitment and retention of excellent staff. 8. Transforming governance to strengthen public health. These changes will lead to increased effectiveness of the governance of WHO, in part by clarifying the roles of the governing bodies. A reformed WHO will also play a larger role in global health governance by bringing coherence to the many initiatives involved in global health.
Components of the reform Core Business 9. Having defined the areas of work, the task now is to further define: (1) the priorities in each area of core business; (2) the expected outputs; and (3) proposed measurements of performance. Some of the priorities that have been identified thus far are highlighted below. Health systems and institutions 10. Strengthening health systems that are based on primary health care will remain WHO’s top priority. This will include, among many components, universal coverage and health financing, the promotion of access to medical products and information and the development of the health workforce. WHO will continue to put most of its efforts into countries with the weakest health systems. Health and development 11. The focus of WHO will be to support countries through the provision of authoritative guidance, norms, standards and technical cooperation in these areas: the health-related Millennium Development Goals and poverty reduction, prevention and control of noncommunicable diseases, environmental health and increased awareness of the social determinants of health. Health security 12. For public health emergencies, WHO will provide surveillance, alert and verification, and event management systems, along with direct operational support on the ground when needed. A key priority will be to assist countries to build the institutional and laboratory capacity, epidemiological surveillance and risk communication, stockpiling of essential commodities, networks, linkages and rapid-response plans required to deal with public health emergencies
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and to fully implement the International Health Regulations (2005). For natural disasters and other humanitarian crises, WHO’s priority is to provide strategic information and to lead the health cluster. Evidence on health trends and determinants 13. Collection, collation, analysis and dissemination of health-related data from all countries, and strengthening the information systems that generate and use these data are key elements of core business. Overall, the priority will be to work with countries to strengthen the institutional capacity to generate and present information in ways that meet the needs of policy makers and managers. Outcomes of particular concern will be to establish vital registration systems—in line with the recommendations of the Information and Accountability Commission; to increase the quality, rigour and integrity of WHO’s knowledge base, evidence-based guidelines and recommendations; and to put in place a organization-wide system for managing data that increases the quality of information services, increases efficiency through working with collaborating centres and other partners; and reduces the burden of data demands on countries. Convening for better health 14. A priority in this area will be for WHO to use its convening power to bring different initiatives together, including those outside the health sector but whose work affects health, for increased coherence and inclusiveness. WHO will also use its convening power to bring together regional and subregional partners at country level that can help countries with their national health policies, strategies and plans.
Financing and managerial reforms 15. Work is ongoing to improve WHO’s way of doing business. The priority areas are: (1) increased organizational effectiveness, with a special focus on improved country performance through a clear description of products and services, and clarity on roles and responsibilities and synergies of the three levels of WHO, aligned to each area of core business. enhanced results-based planning, management and accountability, with a robust results-based management framework, incorporating short-, medium-and long-term planning, based on a clear results chain; specific measures to improve accountability and transparency, including steps to strengthen programmatic and financial controls and a policy on disclosure of information; and an evaluation policy framework that includes objective performance assessment and an approach to independent evaluation. strengthened financing, with a corporate approach to resource mobilization and effective strategic communication. An increased proportion of predictable, sustainable and flexible funding, with stronger financial management, is an essential component of reform. Outputs will include proposals for maximizing Assessed Contributions and
(2)
(3)
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a replenishment model for Core Voluntary Contributions; proposals to expand the resource base, including a possible mechanism to pool funds from non-traditional sources; and strengthened financial management and controls, including objective and transparent allocation of resources. (4) an improved human resources framework, which will include a workforce planning approach; a revised staffing model (core and project staff); streamlined competencybased recruitment processes linked to organizational needs; and enhanced performance management and development processes.
Governance 16. Both global health governance and the governance of WHO itself are addressed in this part of the reform. A priority is to capitalize more effectively on WHO’s leadership position in global health, using the Organization’s constitutional mandate to be the “directing and coordinating authority on international health work”. (1) Potential outputs in global health governance include: (1) establishment of regular consultation with a wide range of partners in global health; (2) creation of a multistakeholder World Health Forum, convened by WHO, to ensure that all voices are heard; clarify roles and responsibilities, with the aims of sharpening the division of labour, avoiding fragmentation, eliminating duplication of effort and contributing to better health outcomes; and (3) development of a charter or framework for global health governance. Potential outputs in WHO’s governance include: (1) the creation of a more coherent and robust mechanism for corporate priority setting through the Governing Bodies (including the World Health Assembly, the Executive Board, the Programme, Budget and Administration Committee of the Executive Board, the Regional Committees and subcommittees), such that resolutions and decisions, programmes, Secretariat capacity and financing are closely coordinated; and (2) stronger oversight mechanisms at all three levels of the Organization.
(2)
Process of the reform leading to the Executive Board special session Principles 17. Development and implementation of the WHO reform process is inclusive, driven collectively by Member States, open and transparent, developed through extensive consultations with Member States and staff, and action oriented.
Meetings and background papers 18. For the special session of the Executive Board 1-3 November 2011, all Member States will review and discuss a comprehensive proposal for WHO reform prepared by the Secretariat that
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will incorporate an overview of the reform programme, and proposals on core business, financing and managerial reforms, and governance. The core business section will describe the priorities for each area of core business, the expected outputs and proposed measurements of performance in each area, and a mechanism for prioritization. The financing and managerial reforms section will include a framework for results-based planning, an accountability and transparency framework, and a draft evaluation policy, including an approach to independent evaluation. The governance section will describe proposals to strengthen WHO’s governance and to bring greater coherence to global health governance, including the proposed World Health Forum. 19.
At its meeting on 25 May 2011, the Executive Board also requested the Director-General to develop three concept papers on: the governance of WHO, an independent evaluation of WHO, and the World Health Forum2. The Executive Board also requested the Director-General to hold consultations among Member States on these papers at WHO headquarters, and to create a platform for web-based consultations. It further asked the Regional Committees to hold strategic discussions on the reform process during their upcoming meetings.
Consultation 20. The first consultation with Geneva-based Missions took place on 1 July 2011. At this meeting, the Missions discussed the three concept papers. A summary of this consultation was prepared. A second consultation with Geneva-based Missions will take place on 15 September 2011, at which time the draft proposals for financing and managerial reforms prepared by the Secretariat will be discussed. 21. The Regional Committees will receive this overview paper, along with the three papers on the governance of WHO, an independent evaluation of WHO, and the World Health Forum, together with the summary of the July consultation with the Geneva-based Missions. A summary of the deliberations in the Regional Committees will be reported to the special session of the Executive Board. 22. Consultation with Member States and staff will continue throughout the coming months. Web-based platforms are being developed to provide the widest possible access to updated information and to receive feedback on the proposals. Consultation on the three concept papers will continue until the end of September 2011; consultation on the financing and managerial reforms will continue through the end of the Executive Board special session. 23. WHO staff at all levels of the Organization are being consulted about the reform through town-hall meetings and an intranet site, where a feedback form is also available. To support the development of proposals on WHO reform, the Secretariat has organized itself into a series of Task Forces and working groups across all levels of the Organization. 24. The Executive Board special session will decide on the next steps of the reform.
2
EB129(8) WHO reform
REGIONAL COMMITTEE
Provisional Agenda item 3.1
Sixty-fourth Session Jaipur, Rajasthan, India 6–9 September 2011
SEA/RC64/3 Inf. Doc.2 30 August 2011
Future of financing and programme of reform for WHO WHO-HQ developed a concept paper titled “Governance of WHO”. This information document is submitted to the Sixty-fourth Session of the Regional Committee for its review and information.
SEA/RC64/3 Inf. Doc.2
Governance of WHO Concept Paper 1. In resolution WHA64.2 the World Health Assembly requested the Executive Board to establish an appropriate process to examine the issues related to WHO’s governance identified in the report of the Director-General1. Subsequently, at its 129th session, the Board requested the Secretariat to prepare three concept papers by the end of June 2011, the content of which would continue to evolve throughout the consultative process. 2. In line with the Executive Board’s decision2, this paper is the first draft of a concept note in relation to the governance of WHO. It summarizes the main issues identified in recent consultations as well as those raised by the Sixty-fourth World Health Assembly and the Board at its 129th session, and proposes possible ways to continue the discussion. 3. The salient aspects raised by Member States can be grouped into four broad areas. The first relates to priority setting and the need for the governing bodies’ work to be more focused and strategic so that they effectively carry out their Constitutional functions. The key reform here will be the alignment of the governing bodies’ resolutions with corporate priorities, ensuring a more strategic and disciplined approach to decision-making by the Health Assembly, and enabling the necessary oversight of programme and financial implementation, including the fiscal soundness of Organizational practices. 4. The second area relates to the need for better alignment between the global and regional governing bodies. The main issue is the achievement of greater coherence between the regional and the global governing bodies, with better coordination of the respective agendas promoting complementarity and synergy and avoiding duplication of debate. 5. The third area can be summarized as better sequencing of the different governing body meetings. The issues identified include the need to strengthen the role of the Programme, Budget and Administration Committee of the Executive Board and to review the timing and duration of its meetings in order to increase its oversight and preparatory functions, in particular with regard to the consideration of the Proposed programme budget; to ensure that the Board and its committees address a number of issues – especially managerial matters – more effectively and take final executive decisions on them without referral to the Health Assembly; to plan a leaner but more substantive agenda of agreed technical and policy priorities for the Health Assembly and thus facilitate more strategic debate; to explore the need for further subsidiary bodies of the Board, for example on programme development; and to consider a more tactical use of the Independent Expert Oversight Advisory Committee, for example requesting it to perform thematic reviews.
1 2
Document A64/4 Decision EB129(8)
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6. The fourth area can be described as the promotion of more active engagement and participation of all Member States in the governance of the Organization. The issues identified are the following: more informed participation by all Member States so that the governance processes are truly inclusive; and increased attention to the re-balancing of the way in which Member States exercise their role as informed and active participants of the governing bodies by, for example, provision of sufficient briefing on the historical and technical background of issues under consideration. 7. To ensure a thorough process of governance reform that is driven by Member States, the areas for improvement and issues identified above need to be assessed and debated in sufficient depth. Member States may wish to consider establishing an open-ended working group of the Board, with the mandate of developing the agenda for change in the domain of WHO’s governance. This is a proven, effective method of work that has previously been employed by the Board and some regional committees to identify solutions in similar change processes.
Points for discussion 8. Member States are invited to comment on the key issues identified, to suggest others, to propose possible solutions to the points identified, and to comment on the proposed ongoing process.
REGIONAL COMMITTEE
Provisional Agenda item 3.1
Sixty-fourth Session Jaipur, Rajasthan, India 6–9 September 2011
SEA/RC64/3 Inf. Doc.3 30 August 2011
Future of financing and programme of reform for WHO WHO-HQ developed a concept paper titled “Independent Formative Evaluation of the World Health Organization”. This information document is submitted to the Sixty-fourth Session of the Regional Committee for its review and information.
SEA/RC64/3 Inf. Doc.3
Independent Formative Evaluation of the World Health Organization Concept Paper Introduction 1. World Health Assembly resolution WHA64.2 requested the Director-General “in consultation with Member States to develop an approach to independent evaluation, and to present a first report on the independent evaluation of the work of WHO to the Sixty-fifth World Health Assembly in May 2012”. Subsequently, the 129th Executive Board requested that, by the end of June 2011, three concept papers be prepared which will be further revised on an ongoing basis throughout the consultative process. In line with the Executive Board Decision, this paper is the first draft of a concept note setting out the proposed scope, terms of reference and process for the Independent Evaluation. 2. The aim is to establish an efficient and effective process for independent evaluation of WHO, which is rapid, is not resource intensive, and has significant impact and influence. Experience with this process will inform decisions on establishment of a mechanism for regular independent evaluation of the work of WHO. Key principles that will apply in planning and conducting the evaluation are independence, transparency, credibility and efficiency. An independent formative1 assessment of a thematic area of work for the Organization will also contribute to shaping and guiding several elements of WHO Reform, for example, improving results-based planning and accountability, and increasing WHO’s effectiveness at the country level.
Purpose 3. The purpose is to develop an approach to independent evaluation of the work of WHO in order to improve programme performance. The outcome of the evaluation will be a report to Member States on the work of WHO in a thematic area, with specific recommendations on steps to enhance the work of the Organization in this area.
Scope and Terms of Reference 4. Member States have expressed support for the proposal that the evaluation should focus on health systems strengthening, as this is a high priority for Member States, a fundamental requirement for improving health outcomes and the Millennium Development Goals, a major and increasingly important area of work for WHO at each level of the Organization. The 1 “Formative evaluation” is designed with the purpose of improving programmes, and contrasts with “summative” evaluation, which examine the effects or outcomes of programmes.
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evaluation provides an opportunity to clarify the role of WHO in this area. It will focus on WHO’s capacity to support countries (developed and developing) in strengthening their health systems, including national health policies, strategies and plans; universal coverage and health systems financing; health work force; access to essential medicines and technologies; and health information systems. 5. The evaluation will encompass the three levels of WHO, and the six core functions of the Organization as described in the Eleventh General Programme of Work2 as applied to the work of the Organization in health systems strengthening. It will review the ways in which these functions are carried out, and make proposals for enhancing internal and external alignment, effectiveness, efficiency and transparency of the work of WHO. These will include specific measures to improve results-based management and accountability; enhance human resources; and strengthen priority setting, financing, resource mobilization and resource allocation. WHO Functions Providing leadership on matters critical to health and engaging in partnerships where joint action is needed. Study questions to be addressed at the global, regional, subregional and national level What do countries expect from WHO in terms of products and services for health systems strengthening – what are the key aspects of health systems strengthening on which WHO should focus its attention and resources? Does WHO exercise effective leadership in health systems and how could this improved? Which partnerships with other agencies have been most effective in supporting health systems strengthening and how can these collaborations be enhanced to strengthen coherence and alignment? How is WHO influencing the research agenda around health systems? How could WHO improve its effectiveness in disseminating knowledge and innovation? To what extent is the development of norms, standards and global public goods for health systems driven by country demand, and how could this be improved? Are there any ways in which the development process for norms and standards could be made more efficient, transparent and objective? How effectively does WHO monitor and report on the implementation of norms and standards and how could this be improved? How effectively does WHO help countries translate norms and standards into national policy and what could be done to strengthen the alignment of the different levels of the Organization to more effectively support this process?
Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge Setting norms and standards, and promoting and monitoring their implementation
Articulating ethical and evidencebased policy options
2
Eleventh General Programme of Work 2006–2015. Geneva, World Health Organization, 2006.
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Providing technical support, catalysing change, and building sustainable institutional capacity
Is WHO structured appropriately to provide adequate support to Member States in health systems strengthening? How can different WHO programmes align their work more effectively to contribute to health systems strengthening? How could WHO change the way it delivers technical support to more effectively build sustainable institutional capacity in countries? How could the monitoring of health indicators by WHO be further strengthened to enhance accountability?
Monitoring the health situation and assessing health trends
6.
The Independent Evaluation will also address several aspects of WHO Reform:
How can the structure, staffing and alignment of WHO be strengthened to provide more effective support to countries in the area of health systems strengthening? How effective is the current planning framework in articulating the work of WHO in health systems strengthening, and in functioning as a tool for programming, accountability, resource mobilization and resource allocation. What steps need to be taken to strengthen financing, resource mobilization and strategic communications for health systems strengthening in WHO? What changes to human resource policy, planning and management would have the most impact in increasing the competence and capacity of WHO to support countries?
7. In carrying out the evaluation, the Evaluation Consortium will draw on existing data, reporting and assessments, and will seek the views of Member States, staff and partners. The Evaluation Consortium will make visits to headquarters, Regional Offices, and selected Country Offices. The Evaluation Consortium will have access to all relevant documentation in the secretariat.
Oversight 8. The Executive Board will provide oversight for the Independent Evaluation, reviewing the Terms of Reference and Work Plan, selecting the Evaluation Consortium, and receiving regular reports on the activities, observations and recommendations of the Evaluation Consortium. The Director-General will propose that the Executive Board establishes a subgroup of the Board as an Evaluation Oversight Committee to carry out these functions. The Director-General will provide a secretariat for the Independent Evaluation.
Selection of Evaluation Consortium 9. The evaluation will be carried out by an independent Evaluation Consortium, selected through an objective and transparent process. The Evaluation Consortium will comprise a multidisciplinary team of 8–10 individuals from a consortium of institutions with proven capacity and
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experience in carrying out evaluations of the work of international organizations in the field of public health, and with the technical and managerial experience and skills that reflect the purpose and scope of the evaluation. These will include technical aspects of health systems strengthening and organizational aspects of planning, resource management, organizational design and human resources. Members of the Evaluation Consortium will be expected to exercise their professional judgement, and will be free from conflict of interest. 10. The Evaluation Consortium will be selected following a public “Request for Proposals” for an Evaluation Consortium and Work Plan. To reflect the scope and diversity of the work of WHO, priority will be given to proposals submitted by consortia of institutions from both developing and developed countries. 11. The criteria for selection of the Evaluation Consortium will be (1) demonstrated capacity and experience of the consortium of institutions submitting the Proposal in evaluation of international organizations in public health; (2) evidence of understanding of the purpose and expected outcome of the evaluation as reflected in the Proposal and Work Plan; (3) experience, competence and diversity of proposed members of the Evaluation Consortium, and; (4) cost.
Proposed Process 12. The Director-General will present a draft Scope and Terms of Reference for the Independent Evaluation to the Special Session of the Executive Board in November 2011. Following endorsement by the Executive Board, the Director-General will issue a public Request for Proposals. These proposals will be assessed by the Evaluation Oversight Committee constituted by the Executive Board based on the above criteria, and the Evaluation Consortium selected. The Executive Board will be informed of the outcome of the selection process, and the proposed Work Plan. 13. An initial meeting of the Evaluation Consortium will be held at WHO headquarters in January with the Evaluation Oversight Committee to discuss the Work Plan for the Independent Evaluation. The Evaluation Consortium will commence its work in February 2012. 14. The Evaluation Consortium will make visits to WHO headquarters, the six Regional Offices and several Country Offices. The Evaluation Consortium will also engage with Member States and other key stakeholders. 15. The Evaluation Consortium will meet in April 2012 at WHO headquarters for a consultation on their findings with the Member States (Geneva-based missions) and the secretariat. The Evaluation Consortium will present a first report to the Sixty-fifth World Health Assembly in May 2012.
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Proposed Time Line Special Session of Executive Board approves Terms of Reference for Independent Evaluation and establishes Evaluation Oversight Committee Director-General Issues Request for Proposals for Independent Evaluation Evaluation Oversight Committee reviews proposals and selects Evaluation Consortium Award of contract to the Evaluation Consortium “Kick off” meeting of Evaluation Consortium with Evaluation Oversight Committee to discuss Work Plan Headquarters, Regional and Country visits by Evaluation Consortium Consultation on interim report of Evaluation Consortium First report of Independent Evaluation to Sixty-fifth World Health Assembly Nov 2011 Nov 2011 Dec 2011 Jan 2012 Jan 2012 Feb–Apr 2012 Apr 2012 May 2012
Budget (USD)* Evaluation Consortium: 10 team members for 100 days Travel and expenses (6 field visits per team member, 7 days per visit) Evaluation Consortium Reports (publishing and translation) TOTAL * Budgets are indicative. Secretariat costs are not included.
850 000 400 000 50 000 1 300 000
Issues for Consideration by Member States 16. Do Member States support: (1) (2) (3) (4) the proposed Scope and Terms of Reference for the Independent Evaluation? the proposed process for providing oversight for the Independent Evaluation? the proposed process for selecting the Evaluation Consortium? the proposed timeline for the Independent Evaluation?
REGIONAL COMMITTEE
Provisional Agenda item 3.1
Sixty-fourth Session Jaipur, Rajasthan, India 6–9 September 2011
SEA/RC64/3 Inf. Doc.4 30 August 2011
Future of financing and programme of reform for WHO WHO-HQ developed a concept paper titled “World Health Forum”. This information document is submitted to the Sixty-fourth Session of the Regional Committee for its review and information.
SEA/RC64/3 Inf. Doc.4
World Health Forum Concept Paper
Introduction 1. World Health Assembly resolution WHA64.2 requested the Director-General “to present a detailed concept paper for the November 2012 World Health Forum, setting out objectives, number of participants, format and costs to the Executive Board at its 130th Session in January 2012”. Subsequently, the129th Executive Board requested, by the end of June 2011, three concept papers which will be further revised on an ongoing basis throughout the consultative process. In line with the Executive Board decision, this paper is the first draft of a concept note in relation to the World Health Forum. 2. Increased investment in health over the last decade has resulted in significant improvements in health outcomes, an increasingly complex institutional environment and a growing number of organizations involved in global health. While the growing prominence of health in international affairs is welcome, there is a need to promote greater coherence and to provide an opportunity for a more inclusive dialogue between the many different actors involved. At present, however, there is no single platform that allows interaction between governments, global health organizations, partnerships, regional organizations, multilateral and bilateral agencies, philanthropic foundations, CSOs, private sector organizations and other relevant stakeholders. 3. Through the exercise of its role as the directing and coordinating authority for international health work WHO can provide such a platform. As an informal, multi-stakeholder body the World Health Forum will make it possible to capture a wide range of views and perspectives on major current and future issues in global health. It will not take decisions affecting individual organizations, nor will it change the decision-making prerogative of WHO’s own governing bodies. The conclusions of the Forum’s deliberations will be transmitted to the World Health Assembly via the Executive Board, as well as being available to all participating organizations.
Purpose, outcome and objectives 4. The purpose of the World Health Forum will be to explore, in an informal and multistakeholder setting, ways in which the major actors in global health can work more effectively together – globally and at country level – to increase effectiveness, coherence and accountability and to reduce fragmentation and duplication of effort. 5. The forum will provide an opportunity to hear a diversity of views and to capture elements of best practice. The initial outcome will be a report on principles and approaches in line with the Forum’s overall purpose. The focus will not just be on the work and role of WHO, but on ways of improving health outcomes through policy coherence and more effective collective action across a range of organizations and partnerships.
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6. Specific objectives for the World Health Forum will be to (a) identify the major obstacles and constraints to more collaborative work across all the partners engaged in global health; (b) to define principles and approaches that will promote policy coherence and more effective working relationships at global and country level; and (c) to outline the steps needed to translate principles into practice.
Organization and management of the first forum 7. It is proposed that the first forum be held in Geneva over three days in November 2012. Once established the Forum will be convened every two years for a further two cycles, after which it will be independently reviewed. 8. The Forum will be open to all Member States. Representatives of all major global health organizations and partnerships will also be invited. Other participants will be invited from CSOs, academic institutions/think-tanks, professional associations, foundations, and the private sector. The aim will be to attract a number of participants sufficient to ensure a diversity of viewpoints, institutions and geographical representation, but small enough number to allow structured debate and clear conclusions1. While limiting the size of individual delegations may be necessary to ensure manageable numbers, the Forum will be web-cast to increase access to a wider audience. It may also be possible to explore the possibility of using web based technology to allow more direct interaction prior to the Forum itself. 9. The agenda for the meeting will be structured around the three meeting objectives. The method of work will mix a limited number of plenary sessions with facilitated thematic parallel sessions. The focus will be on structured debate rather than presentations or prepared statements. The meeting will select a chair and vice-chairs from the groups represented. The WHO Secretariat will act as rapporteur and support the Chair and vice-chairs. Formal background papers will be kept to a minimum, and circulated in advance. 10. A Chair’s summary of key conclusions will be drafted at the end of the meeting, and more detailed report will be prepared shortly after. The meeting Chair will present a report of the Forum to the subsequent meeting of the WHO Executive Board. 11. Work is in hand to draw on the experience of other institutions and sectors that run multistakeholder forums to refine the eventual proposal to the Executive Board2. Once the Executive Board has finalized the proposal in January 2012, the Director-General will convene a Steering
1
For comparison, the Global Forum on noncommunicable diseases which preceded the recent Moscow Ministerial meeting attracted around 300 people. GAVI’s partnership Forum has around 350 participants, and the Global Fund’s equivalent about 400. By way of contrast the World Economic Forum in Davos invites around 2 500 participants. The World Social Forum in 2011 attracted 75 000 people and the most recent World Urban Forum in 2010 organized by UN Habitat attracted nearly 14 000 participants. Other examples of multi-stakeholder forums include the Committee on World Food Security, the Working Party on Aid Effectiveness, the International Dialogue on Conflict and Fragility. Member States may also wish to suggest other relevant bodies.
2
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Committee (including both Member States and other organizations) to oversee more detailed preparations, including the nomination and invitation of participants and speakers. 12. The cost of the Forum will include preparatory activities ($100 000) as well as the hosting of the meeting itself ($675 000). While many participants will be self-financing, support for Member States (LDCs) will be on the same basis as for the World Health Assembly.
Points for discussion 13. The first stage in the consultation seeks Member States views on the proposed purpose, objectives, selection of participants and management of the Forum. Member States are invited to comment on the proposals above, to raise any other issues, or to suggest alternative ideas to those outlined in this note.