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WORLD HEALTH ORGANI ZATION
ORGANISATION MONDIALE DE LA SANT~
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REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL OU PACIFIQUE OCCIDENTAL
WPRjRC 27/4 21 June 1976 Twenty-seventh session Manila 6.011 September 1976 Provisional agenda item 10 FORM OF PRESENTATION OF PROORAMME BUtGET Development of Programme Budgeting and Management of WHO's Resources at Country Level 1. INTROOOCTION ORIGINAL: EmLISH
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1.1 Progral1lll1ng, budgeting and management concepts in WHO have been under continuing review, development and improvement in the Regional COlMli ttees, Executive Board, World Health Assembly and at all levels of the Organization since its founding in 1948. 1.2 A particularly important development took place in 1912, when the World Health Assembly, in resolution WHA25.23 adopted a new "programme budget" form of presentation based on principles of a "progra11lrr.e oriented" approach to planning, budgeting and management, set forth in the Director-General's report on this subject2 • These principles could be summarized as "programming by objectives and budgeting by programmes "3 • twenty~fifth
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1.3 The Executive Board pursued this theme of programme oriented budgeting and management in its "Organizational Study on the Interrelationships Between the Central Technical Services of WHO and Programmes of Direct Assistance to Member states", wherein the Board stressed the importance of prograllllle oriented planning at country level and concluded, "it is evident that, after its first twenty~five years of existence. WHO should
1
WHO Handbook of Resolutions and Decis1ons, Vol. I, 1973, p. 197.
2 WHO Off1cial Records, No. 201, 1972, Annex 7, pp.
54-68.
3 WHO OffiCial Records, No. 212, 1973, Introduction, p. 9.
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pl\ge 2 n0t retain the Qonc~pt of fragmented projects. but must definitely orient its direct assistance to countries towardo :1 sincle programme approach within which proJects should be identified as specifiC sets of activities t~ be implemented 1n !l glven period but in relation to overall obJectives"l. l.J~ m~es ~i.
This docuroont deals with some of the pl"act:l cal implications of, and specific reco~~ndat1ons for, more programme oriented budgeting and
of WHO's resources, particularly for WHO technical co-operation country level. which is an important subject of concern for the Regional Committees, Executive Board, World Health Assembly and the entire Organization and its Member States. 2. PROBIBM9 ASSOCIATED WITH THE FRAGMENrED PROJEm' APPROACH
m'Ul~ement
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WHO's country programmes usually consist of a set of activities known as proJects. Tne proJect concept dates back to the very beginnings of the Organization, ~i is generally applied in institutions and programmes of U:e United Nations system. It stemmed from the "sectoral" approach adopted initially to deal with fragmented requests of goverr~ts for specific :)..~sistance in areas of priority, such as malaria. maternal and child health or ervironmental sanitation. 2.2 As the Executive Board observed in its Organizational Study. "the liccumulation in WHO-assisted country programmes of an increasing number of individual projects. however efficiently planned and effectively delivered. has undoubtedly resulted in a patchwork of activities. lacking general purpose and balance and bearing insuff1cient relationship to nat10nal development. The support given by the Organization to national health planning has been a move in the right direction but it has all too often been conceived 1ndependently from ongoing project activities and therefore failed, 1n most installoes, to integrate them into ooherent and meaningful prograllllles"2. 2.3 It has frequently been stated in WHO that "planning begins at country level". This is 1nde.ed true. but the nature of such planning is changing in a fundamental way. The traditional relationship of "assisting agenoy" responding to ad hoo requests of an "assisted government" is being replaced by a concept of joint prograllllle planning by collaborating partners in health. It was in order to reflect this collaborative, programme oriented approach thl\t the Executive Board. at its fifty-seventh session. endorsed the use of tho term "technical cOt-operation" in preference to "technical assistance".
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1 WHO Official Records, No. 223. 1975. Annex 7, pp. 62-106. 2 WHO Official Records. No. 223. 1975. Annex 7. pp. 72-7'3.
WPR/RC 2 7/4 ~
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and urged that the term technical co-operation be uniformly used by the Board, Health Ansembly, Regional Committees and offices throughout the Organization and in the official documentation of WHO I • 2.4 Programming for technical co-operation at country level is a multi-sectoral, collaborative process in which national health authorities, WHO country representatives, regional offices and WHO headquarters are all associated. Country health planning and programming begins with multisectoral problem analysis, setting of overall priorities and policies. and identification of the general strategy of attack and pattern of collaboration. It is only within this framework that detailed projects and activities are eventually formulated. Thus the collaborative technical co-operation programming concept is fundamentally different from the fragmented project approach of "technical assistance" requests in the past.
2.5 Fragmented project planning has had the undesirable effect of distorting or misrepresenting the work of WHO as shown in the Programm~ Budget. Recent analyses in WHO, !ncluding a financial and effectiveness audit of country projects in one region carried out by the External Auditor, have demonstrated that a significant percentage of country projects included in the budget were never implemented, and of those implementpd, a signific~nt share deviated more than 50 per cent. from the budget, mainly as a result of changes in requests from governments, A great deal of time and effort must be expended to make detailed budget revisions up to and during the operatil1i' year. The analysis implies that allocation and budgeting of resources based on the accumulation of detailed and fragmented project proposals is not an effective methodology for planning the health programmes of WHO or its ~1",mber states. 2.6 The detailed planning of country project proposals has included the setting out of detailed cost estimates for project staff. equipment, suppllc~, transport, fellowships and other objects of expenditure two or three ye~r~ prior to the beginning of the relevant operating year. The attempt in the WHO planning process to formulate these details so far in advance, in orrj'-:r to be in a position to submit such detailed project cost estimates in programme budget documents in time for review by the Regional Committees. Executive Board and World Health Assembly. appears inconsistent with the requirements of the country health planning process and the need for flexibility on the part of the Organization and Member states.
2.7 The detailed advance planning of country projects has the further undesirable effect of making such planning out of phase with the rest of WHO's own planning cycle and the national budget preparation of most countries. By the time regional and headquarters programmes are being planned, country projects are already decided upon, thereby discouraging mutual dialogue and adaption of proposals between echelons. There is a distinct danger that such detailed planning of country projects. signed and sealed so early in the programme budgeting process between villO and 1
WHO Official Records. No. 231, 1976. p. 128. paragraph 15.
WPR/RC27/4 page 4 Member states. will become unresponsive to chaQging needs and priorities. It would appear preferable to plan ahead on a broader. more programme oriented basis, and move to detail~d project planning closer to and as a part of the implementation process, when national authorities are preparing the national health budget, when the availability of external funds is more likely to be known, and when there has been an opportunity for better pl.anning dialogue between all echelons of WHO. 2.8 The External Auditor summarized the situation in his Report to the World Health Assembly for the financial year 1975. and concluded. "My recommendations emphasized the need for planni~ to be programme oriented, ~s distinct from project oriented, with a clearer d~finition of objectives against which evaluation could be made. A substantial part of the present work with frequent budget revisions could be avoided. If the Regional Committee takes d0cisions on planning and budgeting only on broad lines, and if the detailed project planning takes place at a later stage and as part of the programme implementation, it would be possible to arrive at a smoother and more rational planning procedure"l. 2.9 It is submitted that the time has come to discard the practice of building up the programme and budget on a series of fragmented projects and to orient WHO's technical cOo-operation towards a single programme approach within which projects are identified, planned and implemented in relation to overall pl'ogramme objecti v'Cs, and in closer harmony with the national health planning process and programming at all levels of WHO. To '.:.his end a new programme budgeting procedure is suggested for consideration by the Regional Committee. and with the latter's endorsement. by the Executive Board and World Health Assembly.
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SUGGESTED PROORAMME BUIXlETIID PROCEroRE
3.1 Instead of reviewing details of proposed country programmes. the Regional Director would initiate the new programme budget cycle two or three years prior to the operating period by meeting with WHO Representatives and Regional Adviser3 to consider broad policy trends, general priorities in health, regional and national needs nod their stated priorities. and the appropriate broad lines of participation by WHO and other partners in international health work. in accQrdance with cuidelines set by the General Programme of Work for a Specific Period and various resolutions of the Regional Committee, Executive Board and Vlor Id He alth Assembly. This dialogue would provide the basis for overall programme guidance to the WHO Representatives and ReGional Advisers and the setting by the Regional Director of provisional country planning figures for \'/HO technical cOo-operation. within the tentative regional allocation established by the Directo~eneral for each region. 1 WHO Official Records, No. 230, Report of the External Auditor. p. 124.
WPR/RC27/4 page 5 3.2 The WHO country planning figures should not be considered as being synonymous with UNDP "indicative planning figures". While it is important for a government's own planning to know the provisional financial implications of WHO's collaboration, the focus should be on the form of ~JHO assistance really needed and not on the monetary level provisionally established. In this respect, the WHO provisional planning figure is meaningful only in the context of the programmes of the technical co.-operation envisaged. 3.3 ~~
Following the establishment of provisional country planning figure, least two years prior to the operation period, WHO Representatives and Regional Advtsers would begin the formal programming process with national authorities, working closely with the Ministry of Health togeth8r wi th officials in related soc10- economic fields as may be appropriate, to secure mutual agreement on: (a) the main developmental thrusts in public health planned for the next several years; (b) action proposed at national level to give effect to the General Programme of Work and resolutions of the World Health Assembly, the Executive Board and the Regional Committee; (c) areas in which external co.-operation will be sought and in which the participation of WHO appears particularly desirable; (d) programme objectives, targets and anticipated output of WHO co-operation proposed for the biennium and (e) a tentative estimate of the cost of WHO technical co.-operation by major programme or programme. 3.4 The conclusions from the programming process with national authorities outlined above would be summarized in the form of narrative country programme statements, setting out broad programme trends, objectives ann modes of action, with the country planning figure broken down by major programmes or areas of co-operation, without giving details of staff, equipment, supplies, transport, fellowships or other detailed objects of expendi ture. These country programme statements and planning figures for major programmes or areas of co-operation, would be submitted, as part of the proposed regional programme budgets, to the Regional Committee for review, and ultimately included in the Director-General's proposed programme Dudget for consideration by the Executive Board and World Health Assembly.
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3.5 ~rsuant to the same programme budgeting concept, proposals for inter-country projects and programmes at all echelons of the Organization would be developed and presented in programme oriented terms in the programme budget documents to be reviewed by Regional Committees, the Executive Board and World Health Assembly. Thus detailed activity and project lists would not be contained in the proposed programme budgets, although such detailed information would be captured and monitored by the WHO information system for programme development, management and evaluation purposes. 3.6 The detailed plans of operation or work necessary for the implementation of specific co.-operation acti vi ties at c01.mtry level would continue to be developed jOintly with the national authorities, for review with the
WPR/RC 27/4 page 6 Regional Director at a meeting of WHO Representatives, Regional Advisers and national co-ordinators as may be appropriate, in the year immediately preceding the operating period. It is only at this point that the broad programme proposals referred to in paragraph 3.4 above and included in the regional programme budget document, would be cast in detailed terms of human resources, equipment, supplies, transport and other detailed objects of expenditure, with supporting cost estimates.
3.7 The dialogue with national authorities on the detailed plans of operation or work would continue during the operating period, as part of the process of ongoing management, evaluation and pre-planning of WHO technical co-operation activities. While accounting controls would monitor expenditure within authority to spend, sufficient flexibility could be exercised to adapt to changing needs and conditions. Savings identified during the operating period would be available for reprogramming within the country, between countries, or even between regions, as overall programme operations and priorities might require.
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3.8 Thus the effect of the proposed programme budgeting procedure would be to: (a) (b) (c) Build WHO technical co-operation programmes on board programme lines rather than on detailed, fragmented projects. Plan WHO country programmes in joint collaboration with national authorities and within country planning figures. Present such proposals in the form of narrative country programme statements with the country planning figure broken down by major programmes or areas of co-operation in the proposed programme budget. Develop detailed plans of operation or work at a later stage, closer to and as a part of programme implementation.
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3.9 A brief outline of the proposed programme budgeting cycle for WHO country programmes is contained in Annex 1. 4. CCNCIDSION
4.1 If the new programme budgeting procedure for the planning and implementation of WHO technical co-operation programmes as outlined in this report meet with the approval of the Regional Committee, it may be desirable to consider adoption of the following resolution:
WPR,IRC27/4 page "'Ihe Regional Conunittee, Having oonsidered the report of the Regional Direotor on the development of progranune budgeting and management of WHO's resouroes at oountry level, and Stressing the importance of a programme oriented approach to the collaborative planning and implementation of WHO technioal co-operation at oountry level, 1. ENDORSES the programme budgeting procedures and the fOnl! of budget presentation outlined in the report; and 2. RECOMMENDS to the Exeoutive Board that the proposed prograllllle budgeting prooedures be adopted with effeot from the forthooming progranune budget oyole and that the proposed fOnl! of budget presentation be introduced in the proposed programme budget for 1980-1981. "
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PROPOSED PROGRAMME BUDGETING CYCLE FOR WHO COUNTRY PROGRAMMES
ACTION 1. Tentative allocation for Region notified to Regional Director WHO Representatives Meeting a. Programme guidance b. Provisional planning figures Formal programming at country level by main programme areas WHO Representatives Meeting on Proposed Regional Programme Review of WHO proposed regional programme by Regional Committee Review of WHO programme budget by Executive Board and World Health Assembly Preparation of detailed plan of work for country programme for each operating year WHO Representatives Meeting to finalize programme details First and second operating years of biennium
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