REGIONAL COMMITTEE Sixtieth session Thimphu, Bhutan 31 August – 3 September 2007
Provisional Agenda item 14.3
SEA/RC60/14 13 July 2007
PROGRESS REPORTS REQUESTED BY MEMBER STATES: WHO AND REFORMS OF THE UN SYSTEM: IMPACT AT COUNTRY LEVEL This paper reviews the reform agenda of the United Nations with implications on health and WHO activities at the country level, and reports on the status of WHO’s involvement in support of Member countries of the South-East Asia Region. The paper recognizes the significant impact the various UN reform agendas have on WHO activities and on its relations with national authorities. Also noting that none of the eight “One UN” pilot countries are in the South-East Asia Region, the paper highlights that keeping Member countries informed on developments in these eight countries would facilitate informed decision while Member countries consider their reaction to UN reforms and to the enlargement of the list of pilot countries. The paper suggests that the impact of UN reforms will depend on Member countries’ reaction to three interlinked processes: consultations on the UN Secretary-General’s Highlevel Panel on UN System-wide Coherence (HLP-SWC) report; evaluation of “One UN” pilot programmes; and the Triennial Comprehensive Policy Review of Operational Activities of the United Nations Development System (TCPR) in 2007. At the country level, an inter-sectoral dialogue mainly between officials of ministries of foreign affairs and health will enable the health sector to gain optimally from the UN reform process. Such dialogue will facilitate coherent reform policies and directions for better health and development outcomes to be presented and agreed upon at the UN and WHO governing body forums. The Regional Office is planning to organize a meeting to facilitate such a dialogue between officials of the ministries of foreign affairs and health to explore areas of synergy. This paper was reviewed by the Joint Meeting of Health Secretaries and the Consultative Committee for Programme Development and Management held in the Regional Office, New Delhi, 2-6 July 2007.
The Joint Meeting made the following recommendations: Action by Member States To actively participate in the regional meeting planned by the Regional Office in October 2007 with the aim of facilitating dialogue between Health officials and Foreign Affairs officials and contributing to the UN reform debates; and to propose to set up a WHO Executive Board Working Group to investigate the implication of UN reform and the work of WHO and provide recommendations through the Executive Board on UN reform. Action by WHO-SEARO To facilitate capacity building in Member States towards understanding and actively participating in UN reform and its implication on health; and to communicate to Member States on the progress made and lessons learnt from UN reform and the work of WHO, including updates from the eight “One UN” pilot countries. The document is now submitted to the Sixtieth session of the Regional Committee for its consideration.
Contents Introduction ............................................................................................................................... 1 WHO policy directions ............................................................................................................... 1 Current status ............................................................................................................................. 3 Implementation at country level ................................................................................................. 5 WHO activities in the Region ..................................................................................................... 5 Conclusion ................................................................................................................................. 6
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Introduction 1. United Nations reform has been at the centre of the international development cooperation dialogue for the past few decades. In the last decade, many significant reforms were discussed or institutionalized, including the “Millennium Development Goals” of the 2000 Millennium Summit and the “Outcome Document” of the 2005 World Summit that, among other issues, emphasize the need for a more strategic, comprehensive and results-focused approach to UN reform. These reforms have also changed the role of the UN in the increasingly globalized and interdependent world with its structure and mandates significantly expanded. 2. The most recent reforms are contained in the Report of UN Secretary-General’s High Level Panel on UN System-wide Coherence (HLP-SWC) in the Areas of Development, Humanitarian Assistance, and the Environment; “Delivering as One”1 and the Triennial Comprehensive Policy Review of Operational Activities of the United Nations Development System (TCPR) of 20072. Although UN reform is not a new subject, the recent reforms are different, as seen by the strong commitment they are getting from Member countries. 3. Moreover, over the past decades health has become a well established priority for the international development agenda, well enshrined in the Millennium Development Goals. It is also viewed as a key aspect in humanitarian assistance, environment and security at national and global levels by the UN as well as the international community.
WHO policy directions 4. The UN reforms have a significant bearing on health and development cooperation at the country and international levels. Hence, the reforms initiated by various Secretaries General and UN bodies and their implications on health and the work of WHO have been the subject of discussions and resolutions at various WHO governing body meetings. In the past five years, the topic of UN reform has been a regular agenda item at the World Health Assembly and the Executive Board. Furthermore, two resolutions have also been passed3,4. 5. For WHO, World Health Assembly Resolution WHA 58.25 on “United Nations reform process and WHO’s role in harmonization of operational development activities at country level” adopted in May 2005 provided relevant policy guidance on UN reform issues on improving coherence at the country level. The resolution emphasized the following two main 1
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UN General Assembly: April 2007 (A/61/583): and Report of the Secretary-General on the Recommendations Contained in the Report (A/61/836) UN Economic and Social Council Substantive Session, to be discussed on 10th July 2007 (A/62/73-E/2007/52) 58th World Health Assembly, 2005 resolution WHA58.25: United Nations reform process and WHO’s role in harmonization of operational development activities at country level 59th World Health Assembly, 2006 Resolution WHA59.12: Implementation by WHO of the recommendations of the Global Task Team on Improving AIDS Coordination among Multilateral Institutions and International Donors
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points; (1) WHO should adhere to the international harmonization and alignment agenda by participating in the United Nations Development Framework, closely working with United Nations Country Teams and the UN Resident Coordinator at country level, in order to ensure coherence and efficiency; and (2) to take into account the Triennial Comprehensive Policy Review and to take specific steps to further rationalize procedures and reduce transaction costs. 6. Since the 2005 World Summit, the WHO Secretariat is actively engaged in internal and external consultations to define the Organization’s views and directions and issue guidance. WHO is also actively involved in the “One UN” pilot countries; the review of the UN Chief Executive Board and the various forums and working groups of the UN Development Group. 7. The current directions and guidance for WHO on UN reform at the country level are based on the following principles: • • • • • • •
Focus on improved health outcomes Accountability to Member countries Based on National needs and priorities Focus on aid effectiveness as reflected in the Rome & Paris Declarations Partnerships for support to countries Contributing to global commitments Ensuring coherence
8. The directions and guidance, among other issues, highlighted the following components and priorities: •
The need for WHO to actively advocate for and fully support UN reform efforts that will strengthen its global leadership, coordination and partnership roles while appropriately recognizing the increasing importance and cross-cutting nature of public health issues. WHO should also advocate for the UN system needs, redefine its strategic direction focusing on knowledge generation, norms and standards development, innovation and policy development. The need for WHO to advocate for implementation of a pragmatic and robust resultsbased, system-wide enabling environment throughout the UN system and for a better defined division of labour based on competency and complementarity. The need to focus on results within a common framework to achieve a more appropriate targeting of resources and greater transparency and accountability. Country ownership and leadership in national development as the basis for WHO’s cooperation. Key elements of WHO’s work at all levels are directed by national health and development needs and priorities. WHO has as the basis its Country Cooperation Strategy (CCS) and General Programme of Work (GPW) as tools for defining global, regional and national priorities and plans and ensures consistency with the
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internationally agreed development goals and the United Nations Development Assistance Framework (UNDAF). •
The need for WHO to support cost-effective business–support functions, with particular emphasis on common standards, and due regard for the policies of individual organizations. The need for a strategic approach for coordination within the United Nations system, including effective alignment and, where appropriate, integration and rationalization of specific coordination needs for reform efforts and within the overall coordination framework of the United Nations system including reforming the Chief Executive Board (CEB) and the UN Development Group (UNDG). Efforts by organizations individually and the United Nations system collectively to improve their relevance and effectiveness need to go together with a coherent and effective approach to financing of the United Nations system by governments. Appropriate financing is essential if organizations are to act in a global, impartial and efficient manner.
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Current status 9. Report of the High-Level Panel on UN System-wide Coherence: The Report has been submitted to the UN General Assembly for discussions with full endorsement from the UN Secretary-General Ban Ki-moon in April, 2007. Intergovernmental negotiations and discussions among UN agencies and other stakeholders are ongoing. The outcome of these negotiations will be crucial in determining how the UN will take in full or in part the various issues raised in the report. As the HLP-SWC report has a strong link with TCPR, the negotiations will also have an implication on the follow-up actions of the latter. 10. “One UN” Pilot: Following the submission of the report, “Delivering as One”, by the HLPSWC that recommended the implementation of “One UN” at country level to be piloted in five countries by the end of 2007, and the Secretary-General’s instruction to the UNDP Administrator as chair of the UN Development Group, eight countries5 requested to be included as pilot countries. The key features of the “One UN” country programme are one programme, one leader, one budgetary framework and, where appropriate, one office. The “One UN” pilot countries will be reviewed and evaluated mainly by the United Nations Evaluation Group (UNEG) and the result presented to Member countries. 11. WHO is an active partner in these “One UN” pilots. The lessons drawn to date by WHO have indicated the following as crucial factors for success; (1) national ownership and leadership; (2) the critical importance of having one UN country programme and 3) the need for the UNRC system and the “One UN” to be inclusive. 12. The latest Triennial Comprehensive Policy Review (TCPR) of 2007: During the first week of July 2007, the High-level Segment of ECOSOC will discuss the report submitted by the 5
Albania, Cape Verde, Mozambique, Pakistan, Rwanda, United Republic of Tanzania, Uruguay and Viet Nam.
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Secretary-General on the TCPR. The TCPR in addition to the updates on developments since the 2004 TCPR and the 2005 General Assembly’s resolution (GA 59/250) on the subject, highlighted the following; •
Acknowledging the shortcoming of the Resident Coordinator System, the Common Country assessment (CCA) and UNDAF, recommends for these processes to be more inclusive of other agencies and UN entities. Acknowledges that the specialized agencies and the Bretton Woods Institutes have independent governing bodies and structure that do not report to ECOSOC and GA and this factor has to be taken into the overall prospective while the review is considered in the Council. Appreciated WHO’s Medium Term Strategic Plan and the concept of negotiated core voluntary funding as potentially transaction cost saving and innovative. The review acknowledged that a significant amount of supplementary (voluntary) funding is raised from bilateral donors and public-private partnerships at country level and analyzed their shortcomings including the increase in transaction cost incurred on the UN agencies. Reaffirms the UN System’s comparative advantages in national capacity development and development effectiveness and acknowledges WHO’s contribution in development of technical and technological capacity including those in norm setting. Acknowledges that a new trend is developing where UN Country Teams (UNCT) are opting not to conduct a CCA but to make use of the national processes. More and more UNCTs are harmonizing their UNDAF with national programming cycles. The challenge is in striking a balance between the UN system’s strategic focus and the need for inclusiveness in order to best respond to national priorities. Acknowledges the UNRC system is firmly anchored in UNDP and this creates conflicts of interest where the UNRC is also Representative of UNDP. To address this, UNDP has started appointing UNDP country directors. Such appointments will number 40 by the end of 2007. Most of all, the report emphasised that the UNRC can correctly function only when it is based on the principles of collegiality and a high degree of participation of all agencies at country level. While discussing the regional dimension, the review emphasised the need for regional alignment in terms of location of regional offices and geographical coverage of UN agencies but failed to highlight the unique nature of WHO in this respect. Acknowledges increase in engagement of National Professional Officers as a positive development that would strengthen the national response capacity and increase relevance and continuity for the UN system programmes at country level.
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Implementation at country level 13. In support of the HLP-SWC, the Norwegian Government had initiated a high-level regional consultation in Indonesia in March 2007. From the South-East Asia Region, Bangladesh, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand were represented by senior Foreign Affairs officials. Considering the strong influence officials of Foreign Affairs have in shaping the general UN reform agenda, it is important for health authorities to collaborate and create the necessary understanding of the implication of UN reforms on health and on WHO activities at the country level. 14. In related developments, the governments of Norway and France, together with Brazil, Indonesia, Senegal, South Africa and Thailand launched a “Global Health and Foreign Policy Initiative” aimed to explore the links between foreign policy and health. The initiative issued the “Oslo Ministerial Declaration” on 20 March 2007, that identified Global health as a pressing foreign policy issue of our time. SEAR Member countries could draw lessons from the experience of the Ministry of Health officials of Indonesia and Thailand who were active participants of the initiative. 15. None of the SEAR countries are included in the “One UN” pilot programme. Hence, the implication of the UN activities in support of the “One UN” pilot is not known. SEAR Member countries would have to rely on the updates, assessments and evaluation from the UN and individual agencies. 16. While recognizing the value of the UNDAF for the collective UN system, it also needs to be acknowledged that the UNDAF provides limited opportunities to articulate and thereby leverage action in the health sector. This limitation of UNDAF and the “One UN” approach is also observed by some of our Member countries who pointed out that the concept of “comparative advantage” implicit in the UNDAF is likely to undermine the contribution, which individual agencies bring to development cooperation.
WHO activities in the Region 17. WHO Representatives’ Offices are active in all the UNCT in Member countries of the Region. WHO is also involved in the CCA/UNDAF processes in all countries except in the Democratic People’s Republic of Korea where a similar process known as “UN Strategic Framework” exists. In all the countries the WHO Country Cooperation Strategy guides WHO’s inputs to the CCA/UNDAF process. 18. With the aim of creating better understanding and getting inputs for the consultations on the subject, Ministry of Health counterparts and WHO staff participated in various forums organized by the WHO Regional Office for South-East Asia and WHO Representatives’ Offices where “UN Reform and its implication to health and WHO activities at country level” were discussed.
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Conclusion •
As mentioned above, the following processes will determine how the UN will take the reform agenda forward specially at the country level; 1) the intergovernmental negotiations at the UN General Assembly and the stakeholders consultations on the HLP-SWC report; 2) the result of the assessment and evaluation of the “One UN” pilot programmes in the eight countries; and 3) the debate at the high-level segment of ECOSOC on the 2007 TCPR in July 2007. Furthermore, these issues will also be discussed in the governing bodies of specialized agencies like WHO, ILO and FAO and interagency coordinating bodies of the UN like the CEB and UNDG as well. The coherence of positions taken by Member countries in the various governing bodies will also determine the policy alignment for the reform among UN programmes and funds and specialized agencies. In general, the current UN reform proposals as reflected in the TCPR as well as the HLP-SWC report are strongly supported by donor countries. Even before the debate on the HLP-SWC report at the UN General Assembly, there is already dedicated funding linked to implementation of the recommendations. This will put additional pressure on national authorities to agree on the recommendations before the full implications are examined in inter-sectoral forums. Such inter-sectoral opportunities are rarely available to foreign affairs officials to share with their health colleagues and present a common and coherent country position that is reflected in both the UN governing body forums and the World Health Assembly and Executive Board. WHO SEARO is planning a meeting that will facilitate such a dialogue between Ministry of health and Ministry of foreign affairs and explore areas of synergy in efforts to influence policy for better health and development outcomes.
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19. This meeting is requested to consider this paper and to provide its observations and recommendations.