WORLD HEALTH ORGANIZATiON
ORGANISATION MONDIALE
DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-ruth session Shanghai, China 13-17 September 2004
WPRlRC55/3 3 August 2004 ORIGINAL: ENGLISH
Provisional agenda item 9
PROGRAMME BUDGET, 2002-2003: BUDGET PERFORMANCE (FINAL REPORT)
This document presents the final report on programme implementation of the regular budget for the 2002-2003 biennium. implementation of other sources of funds. In monetary terms, the implementation of the regular budget from 1 January 2002 to 31 December 2003 amounted to US$ 71 975 000, or 100% of the operating budget. In addition, activities implemented using other funds amounted to US$ 58 810 986. Total funds implemented during the period therefore amounted to US$ 130 785 986 (Annex 2, column 7). Information on the implementation of programmes by country is also provided (Annex 3). This is a new feature of the report. Information on outcomes is provided in Annex 4 of this report. The information is based on an end-of-biennium assessment Information is also provided on
exercise and covers the period 1 January 2002 to 31 December 2003.
An interim report on the implementation of the regular budget and .other sources of funds for 2002-2003 was presented to the fifty-fourth session ofthe Regional Committee. The Regional Committee may now wish to review and discuss the fmal implementation figures.
WPR/RCS5/3 page 2
This final report on budget perfonnance for the biennium 2002-2003 follows the interim report presented to the Regional Committee at its fifty-fourth session in September 2003. The programme outcomes reflect the situation as at 31 December 2003, based on information extracted from the endof-biennium assessment exercise conducted by all focuses and country offices. Information 15
also
included on implementation of other sources of funds to provide a comprehensive picture of the total funds obligated and programme outcomes for each focus. The 2002-2003 proposed programme budget for the Western Pacific Region was fIrst presented to the Regional Committee at its fifty-first session in September 2000. It was subsequently approved at the Fifty-fourth World Health Assembly as part of the global programme budget. The regular budget that was approved by the Health Assembly amounted to US$ 73 262 000 (a redUCTIon of 3.5% from the 2000-2001 approved programme budget ofUSS 75 889000 as a result ofresoiution WHA51.31). However, since then a number of important changes have been made: 1.
In November 2001, the Director-General established the initial working allocation at 98% of the 2002-2003 approved programme budget (US$ 1 465 000, or 2%, was withheld). This was necessary because of an anticipated shortfall in the collection of assessed contributions to the regular budget. An additional US$ 219 000, or 0.3%, was retamed for WHO's security costs. As a result, initial working allocations released to the Western Pacific Region amounted to US$ 71 578 000 (Annex 1). It was agreed with the Director-General that, with effect from the 2002-2003 biennium, no adjustments would be made to the Region's working allocation as a result of changes in the exchange rate of the Philippine peso to the US dollar.
2.
Since the initial working allocation of US$ 71 578 000 for 2002-2003 was first released in November 2001, further adjustments have been made to the budget. Additional fimds of USS 397 000 (compared with US$ 255 000 in 2000-2001) were allocated by Headquarters for regional activities to be carried out by the focuses on Sexually transmitted infections, inciuding
EN/AIDS, Tobacco Free Initiative, Health systems development and financmg, and Programme planning, monitoring and evaluation. These changes are shown in Annex :. Tne [mal working allocation as at 31 December 2003 was US$ 71 975 000 (Annex 1 and Annex 2, column 1). Annex 2 also illustrates the final financial implementation report by each regional focus.
3.
A number of other changes to the working allocation were made during the course of the biennium. Annex 2, column 2, consolidates all the changes that have occurred as a result of efficiency savings, changes to absorb cost increases, cost variations and changes due to reprogramming. The figures in column 2 are therefore net amounts.
WPRlRC5S/3
page 3 The appropriation resolution WHA54.20 for the financial period 2002-2003 requested the Director-General to continue efforts to effect efficiency savings in pursuance of resolution WHA52.20, to be applied towards the required adjustments for cost increases and currency fluctuations. For the Western Pacific Region, savings ofUS$ 1 300000 (equivalent to 1.8% of the approved regular budget of US$ 73 262 000) were identified, largely from staff-related costs and to a lesser extent duty travel by staff. These savings were transferred to the following areas identified as priorities by the Director-General: (the relevant regional focus is given in brackets); malaria (Malaria, other vectorbome and parasitic diseases); tuberculosis (Stop TB and leprosy elimination); tobacco (Tobacco Free Initiative); making pregnancy safer (Reproductive health); liN!AIDS (Sexually transmitted infections, including HIV!AIDS); food safety (Healthy settings and environment); surveillance, prevention and management of noncommunicable diseases (Noncommunicable diseases, including mental health); mental health (Noncommunicable diseases, including mental health); blood safety (Health systems reform); evidence for health policy (Health information and evidence for policy); and organization of health services (Health systems reforms and Human resources for health). In addition, funds from savings and unimplemented activities were shifted to fund the enormous regional response to the outbreak of severe acute respiratory syndrome (SARS). 4. As requested by the Regional Committee, the programme budget was implemented m accordance with the themes and focuses proposed in the document WHO in the Western Pacific Region: aframeworkfor action (WPRlRC50/2).
At 31 December 2003, the full working allocation ofUS$ 71975000, or 100% of the regular budget, had been obligated (see Armex 2, colurrms 4 and 5). Implementation of other funds is shown in Armex 2, column 6. The total amount of other funds obligated as at 31 December 2003 was US$ 58 810 986. Column 6 highlights the fact that US$ 4 910 846 of "other sources of funds" was spent on communicable disease surveillance and response, primarily for the regional response to the SARS epidemic. Columns 7 and 8 illustrate implementation of all funds and implementation by focus as a percentage of total implementation. Annex 3 contains information on the financial implementation of country programmes financed by the regular budget and specific country programmes supported by other funds. The programme budget 2002-2003 followed a results-based approach, revolving around a set of objectives, strategies and expected results. A key feature of results-based budgeting is
WPRlRC5513 page 4
that it compels WHO to submit itself to self scrutiny and to compare actual accomplishments to expected results. Results-based budgeting requires formulation of programmes and budgets that are driven by expected results articulated at the outset of the budgeting process. Annex 4 provides a detailed narrative summary of what WHO programmes in the Region achieved in the 20022003 biennium. The report is presented for all 17 focuses by the expected results included in the proposed programme budget approved by the Regional Committee at its fifty-second sessIon. Additional information on WHO activities in the Region during the biennium is contained in The Work of WHO in the Western Pacific Region: 1 July 2001-30 June 2002, 1 July 2002-30 June 2003 and 1 July 2003 to 30 June 2004.
WPRJRC55/3 page 5
ANNEXl Changes to the 2002·2003 regular budget as at 31 December 2003
Changes made
Total
ill§il
Column reference in Annex 2
I.
Programme budget presented to the Regional Committee at its fifty·first session and approved at the Fifty·fourth World Health Assembly 2% of budget withheld by the Director-General as contingency reserve 0.3% share in security cost
73262000
1465000 219000
(1 684000)
II.
Initial working allocation
71578000
Funds allocated from Headquarters for specific programme activities
397000
III.
Final working allocation
71 975000
WPRlRC55/3 page 6
Flnallinariclallmplementatlon • regular budget and funds from other sources for the biennium 2002·2003 as at 31 December 2003
(1)
Final working allocation COMBATING COMMUNICABLE DISEASES 1 Expanded programme on immunization 2 Malaria, other vectorborne and parasitic diseases 3 Stop TB and leprosy elimination 4 Sexually transmitted infections, including HIVIAIDS 5 Communicable disease surveillance and Subtotal res~onse
(2) Programme changes during Implementation and other chanses
(3) Operating budget (1)+12)
(5) Percentage of operating budget Actual implemented expenditures' obligations 14~(3) (4) 2327044 3696727 1 671 022 1 573269 3311232 12579294 100.72% 100.16% 100.46% 100.00% 100.12% 100.27%
(6)
(7)
(8)
Other
lourees im~lemented
Percentage All funds of all funds Implemented Implemented bl focus (4)+16)
1 852500 3158200 2129600 1 338000 2404400 10882700
457803 532516 (466272) 235269 902900 1 662216
2310303 3690 716 1 663328 1 573 269 3307300 12544916
12294428 7873212 6872 817 3507287 4910849 35458593
14621472 11569939 8543839 5080556 8222 081 48037887
11.18% 8.85% 6.53% 3.88% 6.29% 36.73%
BUILDING HEALTHY COMMUNITIES AND POPULATIONS 6 Healthy settings and environment 7 Child and adolescent heaith and development 8 Reproductive health 9 Noncommunicable diseases, including mental health 10 Tobacco Free Initiative Subtotal HEALTH SECTOR DEVELOPMENT 11 Health systems reform 12 Human resources development 13 Heallh informalion and evidence for policy 14 Eme~en~ and humanitarian action Subtotal 12904400 7581400 1616000 150500 22252300 299242 ( 404 947) 178191 (33489) 38997 13203642 7176453 1 794 191 117011 22291 297 13235863 7075109 1 795067 118 021 22224060 100.24% 98.59% 100.05% 100.86% 99.70% 4 022 233 1 297722 561 041 1 364 002 7244998 17 258 096 8372 831 2356108 1482023 29469 058 13.20% 6.40% 1.80% 1.13% 22.53% 7800750 2395 000 1 331 500 3708750 796 000 16 032 000 (475489) 277274 ( 182 229) (374585) 101074 (653955) 7325261 2672 274 1149271 3334165 897074 15378045 7341000 2674251 1152780 3342544 897073 15407648 100.21% 100.07% 100.31% 100.25% 100.00% 100.19% 1 658362 1 602207 3642817 1 067878 2006565 9977829 8999362 4276458 4795597 4410422 2903638 25385477 6.88% 3.27% 3.67% 3.37% 2.22% 19.41%
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;I;> Final financial implementation. regular budget and funds from other sources for the biennium 2002·2003 as at 31 December 2003 1:1 1:1 II> ~
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(1 ) Final working allocation REACHING OUT
(2) Programme changes during implementation and other chanses
(3) Operating budget
!11!(2)
(6) (5) Percentage of Other operating budget Actual Implemented sources expendituresl Im~Iemented obligations (4)!!3)
(4)
(8) Percentage All funds olall funds Implemented implemented by focus !W!G)
(7)
~
15 Infonnation technology 16 External relations 17 Public infonnation Subtotal ADMINISTRATION AND FINANCE Budget and finance Personnel General administration Su~~I~
1 585 000 9930000 1 812 000 13327000
(297537) 655313
1 287463 10585313 1402556 13275332
1 287463 10588 167 1402557 13278 187
100.00% 100.03% 10000% 100.02%
0 4876970
1 287463 15465 137 1 402557 18155157
0.98% 11.83% 1.07% 13.88%
! 409 444) ! 51668)
a 4876970
1377 000 670000 4296000 625 000 6968000
(525 078) 36757 ( 128 803)
851 922 706757 4 167 197 435867 6161 743
851 921 706765 4 167 199 435868 6161 753
100.00% 100.00% 100.00% 100.00% 100.00%
241634 274043 666828 70 091 1 252596
1 093555 980808 4834027 505959 7414349
0.83% 0.75% 3.70% 0.39% 5.67%
Subtotal REGIONAL DIRECTOR'S OFFICE Regional Committee Regional Directors development programme Executive management Subtotal Total
! 189 133) !806 257)
454000 999 000 1 060000 2513000 71 975000
30667
484667 999000 840000 2323667 71 975000
485058 999000 840000 2324058 71 975000
100.08% 100.00% 100.00% 100.02% 100.00%
0 0
485058 999 000 840000 2324 058 130785986
0.37% 0.77% 0.64% 1.78% 100.00%
a ! 220 000) ! 189333) 0
a 58810 986
a
WPRlRC55/3 page 9 ANNEX 3 Final financial implementation by country for biennium 2002-2003 as at 31 December 2003 Country implementation Total as percentage Actual implementation of total expenditures/ implementation obligations
Regular budget Country/Area American Samoa Australia Brunei Darussalam Cambodia China1 Cook Islands 1 Fiji French Polynesia Guam Hong Kong (China) Japan Kiribati Lao People's Democratic Republic Macao (China) Malaysia Marshall Islands Micronesia, Federated States of Mongolia1 Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga1 Tuvalu Vanuatu Viet Nam Sub·total· countries WHO Representatives Total· countries Regional and intercountry Total Allocation withhheid by HQ (net of transfers) Total implementation 11ncludes country activities funded by RDDPfunds. 1 1 Working allocation Actual expenditures/ obligations % of working allocation
Other sources
130000 0 50000 1506000 6781 000 426000 1088000 50000 50000 50000 39000 670000 1 670000 50000 956000 220000 522000 2403000 96000 50000 40 000 97000 50000 119000 2421 000 1 550000 1 201 000 1222000 50000 1563000 101 000 1157000 115000 1260000 4522000 32275000 8385000 40660000 32602000 73262000 (1287000) 71975000
81 951 0 21528 2121486 6653494 348356 1041211 53633 10 000 1500 17000 635489 1 807094 35690 772 256 192863 463668 2427911 102660 18650 33854 71 010 37628 130353 2057581 1519035 1205190 948793 35573 1 046237 79692 990682 107391 1121135 4846943 31037537 9030463 40 068 000 31907000 71975000 71975000
63.04 43.06 140.87 98.12 81.77 95.70 107.27 20.00 3.00 43.59 94.85 108.21 71.38 80.78 87.67 88.83 101.04 106.94 37.30 84.84 73.21 75.26 109.54 84.99 98.00 100.35 77.64 71.15 66.94 78.90 85.63 93.38 88.98 107.19 96.17 107.70 98.54 97.87 98.24 100.00
0 0 0 6239947 4916699 34495 23785 0 0 0 0 53935 1 060108 0 8607 52300 57842 234 465 32441 0 0 0 0 0 767234 2289931 184372 92828 0 251 942 0 117069 100710 87730 1 792863 18399303 271 504 18670807 40140 179 58810986 58810 986
81 951
0.06 0.02 6.39 8.85 0.29 0.81 0.04 0.01 0.00 0.01 0.53 2.19 0.03 0.60 0.19
a 21 528 8361 433 11570193 382851 1 064996 53633 10000 1500 17000 689424 2867202 35690 780863 245163 521 510 2662376 135101 18650 33854 71 010 37628 130353 2824815 3808966 1 389562 1 041 621 35573 1 298179 79692 1107751 208101 1 208865 6639806 49 436 840 9301 967 58738807 72 047 179 130785986 130785986
DAD 2.04 0.10 001 0.03 0.05 0.03 0.10 2.16 2.91 1.06 0.80 0.03 0.99 0.06 0.85 0.16 0.92 5.08 37.80 7.11 44.91 55.09 100.00 100.00
WPRlRC55/3 page 10
WPRlRC55/3 page 11
ANNEX 4
OUTCOMES (1 JANUARY 2002 - 31 DECEMBER 2003) 1. Expanded programme on immunization
Expected result
Achievement of expected result as measured by indicators
1. Support provided to countries and areas in planning and conducting Expanded Programme on Immunization (EPI) and disease control activities.
•
Thirty-six countries and areas have adopted and implemented national EPI target diseases control activity plans. There is high awareness throughout the Region of the importance of developing and maintaining a strong national EPI.
2. Support provided to ensure that no country or area reports cases of poliomyelitis due to indigenous wild poliovirus.
•
Thirty-six countries and areas provided acute flaccid paralysis (AFP)/poliomyelitis surveillance reports to WHO. No new case of wild poliomyelitis was reported during the biennium. Technical assistance from WHO has supported the maintenance of good quality AFP surveillance and high coverage of oral poliomyelitis vaccine, especially in the target countries of Cambodia, China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam. I
3. Countries and areas enabled to reduce measles transmission to very low levels, eliminate neonatal tetanus as a public health problem, and control outbreaks of other vaccinepreventable diseases. 4. All countries and areas enabled to maintain routine EPI coverage at over 90% and to provide highquality services with safe injections and potent vaccines.
•
67% of target countries and areas reported reductions in numbers of measles cases. A regional measles elimination programme was introduced and is being implemented with the strong support of countries and areas in the Region. 87% of countries and areas have reached the elimination goal for neonatal tetanus.
•
70% of countries and areas maintained routine coverage ofEPI vaccines at over 90%. The "two pillar" concept of strengthening the routine delivery EPI vaccines through measles elimination and hepatitis B control was introduced during the biennium.
WPRlRC55/3 page 12
Annex 4
Expected result
Achievement of expected result measured by indicators
a~
5. Countries in the Region will
• !
89% of countries and areas are self-sufficient or partially self sufficient in the supply of good quality EPr vaccines. I , i ,
continue to move towards selfsufficiency in the supply (including production where appropriate) of good quality vaccines.
!
,
I
6. Support given to ensure that hepatitis B vaccine is fully integrated with the EPr in all countries and areas as per WHO's recommendation, and that at least one other antigen is targeted for introduction in selected countries and areas.
I , 1
•
All countries and areas in the Region have integrated hepatitis B vaccine into their national EPrs. No new antigens were targeted for introduction in countries or areas during the biennium. Policy related to the introduction of new antigens has been modified towards an emphasis on the evaluation of capacity to implement and sustain administration of additional vaccines. In this way there will be greater assurance that addition of
!
I
, !
I
new antigens to national immunization schedules can be sustained in the longer term.
I
WPRlRC55/3 page 13 Annex 4 2. Malaria, other vectorborne and parasitic diseases Expected result Achievement of expected result as measured by indicators
:
I
l.
Effective dengue vector control through active source reduction promoted.
•
In 2002, annual data on dengue cases and deaths were
received by WHO from countries and areas. In 2003, a system of rumoUT surveillance was established. It indicated that there were 17 outbreaks in the Region in 2003. WPRO supported active source reduction in countries, including Cambodia, the Lao People's Democratic Republic, the Philippines and Tonga. Community-based vector control interventions using a communications for behavioural impact (COMBl) approach were implemented in the Lao People's Democratic Republic. In Cambodia, larvicides were distributed and a system of jar covers was developed and evaluated. Regular stockpiles of insecticides and other vector control products were replenished in Fiji. I
i
2.
Support given to effective dengue surveillance through strengthening of the reference laboratory network.
•
In 2003, 547 deaths due to dengue fever were reported
in the Region compared with 467 in 2002. This corresponds with the increased number of reported dengue cases in 2003 (from 87 536 in 2002 to 116 185 in 2003). The reported case fatality rate of dengue was 0.53% in 2002 and 0.47% in 2003. In order to reduce case fatality rates, revised management guidelines were produced and circulated in all dengue endemic
! ,
countries. Support was provided to Cambodia, the Lao People's Democratic Republic and Tonga to improve dengue surveillance. DengueNet was launched in Asia in December 2003 for "real-time" monitoring of the dengue situation in all countries and areas. A regional laboratory network was established. A study was
WPRlRC55/3 page 14
Annex 4
Expected result
Achievement of expected result as measured by indicators commissioned in the Lao People's Democratic Republic to evaluate several commercially available I
! ,
dengue rapid diagnostic tests
I
I
3.
Strong coordination of filariasis elimination in the Pacific through the Pacific Programme for the Elimination of Lymphatic Filariasis (pacELF), and strengthened national programmes.
•
In the Pacific, 11 (American Samoa, Cook Islands, Fiji, French Polynesia, Kiribati, Niue, Samoa, Tonga, Tuvalu, Vanuatu and Wallis and Futuna) of 13 lymphatic filanasis endemic Pacific island countries successfuIly completed mass drug administration (MDA) in 2002 and 2003. Of the 10 Pacific island countries implementing lymphatic filariasis activities through the Pacific Programme for the Elimination of Filariasis (Pac ELF) network, coverage rates ranged from 46% to 98% in 2002 and from 43% to 91% in 2003 (Papua New Guinea and New Caledonia did not begin MDAs). PacELF was fully involved in the planning, coordination and evaluation of lymphatic filariasis elimination programmes for all 10 participating countries. I
4.
Implementation of the global lymphatic filariasis elimination strategy in Cambodia, the Lao People's Democratic Republic, Malaysia, the Philippines and VietNam.
•
Malaysia and Viet Nam launched MDAs in 2002-2003. The third MDA in the Philippines was conducted in 2003 in eight provinces with almost 8.5 million of the 11 million target population (77%) throughout eight provinces covered in 2003.
5.
PacELF strategy for lymphatic fliariasis elimination implemented in all endemic countries and national plans of action coordinated through the PacELF regional mechanism.
•
Of the 13 countries and areas endemic for lymphatic filariasis in the Region, all but New Caledonia and Papua New Guinea actively implemented lymphatic filariasis elimination activities or developed national plans of action for lymphatic filariasis. Comprehensive annual reports and an atlas describing the programme achievements in each country were produced and
WPR/RC55/3 page 15
Annex 4 Expected result I I
Achievement of expected result as measured by indicators
circulated to the countries and areas and PacELF partners. 6.
Support given to dewonning programmes covering more than 75% of schoolchildren.
•
Pilot dewonning projects were initiated in Cambodia, Fiji, the Lao People's Democratic Republic and Viet Nam, and plans for projects were developed for Kiribati, Tuvalu and Vanuatu. Cambodia achieved the target of covering more than 75% of schoolchildren with a dewonning programme but this target has not been achieved regionwide.
7. Effective regional programmes on the control of parasitic zoonoses implemented and national programmes supported.
•
An international meeting on the control of foodborne parasitic infections was held in Viet Nam in November 2002, leading to better cooperation with the Food and Agriculture Organization ofthe United Nations and other partners. Cambodia and the Lao People's Democratic Republic developed plans covering schistosomiasis controL An international meeting on foodborne trematodes was held in Ha Noi in November 2002. Two meetings ofthe Regional
I
,
Network for Research, Surveillance and Control of Asian Schistosomiasis were held in Cambodia (May 2002) and the Lao People's Democratic Republic (November 2003).
8.
Improved international coordination of parasitic control.
•
International coordination meetings on parasitic control were held in 2002 and 2003 in collaboration with the Hashimoto Initiative and there was a useful exchange of ideas and experience. However, more effort is required to improve international collaboration on parasitic control. No new memoranda of understanding for partnership development were developed in 2002-2003, however there was a wide range of informal cooperation
WPRJRC55/3 page 16
Annex 4
Expected result
Achievement of expected result as measured by indicators between WHO and partner agencies in parasitic control in Cambodia and the Lao People's Democratic Republic. Proposals for pilot projects were developed for Fiji, Kiribati, Tuvalu and Vanuatu and funding was obtained for the first two projects. A project was implemented in one province in Viet Nam.
I
9.
Data from sample surveys collected, compiled and a report produced.
•
Surveys were completed and reports compiled in Cambodia, the Lao People's Democratic Republic, Viet Nam, and the Pacific island countries and areas. Development of a pilot project generated by the survey findings for Kiribati was started. A research paper based on the results of the Pacific survey was submitted for publication.
:
i
i
10. Development, monitoring and coordination of national programmes for control of malaria and other vectorbome and parasitic diseases, as well as promotion of Roll Back Malaria (RBM) approaches, facilitated.
•
All 10 countries and areas in the Region (Cambodia, China, the Lao People's Democratic Republic, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea, Solomon Islands, Vanuatu and Viet Nam) endemic for malaria reported annual malana data to WHO. A standardized reporting spreadsheet was distributed by WHO and the quality of reporting has improved in six countries. Support was provided through the Asian Collaborative Training Network for Malaria (ACTMalaria) and national control programmes for the organization of national courses on the management of malaria field operations in Cambodia, the Lao People's Democratic Republic, Malaysia, the Philippines, and Viet Nam. An international training workshop on operational research was conducted in the Philippines. Courses on microscope maintenance and repair in the Lao People's Democratic Republic and Philippines were conducted. I
)
WPRlRC55/3 page 17 Annex 4 !
Expected result
Achievement of expected result as measured by indicators
11. Use of combination treatment
•
Cambodia introduced artemisinin-based combination therapy (ACT) during 2002 into the private sector. A drug-use survey in four provinces in 2002 showed that about 20% of fever patients received ACT, of those receiving ACT, 80% had been tested for malaria. In Yunnan Province, China, and Viet Nam, ACT is one of the nationally recommended treatments. Support was given to update malaria treatment guidelines in endemic countries based on evidence of drug efficacy. This includes deployment of combination therapy in all countries of the Region. Out of nine countries and areas endemic for P. jaiciparum, five have included ACT in their national policies (Cambodia, China, the Philippines, Papua New Guinea and Viet Nam), one is about to change to ACT (the Lao People's Democratic Republic), and three others have combination therapy (Malaysia, Solomon Islands and Vanuatu). There is clear evidence from countries and areas of the Region that the development and deployment of rapid diagnostic tests (RDTs) and the introduction of quality assurance for these tests and for malaria microscopy is improving diagnostic quality although empirical data are not yet available. RDTs are now available in seven countries.
and dipstick diagnosis promoted in at least 50% of falciparum high-risk provinces in Cambodia, Viet Nam and Yunnan Province, China, as well as implementation of evidencebased antimalarial drug policies in all endemic countries.
WPR/RC55/3 page 18
Annex 4
Expected result I
Achievement of expected result as measured by indicators •
12. Regional system for antimalarial drug resistance surveillance operating.
An overview report on antimalarial drug efficacy in the Western Pacific Region was finalized in 2003. The Mekong drug resistance sentinel site network was made functional. Drug efficacy trials were supported in Cambodia, China and the Lao People's Democratic Republic. The Southeast Asian Ministers of Education OrganizationTropical Medicine Programme (SEAMEOITROPMED) collected and mapped biregional Mekong malaria data.
I 13. Malaria surveillance and
•
Annual malaria data have been collected in a timely manner, analysed and returned to endemic countnes and areas within the first three months of the following year.
management informahon strengthened. 14. Support given for improving malaria vector control coverage and targeting. •
Reported data for the Lao People's Democratic RepUblic in 2002 indicated that 34% of the at-risk population was covered by insecticide treated nets (ITNs), compared with 17% in 2000. In June 2003, 20 000 ITNs were purchased and distributed in the Milne Bay province of Papua New Guinea. In the Lao People's Democratic Republic, the distribution ofITNs continued in some areas. Based on the reported data for 2001 and 2002, five malaria-endemic countries in the Region have made progress in 2002 compared to 2001 (Cambodia, the Philippines, Solomon Islands, Vanuatu and Viet Nam) 2003 data is yet to be received. ITN programmes throughout the Region received technical assistance from WHO through the procurement of nets and insecticIdes. I
WPR/RC55/3 page 19 Annex 4
Expected result
Achievement of expected result as measured by indicators
15. Greater Mekong subregional
•
A situation analysis was completed in five of the six Mekong countries and stakeholders' meetings were held. Training was conducted and baseline research on the target groups carried out.
initiative that adopts participatory and locally-driven approach to information, education, and communication (IEC), social mobilization and advocacy developed and implemented.
3. Stop TB and leprosy elimination Expected result Achievement of expected result as measured by indicators
1. Regional capabilities for directly
•
2002 data indicate that 77% of the population in the Region has access to DOTS compared with 60% in 2001. The DOTS enrolment rate in 2002 was 84% compared with 78% in 2001. Countries with a high burden of tuberculosis (TB) - Cambodia, China, the Lao People's Democratic Republic, Mongolia, the Philippines, Papua New Guinea, and Viet Nam - have completed their two-year national DOTS acceleration plans. Donor support for TB control in the Region has increased; the funding gap for TB control in the Region was reduced from 40% in 2001 to 10% in 2003. China has continued to expand DOTS coverage in 24 of its 31 provinces with support from various donors, including the Global Fund to Fight AIDS, Tuberculosis and Malaria.
observed treatment, short-course (DOTS) implementation enhanced, and support provided to countries and areas to achieve this at national and local levels.
WPR/RC55/3 page 20
Annex 4
Expected result
Achievement of expected result as measured by indicators
!
I
J 2. Countries and areas enabled to strengthen tuberculosis surveillance, including that for prevalence, tuberculosislHN coinfection and multi drug resistant tuberculosis.
•
The national TB programmes of35 countries and areas submitted data to WHO on key indicators for TB control during the biennium, especially those countries with a "high" burden of tuberculosis. The quality of this TB surveillance data has improved significantly in recent years. A regional TB surveillance report was prepared in 2003 and published in early 2004. Based on the regional TBIHN framework drafted in 2002, Cambodia
:
I I
implemented four pilot projects on HIVITB during the I
I
biennium in collaboration with WHO. Drug resistance surveillance was initiated in two countries (Cambodia and the Philippines) with a high burden ofTB. This led to increased availability of information on TBIHIV coinfection and drug resistance in some areas. !
--I
3.
Support given to permit all countries and areas in the Region I to achieve the leprosy elimination target ofless than I case per 10 000 population.
•
Of the 35 countries and areas in the Region that achieved I leprosy elimination status in 2000 (defined as a leprosy prevalence less than I case per 10 000 people), 33 sustained elimination status in 2002. Two countries lost elimination status in 2002 (Kiribati and Papua New Guinea) and in two countries (Marshall Islands and the i I I
Federated states of Micronesia) leprosy continued to be a public health problem. 4. Selected countries and areas enabled to set up cost-effective I
I
I I !
•
Selected areas in Cambodia, the Lao People's Democratic Republic and Viet Nam have been included in a post-elimination surveillance project, which was based on the regional guidelines developed in 1999. Two evaluation missions were conducted as part of the post-elimination project. The project was extended to an additional eight provinces in Cambodia and an additional four provinces in Viet Narn during 2003.
leprosy post-elimination surveillance system.
WPRJRC55/3 page 21
Annex 4 4. Sexually transmitted infections, including mvIAIDS Expected result Achievement of expected result as measured by indicators
l.
Support given for the development and implementation of appropriate national policies, strategies and plans for the provision of sexually transmitted infections (ST!) and HNI AIDS prevention and care services.
•
The targeted countries - Cambodia, China, the Philippines and Viet Nam - developed national STI control plans.
2. Support provided for strengthened gathering, analysis and dissemination of data relating to the monitoring, planning and evaluation of STI and HIV/AIDS epidemic. 3. Progress made in the development of AIDS care.
•
Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, the Philippines and Viet Nam achieved the regional surveillance target. One thousand copies of periodic surveillance report (Issue No. 17) were produced and distributed.
•
The National Framework on the Continuum of Care in Cambodia was officially approved and implementation started. The National Operational Plan on HIV / AIDS Care and Treatment in Viet Nam was drafted and is being incorporated into the National Strategic Plan. The Operational Framework on Comprehensive HIV/ AIDS Care at the grassroots level in China was approved and is being implemented. Cambodia, China, Papua New Guinea and Viet Nam were selected at the end of 2003 as countries for priority action under the "3 by 5" Initiative during the 2004·2005 biennium.
WPRlRC55/3 page 22 Annex 4
Expected result
Achievement of expected result as measured by indicators • The "100% condom-use" programme is now being implemented in six countries (Cambodia, China, the Lao People's Democratic Republic, Mongolia, the Philippines and Viet Nam). Scale-up in various countries was supported by several partner agencies. Harm reduction activities are being implemented in three countries (Cambodia, China and Viet Nam). The new National HNIAIDS Strategic Plan in Viet Nam, explicitly !
,4. Member States enabled to
implement and/or scale up STr and HIV/AIDS prevention and control programmes.
identifies harm reduction as the approach towards HIV and drug use.
5. Communicable disease surveillance and response Expected result Achievement of expected result as measured by indicators I I •
1.
Regional task force fully functional and able to plan, monitor and implement activities for surveillance, outbreak alert, outbreak response and preparedness.
Planned regional meetings were postponed due to the severe acute respiratory syndrome (SARS) outbreak but close collaboration on SARS preparedness and response was established with all countries and areas during
I I I
SARS outbreak.
2.
Support provided to enable Member States to assess their needs for enhancing surveillance and response activities.
•
A preliminary assessment on national surveillance was conducted in Cambodia.
3. High-risk countries and areas enabled to establish and implement national control programmes for selected target diseases, such as cholera.
I
A national cholera control programme was established I •
in the Lao People's Democratic Republic. National rabies control programmes were strengthened in Cambodia, the Lao People's Democratic Republic and the Philippines.
WPRlRC55/3 page 23
Annex 4
Expected result
Achievement of expected result as measured by indicators
4.
Strengthened regional capacity for surveillance and outbreak monitoring and response, including guidelines and communication network.
•
A Regional Outbreak Response Team was established with cooperation from the Asian Development Bank. National focal points were identified in countries and areas for revision of the International Health Regulations.
5. Regional laboratory network established for priority diseases, and support given to set up national networks.
•
An influenza laboratory network was established in
China and made fully operational. A regional SARS laboratory network was established.
6. Support provided to establish training programmes for fieldbased surveillance and response at the national and local levels.
•
The field epidemiology training programme in China has been made fully functional. Regional strategies for capacity building in field-based surveillance and response were further developed.
7. Coordination, supervision and implementation of communicable disease control, surveillance and response strengthened through WHO support, including training.
•
The Pacific Public Health Surveillance Network has been made fully functional as an outbreak notification and reporting mechanism for the countries and areas of the Pacific. A multicountry training workshop was conducted.
8. Support given to strengthen the regional response to the SARS outbreak. Support provided to develop 19. I ,
•
Countries and areas in the Region were provided with technical support to prepare for and control the SARS epidemic.
•
Six practical guidelines on SARS were developed and fully utilized by countries and areas of the Region. A regional SARS response and preparedness team was rapidly set up.
country preparedness and response to the SARS outbreak.
10. Support for collection and dissemination of information on SARS to health officials and to the general public to address concerns related to the epidemic.
•
A web page on SARS was created as part of the Regional Office website to disseminate updated information on the epidemic.
WPRlRC55/3 page 24
Annex 4 6. Healthy settings and environment Expected result Achievement of expected result as measured by indicators
1. Selected countries supported to establish a national intersectoral coordinating mechanism with a plan of action and budget for Healthy Cities or Healthy Islands.
•
Cambodia, Fiji, the Lao People's Democratic Republic, Mongolia, Palau and Viet Nam established or strengthened national coordination mechanisms for Healthy Cities or Healthy Islands.
2. Countries and areas enabled to develop model projects, case studies of "good practice" and regional and national guidelines for healthy workplaces, marketplaces, villages! communities!tourism and hospitals.
•
Eight case studies (two each in Malaysia, Mongolia, the Philippines and Viet Nam) on healthy workplaces were completed. The evaluation methodology Jor healthy workplaces and Guidelines Jor healthy workplaces in the agriculture sector were drafted. Data for Malaysia, Mongolia, the Philippines and Singapore were posted on the WHO website. A report on the San Lazaro Extended Child Care Center, as a pilot and demonstration site for Healthy Hospitals, was completed and will be the basis for development of a guidance document on "health-promoting hospitals". Guiding i
I I
Juture action on healthy marketplaces in the Western Pacific Region was written and approved. A total of four model projects either to enhance food safety in marketplaces (the Philippines and Viet Nam) or to trial the guidelines developed for future actions in the Western Pacific Region (two case studies in Vanuatu) were implemented. Six pilot project areas on tourism and health were developed: Fiji; Hirara, Japan; Marikina City and San Fernando, Philippines; Sarawak, Malaysia; and Palau. The case studies were presented at the Regional Consultation on a New Mechanism for Healthy Cities and will be the basis for development of a regional guidance document in 2005.
I
WPRlRC55/3 page 25 Annex 4
Expected result
Achievement of expected result as measured by indicators • Momtonng systems to determme the effeCTIveness of health-promoting schools were strengthened in the Lao People's Democratic Republic, Papua New Guinea and Viet Nam. A review of health promotion infrastructure and financing options began in China, Fiji, Malaysia, Mongolia and the Philippines.
3
Selected countnes enabled to strengthen their monitoring systems for the impact of health promotion activities.
4.
Selected countries supported in establishing a national intersectoral coordinating mechanism with a plan of action for injury prevention.
•
Cambodia, China, the Lao People's Democratic Republic, Mongolia and Viet Nam were supported for policy development, surveillance and interventions related to road traffic injuries. Cambodia and Mongolia were supported for further development and implementation of their national injury prevention plans.
5.
Selected countries supported to develop the necessary capacity to implement an adequate health impact assessment
•
Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, Mongolia and Viet Nam developed and strengthened capacity for adequate health impact assessments.
6. Selected countries enabled to set health-based air and water quality standards, and to set up monitoring systems for air and water quality. ;
•
Cambodia established national drinking water quality standards. Cambodia, the Cook Islands, Fiji, Kiribati, the Lao People's Democratic Republic, the Marshall Islands, Federated States of Micronesia, Mongolia, Palau, Papua New Guinea, Samoa, Tuvalu, Vanuatu
I i I j
and Viet Nam strengthened drinking water quality monitoring. Mongolia and the Philippines established air quality monitoring standards.
WPR/RC55/3 page 26
Annex 4
Expected result
Achievement of expected result as measured by indicators
7.
Countries and areas supponed to secure adequate access to infonnation on chemical, physical and biological health hazards and risks at workplaces, in communities and in homes and how to control them.
•
China, Malaysia, Mongolia, the Philippines, Solomon Islands and Viet Nam established adequate access to infonnation on chemical, physical and biological health hazards.
8.
Selected countries supponed to incorporate standards and codes of practices into relevant occupational health legislation to control chemical, physical and biological health hazards.
•
China, the Republic of Korea" and Viet Nam developed occupational health legislation and health care systems.
9.
Selected countries enabled to write into legislation and adopt in practice appropriate waste management and pollution control technologies, with an emphasis on waste minimization/cleaner technologies and recycling.
•
Fiji, the Lao People's Democratic Republic, Mongolia, Palau and Papua New Guinea established appropriate policies and legislation on waste management or health care waste management.
WPR/RC55/3 page 27 Annex 4
Expected result
Achievement of expected result as measured by indicators • Cambodia, Fiji, Kiribati, the Lao People's Democratic RepUblic, the Philippines and Viet Nam reviewed and strengthened their food safety legislation. Cambodia, China, Fiji, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam were introduced to the "farm-to-table" approach to food safety. Fiji, the Lao People's Democratic Republic and Papua New Guinea undertook contaminant monitoring as part of an effort to introduce a "risk-based" approach to food safety. Cambodia, Mongolia, the Philippines, Vanuatu and Viet Nam conducted food safety education and training. Fiji and Viet Nam implemented food safety surveillance programmes.
10. Selected countries supported to improve food safety by developing and strengthening food safety legislation; strengthen the capacity to apply risk analysis principles; conduct food safety education and training; and implement surveillance and monitoring programmes.
11. The Pacific food safety database established in three Pacific Island countries expanded to a total of ten countries thus strengthening information sharing on food safety legislation; building the capacity to apply risk analysis principles; and demonstrating the importance of surveillance and monitoring programmes.
•
The Pacific food safety database was expanded to Cook Islands, Fiji, Kiribati, Federated States of Micronesia, Palau, Papua New Guinea, Samoa, Solomon Islands, and Vanuatu with import inspectors from each country being trained in imported food control programmes.
WPRlRC55/3 page 28
Annex 4 7. Child and adolescent health and development Expected result Achievement of expected result as measured by indicators
1.
Priority countries and areas supported in planning, implementing, monitoring and evaluating integrated management of childhood illness (IM CI).
•
Thirteen countries and areas were involved in IMCI five countries (Cambodia, China, Mongolia, the Philippines, and Viet Nam) reviewed and used information on progress as a basis for replanning, seven countries are in the early stage of unplementation (Fiji, Kiribati, the Lao People's Democratic Republic, Malaysia, Papua New Gumea, Solomon Islands, and Vanuatu) and Federated States of Micronesia is introducing IMCI. IMCI has been incorporated in national child health policy in Cambodia, China, Fiji, Kiribati, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines, and Viet Nam. Locally adapted IMCI guidelines have been developed in Cambodia, China, Fiji, Kiribati, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines, Solomon Islands, Vanuatu, and Viet Nam. I
2.
Support given to priority countries and areas to develop, implement, and evaluate integrated interventions in adolescent health and development, including use of guidelines and tools developed by the Regional Office.
•
Mongolia implemented standards for improved health services for adolescents. China, Kiribati, Mongolia, the Philippines, the Republic of Korea, and Viet Nam were supported to develop guidelines/tools for adolescent health interventions.
3. Priority countries and areas
•
American Samoa, Cambodia, China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam were supported in infant and young child feeding programmes. Two training courses related to infant and young feeding were
supported to develop, implement, monitor and evaluate plans for infant and young child feeding.
WPRJRC55/3 page 29 Annex 4
Expected result
Achievement of expected result as measured by indicators conducted in the Region: "HN and infant feeding counselling" in Cambodia and "Complementary feeding counselling" in Viet Nam, with participants from Cambodia, the Lao People's Democratic Republic, Papua New Guinea, the Philippines and Viet Nam. A reference booklet on new knowledge on complementary feeding was translated into Lao, Vietnamese, Khmer and Mongolian languages.
,
I
4. Priority countries and areas
•
American Samoa, Cambodia, Fiji, Kiribati, the Lao People's Democratic Republic, Mongolia, Palau, the Philippines, Nauru, Samoa, Tonga and Viet Nam were supported to develop national plans of action for nutrition and plans for the prevention and control of obesity. A "Training course on the management of severe malnutrition" was conducted in Cambodia, with participants from Cambodia, the Lao People's Democratic Republic and the Philippines. I
supported to plan, implement, monitor and evaluate national plans of action for nutrition including, where relevant, plans for the prevention and control of obesity.
5. Priority countries and areas enabled to develop and implement plans of action for the prevention and control of micronutrient deficiencies.
•
Cambodia, China, Mongolia, the Philippines and Viet Nam were supported for the prevention and control of micronutrient deficiencies.
WPRlRC55/3
page 30
Annex 4 8. Reproductive health Expected result Achievement of expected result as measured by indicators
1. Support provided to priority
•
All seven priority countries (China, Cambodia, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, Philippines and Viet Nam) fmalized and began implementation of national plans of action (2001-2005) on maternal mortality reduction and reproductive health. A Biregional Workshop on the Progress of Maternal Mortality reduction was held m the Regional Office in October 2003. National plans of action (2005-2010) were drafted by participating countries I
countries in reviewing, revising, finalizing and implementing national plans of action on maternal mortality reduction and reproductive health. j
i
and areas. 2. Priority countries supported to improve quality of maternal and neonatal health care and family planning services at different levels, partly through the development of guidelines and service protocols.
I I
•
All seven priority countries have developed guidelines and service protocols based on Managing Complications in Pregnancy and Childbirth. Two pnonty countries (the Philippines and Viet Nam) have developed guidelines and service protocols for newborn care. Ten Pacific island countries have revised the service protocol for family planning to improve the quality of service.
!
I
3. Support given for increasing I ,
•
The Mother-Friendly Hospital Initiative has been introduced and expanded to all the hospitals at the soum and aimag levels in Mongolia. Maternity waiting
awareness of how to make pregnancy safer and generating awareness of reproductive health.
i
homes have been established in two provinces of the Lao People's Democratic RepUblic. Reviews on adolescent sexual reproductive health were completed in nine countries. I
I
! I
!
I
J
WPRJRC5S/3 page 31
Annex 4
Expected result
Achievement of expected result as measured by indicators
4. Adequate technical support provided to five project countries for strengthening access to and availability of good quality reproductive health care.
•
The United Nations Human Security Fund-funded project for five Pacific island countries was implemented by WHO, including training of birth attendants in the Solomon Islands. Training in management information systems was undertaken in Kiribati, training on STIIHIV/AIDS was completed in Tuvalu and training for midwives was undertaken in Vanuatu and referral hospitals were provided with basic equipment.
5. Support provided to selected countries and areas to develop or improve their monitoring system to assess the progress of MMR reduction and status of reproductive health.
•
All seven priority countries have improved their monitoring systems for assessing the progress ofMMR reduction and the status of reproductive health. A new data collection form was developed. A pilot test of the reproductive health surveillance system was conducted in the Solomon Islands.
6. Countries and areas enabled to develop strategies and interventions for anaemia, cervical cancer and mental illness in women.
•
A study on the prevention of anaemia among pregnant women is being conducted in Mongolia. Studies on women's health and gender issues were conducted, including a study on risk factors of suicide among women of reproductive age, a survey on domestic . violence against pregnant women (China), training of service providers on prevention and management of domestic violence (China and the Republic of Korea), a study of medico-legal services for persons who have experienced sexual violence and a review of the WHO Protocol for the medical management of child and adult survivors of sexual violence (the Philippines) and introduction of a training module on "Gender and rights in reproductive health" (philippines).
WPRlRC55/3 page 32
Annex 4
Expected result
Achievement of expected result as measured by indicators i I
7. Technical support provided to selected countries to increase their national capacity in adapting appropriate evidencebased guidelines and introduce national policies, strategies, programmes and standards for maternal and newborn care and postpartum care.
•
The document Managing complications in pregnancy and childbirth has been translated into five languages (Cambodian, Chinese, Lao, Mongolian and Vietnamese). Pregnancy. childbirth, postpartum and newborn care: a guide for essential practice (PCPNC) has been translated into three languages (Chinese, Mongolian and Vietnamese). Training courses on PCPNC were conducted in three countries (the Lao People's Democratic Republic, the Philippines and Viet Nam) and training curricula on PCPNC were prepared for 10 Pacific island countries. I
9. Noncommunicable diseases, including mental health Expected result I
I
Achievement of expected result as measured by indicators
1. Priority countries and areas supported in the development and implementation of integrated approaches to the prevention and control of noncommunicable diseases (NCD).
·
Two countries (Mongolia and Viet Nam) have developed national NCD programmes. Development of the programme in Viet Nam took the form of a Prime Ministerial decision adopted in 2002. The Mongolian programme will be proposed to Government in 2004. Demonstration projects on NCD prevention and control were begun in the Philippines (two sites for community-based intervention) and China (a study on childhood obesity I
I
in schools).
I
2. Priority countries supported in the conduct of epidemiological research and in strengthening their registration systems.
•
Implementation of the Viet Nam national diabetes survey was supported. Data collection was completed for NCD surveys in Fiji, Marshall Islands, Federated States of Micronesia, and Samoa. Surveys were commenced in eight other Pacific island countries. I ; , ,
WPRlRC55/3 page 33 Annex 4
I
Expected result
I
Achievement of expected result as measured by indicators
3. Countries supported in the development of documentation for the management of diabetes and hypertension and training of primary health care staff. 4. Increased awareness of policymakers, professionals and the general public about promotion of mental health and prevention of mental illness.
•
Guidelines for the clinical management of diabetes and hypertension were developed (or supported by workshops or audit) with direct WHO support during 2002-2003 in Mongolia, Viet Nam, the Federated States of Micronesia, Samoa and the Cook Islands.
•
Preparation of regional reports on epilepsy and mental health began. A CD-ROM of WHO advocacy materials was published. Mental health situation reports were developed for 16 countries identified for in-depth and comprehensive situation analysis.
5. National legislation, policies and plans of action on the prevention and treatment of mental disorders supported.
•
Preliminary mental health policy and legislation reviews were carried out in 16 countries (Australia, Cambodia, China, Fiji, Japan, Republic of Korea, the Lao People's Democratic Republic, Malaysia, Mongolia, New Zealand, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Vanuatu and Viet Nam) and the results were documented in country reports. Intensive support was provided to four countries (Fiji, Samoa, Papua New Guinea, and Vanuatu) through training courses and visits by technical staff. Workplans and timetables for mental health policy development and legislation reform were put in place in Fiji, Samoa and Vanuatu. Technical and fmancial support were provided for China and Viet Nam.
WPRJRC55/3 page 34
Annex 4
Expected result
Achievement of expected result as measured by indicators
6. Mental health service delivery and evaluation at national and local levels supported.
•
A demonstration project on epilepsy was supported in China. The cost-effectiveness of community-
based mental health services were evaluated in Malaysia. WHO sponsored or supported training courses in Cambodia, China, Fiji, Mongolia, the Republic of Korea, Samoa, Vanuatu and Viet Nam.
7. Development of a research culture and capacity encouraged.
I • I
Three new WHO collaborating centres were designated during the biennium. Support was provided for epidemiological studies on mental disorders and substance abuse in Yunnan and Tibet. China. A Meeting on the Development of Research Culture and Capacity was conducted with participants from ten countries.
8.
Promotion of mental health, prevention of mental illness and suicide, and global campaigns for mental health advocated for and supported.
•
Suicide prevention programmes were begun in Samoa. School mental health programmes were supported in Mongolia. Training materials and courses on mental health in disaster situations were developed in China and the Philippines.
WPRlRC55/3 page 35
Annex 4 10. Tobacco Free Initiative Expected result Achievement of expected result as measured by indicators
1. Member States enabled to put
•
American Samoa, Australia, Fiji, Guam, Hong Kong (China), Japan, the Lao People's Democratic Republic, Mongolia, New Zealand, Niue, Papua New Guinea, Marshall Islands, Northern Mariana Islands, the Philippines, Singapore, Tonga, and Viet Nam have developed national plans of action that reflect evidence-based, comprehensive tobacco control policies. These plans will also help guide implementation of the WHO Framework Convention on Tobacco Control (FCTC).
in place national plans of action on tobacco control detailing deliverable tobacco control strategies and programmes.
2. Support given to Member States to put in place effective policies to deter and control tobacco use, as well as legislation and regulations for tobacco control.
•
American Samoa, Australia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong (China), Japan, the Lao People's Democratic Republic, Macao (China), Malaysia, Marshall Islands, Mongolia, New Zealand, Niue, Northern Mariana Islands, Nauru, Palau, the Philippines, the Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Tuvalu, and Viet Nam have developed policy, legislation, and regulations many as a result of WHO intensive capacity building efforts. These provisions will provide the legislative foundation for implementation ofthe WHO FCTC.
3. Member States encouraged to use integrated approaches to achieving tobacco control targets, including best practices in comprehensive tobacco control.
•
Cambodia, China, Malaysia, Mongolia, the Philippines, Papua New Guinea and Viet Nam have developed integrated approaches to tobacco control such as including tobacco control in health promotion, health sector development and noncommunicable diseases programmes.
WPRlRC55/3 page 36
Annex 4
Expected result
Achievement of expected result as measured by indicators
4.
Greater resources mobilized to support government and WHO tobacco control programmes.
•
The regional budget and extrabudgetary allocations for tobacco control increased in 2002-2003 compared with the previous biennium.
5. Research, monitoring and surveillance systems in place to support tobacco control, including the Global Youth Tobacco Survey, and Global Health Professional Survey and the Global Surveillance of Regional Data. , , ,
•
The global youth tobacco survey (GYTS) was completed in the following countries and areas: China (4 provinces), Fiji, Guam, Federated States of Micronesia, Northern Mariana Islands, Palau, the I
I
Philippines and Singapore. Additional countries and areas that have recently completed the GYTS include Cambodia, Cook Islands, Hong Kong (China), the Lao People's Democratic Republic, Malaysia, Mongolia, the Solomon Islands and Viet Nam.
!
I ,
I I
6. Support given to countries to adopt advocacy, educational and promotional campaigns and materials. 7.
•
The following countries and areas defined advocacy and communication strategies: Cambodia, Kiribati, the Lao People's Democratic Republic, Malaysia, Mongolia, the Philippines, the Republic of Korea, I
and Viet Nam.
Member States encouraged to participate in and support the Framework Convention on Tobacco Control.
•
All developing countries in the Region participated in the negotiations on the Framework Convention. I
11. Health systems reform Expected result Achievement of expected result as measured by indicators
1. Countries and areas enabled to implement and strengthen national drug policies.
•
China, Malaysia, Federated States of Micronesia, and Tuvalu were supported to develop, promulgate and revise national medicine policies. Cambodia, the Lao People's Democratic Republic, Malaysia, and the Philippines were supported to undertake
WPRJRC55/3
page 37 Annex 4
Expected result
Achievement of expected result as measured by indicators comprehensive assessments of the pharmaceutical sector to evaluate the implementation of national medicine policies. Participants from fourteen countries attended the Regional Workshop on Evaluating the Implementation of National Medicine Policies. At its fifty-fourth session in 2003, the Regional Committee discussed the draft regional strategy for improving access to essential medicines in the Western Pacific Region. Cambodia, China, the Lao People's Democratic Republic, Malaysia, Mongolia, the Philippines, and Viet Nam were supported to strengthen their pharmaceutical quality assurance (strengthening good laboratory practices, strengthening pharmaco-vigilance, legislation, training on reference substances, assessment of good manufacturing practices and bioequivalence testing). Cambodia, China, the Lao People's Democratic Republic, and Viet Nam were supported to combat counterfeit drugs. Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, Mongolia, Papua New Guinea, the Philippines, and Viet Nam were supported to improve the rational use of medicines. Cambodia and the Lao People's Democratic Republic were supported to implement a focused rational drug use intervention through monitoring, training and planning. Malaysia and Viet Nam were supported to develop strategy for containment of antimicrobial resistance. Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, the Philippines, Papua New Guinea,
WPRlRC55/3 page 38 Annex 4
Expected result I
Achievement of expected result as measured by indicators Tonga, and Viet Nam were supported to strengthen drug regulatory information system, drug registration (computerization) and training on drug evaluation.
2.
Regional and subregional intercountry collaboration in pharmaceuticals implemented and strengthened.
•
Cambodia, the Lao People's Democratic Republic, and Viet Nam were supported to attend the 20th ASEAN Pharmaceutical Working Group Meeting in 2003. Support was provided for the organization of the 20th ASEAN Pharmaceutical Working Group
I
Meeting. Nineteen countries were supported to attend the Meeting on Improving Access to Essential Medicines and Strengthening Vaccine Security in Pacific Island Countries.
3.
Improved integration of traditional medicine into formal health care systems in countries and areas through WHO support. I
•
Brunei Darussalam received technical assistance to develop its national policy on traditional medicine. Experts from thirteen countries participated in The Second Consultation Meeting on Traditional and Modern Medicine: Harmonizing the Two Approaches. China, Japan and the RepublIc of Korea participated in an informal meeting on acupuncture and discussed the possibility of standardizing acupuncture point locations. Draft WHO guidelines on quality of academic education on traditional medicine were developed. Eleven countries participated in a Regional Meeting on a Network for Policy and Programme Development in Traditional Medicine. A draft manuscript on Medicinal Plants in Papua New Guinea was completed. Viet Nam received technIcal assistance on traditional medicine training skills for traditional medicine lecturers.
WPRlRC55/3 page 39 Annex 4
Expected result
Achievement of expected result as measured by indicators
4.
Improved collaboration between Asian countries on use of herbal medicines.
•
The Forum for Harmonization of Herbal Medicines was established by Australia, China, Hong Kong (China), Japan, the Republic of Korea, Singapore, and Viet Nam with technical support from WHO.
5. Priority countries enabled to improve blood services.
•
Cambodia, China, Cook Islands, Kiribati, Malaysia, Marshall Islands, Federated States of Micronesia, Mongolia, Palau, the Philippines, Solomon Islands, Tonga, and Viet Nam initiated activities to adopt WHO quality management programme for blood safety. Participants from 11 countries attended the first Quality Management Training (QMT) Course on Blood Transfusion Services in 2002 and participants from 13 countries attended the second QMT course in 2003. In China 40 I quality managers were trained in five national QMT courses. A national blood safety workshop was organized in Kiribati and training materials for a distance learning programme on blood safety and clinical use of blood were provided to 10 Pacific island countries. The Philippines received technical assistance on standards development, licensing and regulation and Vanuatu received technical assistance on safe blood handling.
6.
Support provided to countries and areas to improve the quality oflaboratory services.
•
Twenty-one laboratories from 16 countries participated in the Regional External Quality Assurance Scheme (REQAS), supported by WHO.
7. Technical support given to priority countries to assess safe injection issues and develop plans of actions.
•
Country assessments and planning workshops were completed in three priority countries.
WPR/RC55/3 page 40 Annex 4
Expected result
Achievement of expected result as measured by indicators
8. Technical support provided to priority countries to increase their capacity in raising public awareness, creating demand for and improving safe injection practices.
I·
Injection safety supervision guidelines were field tested in Mongolia. Two staff from Cambodia were trained on supervision and monitoring related to injection safety. Information, education and communication (IEC) materials were developed and distributed in Mongolia. Development ofIEC materials began in Cambodia and Viet Nam.
9.
Technical support provided to priority countries to increase their capacity in improving procurement and waste management practices.
•
An assessment was conducted on transfer of
, ,
technology of auto-disable syringes in Mongolia. A medical waste management assessment was conducted in Cambodia. Cambodia also conducted a training workshop on waste management for the !
provincial hospital staff. 10. Policy advice given to countries in economic transition and the Pacific island countries and areas to achieve more equitable, stable and fair health care financing arrangements aimed to protect low-income and disadvantaged populations I I
I I
•
Cambodia, China, Fiji, the Lao People's Democratic Republic, Malaysia, Federated States of Micronesia, Mongolia, Papua New Guinea, Samoa and Viet Nam received policy advice on health insurance development. Twelve experts from eleven countries and areas participated in the third Health Sector
i
,
I
Development Technical Advisory Group meeting, focusing on health financing.
through health insurance. 11. Pilot proj ects on rural commune health insurance designed and implemented in at least three countries with WHO support.
•
Pilot projects on rural health insurance introduced in China, the Lao People's Democratic Republic, the Philippines and Viet Nam .
WPRlRC55/3 page 41
Annex 4
Expected result I
Achievement of expected result as measured by indicators
12. Social health insurance introduced or extended through I
•
A social health insurance policy and development frameworklmasterplan (including extension of insurance coverage) was discussed in 10 countries and an assessment framework for social health insurance was developed in Australia, China, Japan, the Lao People's Democratic Republic, Mongolia, the Philippines, the Republic of Korea, Singapore, and Viet Nam as well as three countries from the SouthEast Asia Region (India, Indonesia and Thailand) .
WHO support in countries and areas that are committed to strengthening their social safety nets for health.
13. National capacity strengthened through WHO support in financial planning, budgeting and management, including resource allocation, utilization and economic analysis and evaluation, in selected countries and areas.
•
A draft training manual on health economics, financial planning, budgeting and management was developed and a book on health care decision-making published. The Third Forum of the Asia Pacific Health Economics Network was organized. Twenty national experts from eight countries of the Pacific were trained during the Intercountry Workshop on National Health Accounts (NHA), Cost Analysis, and Health Insurance. Fifteen national experts attended a local seminar on health economics and financing in Mongolia.
14. All countries and areas enabled to develop methodology for comprehensive, reliable and comparable national health accounts (NHA).
•
NHA international classification and standards were adopted by Australia, China, Japan, New Zealand, the Philippines, and the Republic of Korea. Malaysia, Mongolia, Papua New Guinea, Singapore, Samoa, Tonga, and Viet Nam improved their health expenditure data consistent with NHA. A biregional NHA workshop was held in Bangkok, Thailand, in June 2002 and intercountry NHA workshops were organized for eight countries in the Pacific in collaboration with the World Bank in 2003.
WPR/RC55/3 page 42
Annex 4
r
Expected result
Achievement of expected result as measured by indicators I •
15. Awareness, knowledge and skills of poverty and health issues increased in countries and areas through WHO support. 16. Guidance given for policy development and regulation and production of training materials in policy analysis.
Ten of sixteen toolkit modules with examples of good . practices on poverty and health issues were finalized and editing of the six remaining modules began.
I I •
Guidelines on the legislative process were produced and draft guidelines for enforcement of legislation for health protection developed. The first draft of a handbook on health policy development for practitioners in the Pacific islands was completed.
17. Public health training strengthened in selected countries and areas, and use of essential public health functions introduced to selected countries.
•
Essential public health functions were discussed at the fifty-third session of the Regional Committee in 2002. A consultation workshop involving Australia, New Zealand and 14 Pacific island countries was organized. Technical support was engaged to strengthen public health networks in collaboration with a key public health training institution in VietNam.
I
I
18. Capacity of countries and areas strengthened in the areas of primary health care policy, planning and management.
•
Eleven participants from seven Pacific island countries were supported to attend biomedical equipment training courses. Technical support was provided to the Lao People's Democratic Republic for development of a national medical equipment management policy. Technical support was provided to Mongolia to strengthen diabetes services and support was provided to China and Viet Nam to strengthen primary health care/community health Services.
WPR/RC55/3 page 43 Annex 4 12. Human resources development Expected result
Achievement of expected result as measured by indicators
1. National or institutional
•
Medical basic and post-basic nursing curricula were reviewed and guidelines produced in Cook Islands, Fiji, the Lao People's Democratic Republic, Federated States of Micronesia, Mongolia, Papua New Guinea, Tonga, and Viet Nam. Projects on standards of practice and care were implemented in the Lao People's Democratic Republic, Federated States of Micronesia, Mongolia and Viet Nam.
mechanisms or guidelines for curricular review, evaluation and strengthening established.
2. Health workforce plans developed, using evidencebased methodologies, guidelines or tools.
•
Health workforce analysis, planning and management were undertaken in Cambodia, the Lao People's Democratic Republic, Mongolia, the Philippines, Vanuatu, and Viet Nam. A simplified workforce plarming tool was developed. The fellowships programme was reviewed, guidelines were revised and measures to improve programme outcomes were identified.
3. Strengthened leadership, management and strategic planning and research capacities of health professionals.
•
Training of trainers in leadership and management was conducted involving 20 participants from six countries. A regional consultation on nursing leadership strategies and approaches convened. Twenty-four senior officials from Cambodia, Japan and the Republic of Korea were trained in health leadership and management and 1165 individuals participated in fellowships and study visits - more than 95% of the planned fellowships were achieved.
4.
Promotional, technical and developmental support to regional and country programmes provided.
•
Twenty-one technical missions were conducted to provide support to countries, and regional and global programmes.
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Expected result
Achievement of expected result as measured by indicators • The strategic action plan and accompanying shortterm action plan for nursing HIVI AIDS training was completed. Development of the final draft of curricular liNI AIDS fact sheets/modules for use in the pilot training programmes was also completed.
5.
Strengthened strategic planning through the formulation of a nursing resource capacitybuilding strategic plan for inservice liNIAIDS training for nurses in China, centrally and provincially.
13. Health information and evidence for policy Expected result : I
Achievement of expected result as measured by indicators
l.
Support given to Member States to further develop health information systems (HIS) and strengthen HIS capacity.
•
The Lao People'S Democratic Republic, Marshall Islands, Mongolia and Viet Nam have HIS plans developed and revised systems piloted for operational feasibility to improve data collection.
2. Member States enabled to develop and use health data and indicators so as to monitor and assess health outcomes from district level.
•
China, Mongolia and Viet Nam were supported in the development of health indicators for health planning and service monitoring. Two intercountry workshops and four national workshops were organized to strengthen the use of information/evidence in decision-making
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Expected result
Achievement of expected result as measured by indicators
3.
Countries and areas facilitated in holding national training courses in disease classification and coding training for a core group of medical records personnel to implement International Statistical
•
Five national training workshops on ICD-l 0 were conducted for about 200 core medical records personnel to improve reporting on morbidity and mortality.
.
Classification of Diseases and Related Health Problems, tenth revision (ICD-lO).
4. Methods, procedures and tools, as well as guidelines, provided to support informationgathering and research activities in countries and areas. 5.
•
Publications on medical records management and data quality improvement were published and distributed for country use.
Capacity in countries and areas improved to enable them to perform situation analyses and develop policy profiles.
•
One intercountry workshop for the Pacific island countries and six national workshops were conducted to strengthen health policy development capacity at national and provincial levels in China. Support was provided to participants from three countries on burden of disease training.
6.
Support provided to Member States in upgrading research capabilities through supporting research projects and training.
•
An intercountry workshop and a national workshop on
research methodology to strengthen the capacity of health managers and young researchers in this technical area were conducted. Support was provided for 13 research projects in the Region.
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14. Emergency and humanitarian action Expected result Achievement of expected result as measured by indicators ! I
l. The public health data on emergencies from countries collected, compiled, analysed and shared with Member States and partner agencies. 2. Emergency management improved through strengthened regional partnerships with relevant organizations and increased proactive technical support provided by WHO.
•
Eleven major emergencies were documented and reported in the Western Pacific Region. WHO participated in four assessment missions to emergencies in the Region. !
•
Three interregional training courses were conducted by the South-East Asian Regional Office and the Asian Disaster Preparedness Centre. Regional Office staff participated in planning and implementation of interregional workshops on "total disaster risk management". A stand-by emergency management task force was established in the Regional Office. The task force was convened and members were involved in the response of the Western Pacific Region to emergencies. The Western Pacific Region Emergency Response Manual was printed and distributed to I
I I
regional and country office staff and partner agencies (including a CD-ROM version). A Pocket Emergency Tool - A Handbook on Guidelines for Field Managers I
in the Philippines, was printed and distributed. Draft standard operating procedures for SARS emergency and other public health emergencIes of mternatJonal concern were developed. 3. Sufficient opportunities ensured for national and provincial health staff in disaster-prone countries to promote and update their emergency management capacity. • Three interregional training courses on Public Health and Emergency Management in Asia and the Pacific (PHEMAP) were organized with participants from seven countries and areas. More than 80 national and provincial level staff were trained in three national PHEMAP courses.
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Expected result
Achievement of expected result as measured by indicators
4. Accessibility to lmowledge and skills on best public health practice in emergencies increased among national and provincial health staff in disaster-prone countries.
•
National meetings on best public health practices during emergencies were conducted in Cambodia, the Philippines and Vanuatu. Technical guidelines and manuals on emergency management were written in local languages and distributed to national and provincial health staff in disaster-prone countries. A Pocket Emergency Tool and a Training Manual for National PHEMAP courses were developed in the Philippines.
5. Characteristics of past major disasters, hazard distribution and high-risk communities identified in disaster-prone Member States.
•
A Pacific intercountry workshop on health emergency and disaster management was conducted. Reports on events were compiled but creation of a disaster profile database was hindered by differing levels of development of national health information systems.
15. Information technology Expected result Achievement of expected result as measured by indicators
1. Access improved to Regional Office technical information throughout WHO and Member States.
•
A data-warehouse was developed for statistical and technical data. lnitial support was provided to collate national demographic information by country, age and gender. "Web Trends", a management tool to monitor access to the Regional Office lntranet and lnternet was introduced to generate usage reports for technical units. lntemet connectivity was updated in the Regional Office and in some country offices to improve access to WHO online information.
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Expected result
Achievement of expected result as measured by indicators
2. Priority information products and tools appropriately promoted, disseminated in relevant languages, with ,
•
Basic training on HealthMapper was provided to disease control and other staff from six countries, as well as to staff from the Regional Office and country offices. Regular updates on the HealthMapper programme and programme upgrades are sent to country offices and countries and areas. Technical support was provided to China to participate in planning to enhance health information systems through the Chinese Centre for Disease Control and Prevention. l
training.
16. External relations !
Expected result
Achievement of expected result as measured by indicators Forty-four memoranda of understanding (MOUs) or agreements were signed with donor partners for joint activities at regional and country levels. The Regional Office was involved in clearance procedures for more than 22 MOUs or agreements. WHO has collaborated actively with the United Nations and other agencies in a number of joint activities, such as the meeting of Health Ministers for Pacific Island Countries, organized jointly with the Secretariat of the Pacific Community. Cooperation with the United Nations Development Programme, the United Nations Population Fund, the United Nations Children's Fund, the United Nations Programme on HIV/AIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria was facilitated. i
1. Better collaboration, coordination and communication with United Nations agencies, nongovernmental organizations and other partners in implementing health development activities.
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Expected result
Achievement of expected result as measured by indicators I
2. Building better relations with current donor partners and seeking new ones, and forging a partnership with nonconventional donor partners to maintain and mobilize resources for priority health programmes at regional and country levels.
•
By end of2003, DS$ 63.8 million of extrabudgetary funds had been received or committed for WHO in the Western Pacific Region during the 2002-2003 biennium, representing a 38 % increase compared with the previous biennium. Five additional donor profiles were developed and the five existing profiles updated. The MOD database and dynamic database on committed or received extrabudgetary funds for the Region and a database on estimated extrabudgetary resources for 2004-2005 were developed and updated in a timely manner.
17. Public information
Achievement of expected result Expected result as measured by indicators
1. Improved knowledge among
•
The public information page on the Regional Office website was made more user-friendly. Information on topical public health events was expanded. Full texts of all regional publications and technical documents were made available online.
the general public on the work of WHO via the Regional I
Office website.
2. Media relations improved, leading to increased awareness among journalists of key public health issues.
•
Building on the high profile of SARS and avian influenza, the Public Information Office has further developed WHO's image in the Region as a leading authority on public health.
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Achievement of expected result Expected result as measured by indicators
3. Practical manuals, guidelines, calendars and other advocacy materials, and reference materials published and disseminated.
•
Sixty-one titles were published, including technical documents, advocacy materials and translated versIOns of existing publications. CD-ROMs of regional publications were provided to WHOHeadquarters for inclusion in their database. Support was provided for implementation World Health Day activities around the Region.