Proposed programme budget: 2004-2005

WORLD HEALTH ORGANIZATION

ORGANISATION MONDIALE DE LA SANTE

REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL

REGIONAL COMMITTEE

WPRlRC53/4 31 July 2002 ORIGINAL: ENGLISH

Fifty-third session Kyoto, Japan 16-20 September 2002

Provisional agenda item 9

PROPOSED PROGRAMME BUDGET: 2004-2005

The presentation of the proposed programme budget 2004--2005 is similar to that for 2002-2003. Part 1 is the global proposed programme budget 2004--2005 and is common to all WHO regions (Annex 1), while Part 2 is specific to the Western Pacific Region (Annex 2). Taken together, the two budget documents reflect a more integrated and These documents establish clear

strategic approach to planning and budgeting.

Organization-wide priorities and objectives and regional strategic directions, and outline what WHO as an organization plans to achieve during the period 2004--2005. Annex 3 contains indicative country planning figures for 2004-2005 for the countries and areas in the Region. These figures were prepared using the methodology requested by the Regional Committee in resolution WPRlRC50.Rl. The Regional Committee is asked to comment on the proposed programme budget 2004--2005. The Committee's views will be forwarded to the Director-General and,

together with those from other regional committees, will be taken into account when the proposed programme budget is finalized and submitted to the global governing bodies in 2003.

• WPRlRC53/4

page 2

1. INTRODUCTION

The proposed programme budget 2004-2005 builds on two important policy docwnents. At the global level, the policy guidelines contained in the General Programme of Work 2002-2005 are presented in operational terms under 35 substantive areas of work. At the regional level, the budget is presented according to the themes and focuses described in WHO in the Western Pacific Region: A frameworkfor action' and endorsed by the Regional Corrunittee in 1999. 2 As for the previous bienniwn, the proposed programme budget 2004-2005 is presented in two parts. Annex 1 contains Part I of the budget, which applies to the whole Organization. Annex 2 contains Part 2 of the budget, which is specific to the Westem Pacific Region. Part 2 is a strategic overview, which identifies the main issues and challenges facing the Region for 2004-2005, defines the goals, WHO objectives and indicators, and describes WHO's strategic approaches. Annex 3

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contains the indicative country planning figures for the countries and areas in the Region, which were prepared using the guiding principles detailed in resolution WPRlRC50.Rl. The proposed programme budget 2004-2005 was prepared according to the results-based management approach. The application of this approach to management and budgeting is an essential part of the reforms being carried out throughout the Organization. Preparation of the proposed programme budget 2004-2005 also took into consideration feedback on the programme budget 2002-2003 from the Executive Board, the World Health Assembly and the regional corrunittees, as well as lessons learned from the last budgeting exercise. It outlines what WHO as an organization plans to achieve during the period 2004-2005, both globally and regionally. The Regional Corrunittee is asked to comment on the proposed programme budget 2004-2005. The Corrunittee's views will be forwarded to the Director-General and, together with those from other regional corrunittees, will be taken into account when the proposed programme budget is finalized and submitted to the Executive Board at its 111 th session in January 2003 and subsequently to the Fifty-sixth World Health Assembly in May 2003 for review and adoption.

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J

Document WPRlROO/2. Resolution WPRlRC50.R3.

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WPRlRC53/4 page 3

2. PROPOSED PROGRAMME BUDGET 2004-2005: PART 1

Pan 1 of the proposed programme budget (Annex 1) was developed through a process of close consultation between WHO Headquarters and the six regions, paying due regard to the Organization-wide priorities set out in the General Programme of Work 2002-2005. As for the previous biennium, Part 1 is organized around 35 areas of work. Two areas of work,

"Director-General's and Regional Directors' Offices" and "Director-General's and Regional Directors' development programme and initiatives", were merged. A new area of work, "WHO's presence in countries", was added. For each area of work, the issues and challenges are identified and the goal towards which WHO, its Member States and other partners will work is defined. The WHO objectives reflect the objectives that WHO's Member States and secretariat are committed to. The expected results are the results for which the WHO secretariat is directly responsible. The strategic approaches are approaches that WHO will employ to address the issues and challenges. The role of the secretariat has been clearly differentiated from that of Member States, which means that evaluation of WHO's work will be more easily incorporated into future planning and budgeting exercises.

3. PROPOSED STRATEGIC OVERVIEW OF THE PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

Pan 2 of the proposed programme budget 2004-2005 (Annex 2) is organized according to the regional themes and focuses. For each focus, the most important issues and challenges that face the Region are identified and the regional goals and WHO regional objectives are defined. As for Part 1, these are objectives for WHO's Member States and the secretariat. The strategic approaches WHO proposes to employ during the biennium are then described. In order to show clearly the link between the regional focuses and the global areas of work, conversion tables are provided in Appendices 1 and 2.

WPRlRC53/4 page 4

4. INDICATIVE COUNTRY PLANNING FIGURES

Indicative country planning figures for 2004-2005 (Annex 3) are presented. These have been determined according to resolution WPRlRC50.RI, which was adopted by the fiftieth session of the Regional Committee. Further adjustments were made following guidance from the Director-General. Resolution WPRlRC50.Rl requested the Regional Director to determine country allocations in accordance with the model recommended by resolution WHA51.31. taking into account four additional considerations. 3 Annex 3 also provides a brief explanation of the process used to determine the figures. After the session, the indicative country planning figures will be sent to the Director-General for her approval and the Regional Office will work with countries and areas to develop strategic programme budgets for both country and intercountry programmes. These will be finalized after the proposed programme budget has been considered and endorsed by the global governing bodies.

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5. ACTION EXPECTED FROM THE REGIONAL COMMITTEE

The Regional Committee is asked to comment on the proposed programme budget 2004-2005. The Committee's views will be forwarded to the Director-General and, together with those from other regional committees, will be taken into account when the proposed programme budget is finalized and submitted to the global governing bodies.

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, Resolution WPRlRC50.RI.

ORAFT PPB/2004-2005 ORlGINAL: ENGLISH

WPRlRC53/4 . ANNEXl

WORLD HEALTH ORGANIZATION

PROPOSED P ROGRAMME B U D GET

2004 - 2005

PART

1

WORLD HEALTH ORGANIZATION

PROPOSED PROGRAMME BUD GET

2004 - 2005

PART 1

The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

Printed in Geneva, 2002

II

CONTENTS

I.

Policy and budget for one WHO Director-General's highlights 3 Overall resource context 5 Table 1. Expenditure plan - all sources of funds 5 Table 2. Regular budget summary by organizational level 6 Figure: Regular budget summary by region, 2004-2005, compared with 2002-2003 6

II.

Strategic orientations 2004-2005 by area of work Communicable disease surveillance 10 Communicable disease prevention, eradication and control 12 Research and product development for communicable diseases 14 Malaria 16 Tuberculosis 20 Surveillance, prevention and management of noncommunicable diseases 24 Tobacco 28 Health promotion 32 Injuries and disabilities 34 Mental health and substance abuse 36 Child and adolescent health 40 Research and programme development in reproductive health 44 Making pregnancy safer 46 Women's health 50 HIV/AIDS 52 Sustainable development 56 Nutrition 58 Health and environment 60 Food safety 64 Emergency preparedness and response 68 Essential medicines: access, quality and rational use 70 Immunization and vaccine development 74 Blood safety and clinical technology 76 Evidence for health policy 80 Health information management and dissemination 84 Research policy and promotion 86 Organization of health services 88 Governing bodies 92 Resource mobilization, and external cooperation and partnerships 94 Programme planning, monitoring and evaluation 96 Human resources development 98 Budget and financial management JOO Informatics and infrastructure services 102 Director-General, Regional Directors and independent functions 104 WHO's presence in countries 106 Miscellaneous 108 Exchange rate hedging 108 Real Estate Fund 108 Information Technology Fund 108 Security Fund 108

Annex

Detailed allocation by area of work and office (regular budget) and total estimate for other sources, 2004-2005 (US$ thousand) 1 J0 iii

I POLICY AND BUDGET FOR ONE WHO

DIRECTOR-GENERAL'S HIGHLIGHTS

DIRECTOR-GENERAL'S HIGHLIGHTS

3

OVERALL RESOURCE CONTEXT Expenditure plan for 2004-2005 I. The tables below summarize the overall expenditure plans for the biennium 2004-2005. Further details, by area of work, organizational level, and source of fund, are provided in Part II and in the Annex. 2. Table I summarizes the expenditure plan for the whole Organization, i.e., the total amount that is needed to achieve the expected results of the Proposed programme budget 2004-2005. Expenditure is broken down between the regular budget and other sources of funds. 3. The table also indicates the budget for 2002-2003, approved under resolution WHA54.20, which has been modified to reflect some changes in the areas of work inherent in the 2004-2005 proposals in order to facilitate comparisons between the two bienniums. Regular budget figures in both bienniums are based on cost levels and the rates of exchange for 2002-2003. The budget for other sources of funds reflects projected expenditure for the biennium 2004-2005. 1

TABLE 1. EXPENDITURE PLAN - ALL SOURCES OF FUNDS

(U8$ thousand) Source of funds Total regular budget Total other sources Total all funds 2002-2003 855654 I 380500 2

2004-2005 855654 1 896000 2

Percentage change 0 +37 +23

2236154

2751654

Regular budget 4. The estimates for the regular budget alone are shown in Table 2 below, according to organizational level. At this stage, all regular budget figures are nominal, i.e., they do not include possible adjustments for currency fluctuations and inflation that may be required before submission of the Proposed programme budget to the Fifty-sixth World Health Assembly in May 2003.

1 The relationship between income and expenditure will be shown in the financial statements for the biennium. These statements will also make it possible to compare actual and budgeted expenditure for all areas of work.

2 An amount ofUS$ 262 000 000, or just over half the projected increase ofUS$ 515 500 000, is allocated to the area of work Immunization and vaccine development, mainly for the eradication of poliomyelitis.

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PROPOSED PROGRAMME BUDGET 2004-2005

TABLE

2. REGULAR BUDGET SUMMARY BY ORGANIZATIONAL LEVEL (US$ thousand) Percentage increase/decrease +1 ±O

Organizational level Country Regional Global Subtotal General' Total

2002-2003 336005 227594 279055 842654 13 000 855654

2004-2005 340812 227787 274055 842654 13 000 855 654

-2 0 0 0

'Corresponds to the appropriation section Miscellaneous and will include for 2004-2005 provisions of an overall and administrative nature; i.e. exchange rate hedging, provisions for security, real estate and information technology.

5. The distribution of the regular budget by region, obtained by adding the proposals for the country and regional budget of the respective region, is illustrated in the figure opposite for 2004-2005. This excludes a transfer of US$ 5 million from global to country level, the exact distribution of which will be included in the budget proposals to be submitted to the Executive Board at its 111 th session (January 2003).

Planned resources by area of work 6. The Proposed programme budget 2004-2005 has been divided into 35 substantive areas of work; all related expenditure will be similarly accounted for in the Financial Report. They are grouped into 10 main appropriation sections. The distribution ofreguJar budget funds to areas of work for 2004-2005 includes funds for country-level programme activities. I The regular budget figures for 2002-2003 shown under each area of work have been compiled for comparative purposes, keeping in mind that no break-down of projected expenditure at country level was provided by area of work for this biennium, but rather presented as a separate global provision. For the purpose of increased transparency, each area of work also provides an estimated percentage of the amount of resources that wilJ be spent at (i) country, (ii) regional, and (iii) global levels during 2004-2005. 7. Four items constitute the last appropriation section entitled Miscellaneous, which groups those areas that are of an overall and administrative nature; i.e. exchange rate hedging, and provisions for security, real estate and information technology.

Priorities 8. Under Part II, Strategic orientation 2004-2005 by area of work, information on priority areas of work has been expanded to indicate the nature of support from other areas of work. One new priority has been added as compared with the Proposed programme budget 2002-2003, namely Health and environment. Another two priorities have been expanded and are now defined as: Making pregnancy safer and children's health, and Health systems, including essential medicines. The resulting priority areas of work are highlighted in the Annex.

I The resulting distribution of funds per appropriation section is proposed on the understanding that the usual flexibility to make transfers between sections of 10% will be granted to the Director-General.

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OVERALL RESOURCE CONTEXT

FIGURE: REGULAR BUDGET SUMMARY BY REGION,

2004-2005, COMPARED WITH 2002-2003

(US$ thousand and percentage)

2002-2003

Eastern Mediterranean 83390

33.1%

Africa 186472

Europe 52771 The Americas 74682

South-East Asia 93022

2004-2005

Eastern Mediterranean 81584

34.2%

Africa 192718

Europe 54332 The Americas 72491

South-East Asia 91 169

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PROPOSED PROGRAMME BUDGET 2004-2005

WHO's presence in countries 9. The estimated resources spent on WHO's presence in countries from the regular budget has been increased from just over US$ 92 million in 2002-2003 to almost US$ 120 million in 2004-2005. The purpose of the increase is to strengthen WHO's country offices and to enhance their operational capacities in line with the objectives of WHO's new country focus initiative, including their contribution to crucial national health priorities and the collection and collation of relevant health information in conjunction with national authorities. 10. As regards other sources of funds for WHO's presence in countries, a total of some US$ 20 million has been estimated as support from donors. This budget provision will be supplemented by a contribution of around 1% from total extrabudgetary resources which, on the basis of current estimates, would yield an amount of some US$ 17.5 million, giving an overall total of over US$ 37 million.

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II STRATEGIC ORIENTATIONS

2004-2005

BY AREA OF WORK

I

PROPOSED PROGRAMME BUDGET 2004-2005

COMMUNICABLE DISEASE SURVEILLANCE ISSUES AND CHALLENGES Global health security (as referred to in resolution WHA54.l4) is repeatedly threatened by the emergence of new or newly-recognized pathogens, their possible deliberate or accidental release, and the resurgence of known epidemic threats. Although biological weapons represent the most visible threat to security, emerging or epidemic-prone communicable diseases (such as influenza, meningitis, cholera or Ebola virus haemorrhagic fever) also threaten global health security because they frequently and unexpectedly challenge national health services and disrupt routine control programmes, diverting attention and funds. Most outbreaks and epidemics are caused by known pathogens. The increasing resistance of microorganisms to antimicrobial drugs is undermining available therapy, reducing treatment opportunities and increasing the costs of health care. In addition, new infectious diseases continue to emerge, many of which appear to originate as zoonoses. Outbreaks and epidemics do not recognize national boundaries and, if not contained, can rapidly spread internationally. Unverified and inaccurate information on disease outbreaks often results in excessive reactions by both the media and politicians, leading to panic and inappropriate responses, which in turn may result in significant interruptions of trade, travel and tourism, thereby placing further economic burden on affected countries. Preparedness is critical to improving global health security. National surveillance and response systems should provide ongoing surveillance of important diseases, and also function effectively to provide information for alert and response to outbreaks (whether natural, deliberate or accidental). To be sustainable, such systems should be integrated into national communicable disease surveillance, within the health information system. The.revised International Health Regulations will provide a powerful tool for harmonizing public health action among Member States and provide a framework for the notification, identification and response to public health emergencies of international concern. Despite considerable progress recently, major challenges for the biennium include the need for strengthened global partnership, advocacy and improved international cooperation to deal with epidemic and emerging-disease threats; the need to update and implement national, regional and global surveillance and containment strategies for known epidemic diseases and exploit new tools and knowledge; the reinforcement of mechanisms to detect, verifY and respond rapidly and effectively to unexpected outbreaks and epidemics at local, national, regional and international levels; the development, implementation and evaluation of national plans of action for epidemic alert and response integrated into national communicable disease surveillance systems, and, as far as possible, using a multidisease approach; the completion and implementation of the revised International Health Regulations to provide a regulatory framework for global health security.

GOAL

To work towards global health security and foster action to reduce the impact of communicable diseases on health and the social and economic well-being of all people worldwide.

WHO OBJECTIVE(S)

To ensure that Member States and the international community are better equipped to detect, identifY and respond rapidly to threats to national, regional and global health security arising from epidemic-prone and emerging infectious diseases of known and unknown etiology, and to integrate these activities with the strengthening of their communicable disease surveillance and response systems, national health information systems, and public health programmes and services.

Indicator • Timely detection of and response to epidemics and emerging disease threats of national and international concern

STRATEGIC APPROACHES

Containment of known risks, response to the unexpected and improvement of national preparedness, within the framework of the revised International Health Regulations

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COMMUNICABLE DISEASE SURVEILLANCE

EXPECTED RESULTS o

INDICATORS o o

Advocacy undertaken and partnerships fonned to ensure provision of political, technical and financial support to global health security

Number of appearances of global health security initiatives in the international mass media Number of new partners providing financial, political or technical support to global health security Number of strategies and supporting materials (e.g. standards) for surveillance and containment of known epidemic and emerging disease threats available in official and other relevant languages Proportion of countries that have received technical cooperation for surveillance and containment of known epidemic and emerging disease threats Number of verified events for which responses provided Number of technical partners cooperating with WHO in international alert and response

o

Strategies fonnulated andlor updated and support given for surveillance and containment of known epidemic and emerging disease threats, including influenza, cholera, meningitis, zoonoses, foodbome infection, drug resistance, and those related to deliberate release of biological agents, in close collaboration with WHO collaborating centres Alert and response to public health emergencies coordinated in collaboration with affected States and all Member States, WHO collaborating centres, and partners in the global outbreak alert and response network Support provided to strengthen coordinated national communicable disease surveillance systems, including the capability for early detection, investigation and response to epidemic and emerging infectious disease threats. in close collaboration with Member States and WHO collaborating centres

o

o

o

o

o

o

o

o

Number of responses made by WHO to requests from countries for technical cooperation in implementation of national surveillance plans, including drawing up of preparedness plans, epidemic intelligence, communications, laboratory capacity, field epidemiology and public health mapping Number of supporting materials for surveillance system strengthening (e.g. guidelines and assessment tools) available in official and other relevant languages Presentation to governing bodies of final draft of revised International Health Regulations by 2004 Mechanisms for assessing core capacities necessary for compliance with the Regulations designed, field tested and implemented in at least two countries in each Region

o

Revision of the International Health Regulations completed and the new components and guidance for implementation provided to all Member States

o o

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 27026 26278 43% 20% 37% Other sources 57000 56500 20% 30% 50% All funds 84026 82778 27% 27% 46%

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PROPOSED PROGRAMME BUDGET 2004-2005

COMMUNICABLE DISEASE PREVENTION, ERADICATION AND CONTROL IsSUES AND CHALLENGES

Over 13 million people die each year from infectious and parasitic diseases: one in two deaths in some developing countries. Most deaths occur in nations where one-third of the population lives on incomes ofless than US$ I a day - altogether 1200 million people. Poor people, women, children and the elderly are the most vulnerable. Infectious diseases continue to be the world's leading killer of young adults and children. Diseases or infections for intensified control include Buruli ulcer, dengue/dengue haemorrhagic fever, intestinal parasitoses, leishmaniasis, schistosomiasis, trachoma and trypanosomiasis. Dracunculiasis is targeted for eradication, and leprosy, lymphatic filariasis, onchocerciasis and Chagas disease are targeted for elimination at global or regional level. While mortality associated with many of these neglected diseases is not high, lifelong disability and chronic social and economic consequences may be dramatic. These diseases attract little media and donor attention, but they must be tackled. Fortunately, for most of them, effective and cheap interventions are available. Dealing with these neglected diseases needs strong vector control, surveillance systems, social mobilization and capacity building and emphasis on communicable diseases in complex emergencies. The goal should be strengthening health systems, better use of existing tools to prevent and control communicable diseases, and ultimately, their elimination as major public health problems or eradication. The major challenges for the biennium are as follows: to increase access to drugs and interventions for the different prevention, control and eradication initiatives while reinforcing health systems within the framework of countries' priorities and strategic plans; to deal with communicable diseases in complex emergencies in countries; to develop new tools, including drugs, vaccines and diagnostic tests, and cost-effective strategies for those communicable diseases for which effective tools and strategies are still lacking; to facilitate alliances of partners to work in synergy at global, regional and national levels to deal with neglected diseases; to eliminate globally targeted diseases (leprosy and lymphatic filariasis), and promote regional elimination strategies (for Chagas disease, rabies and others); to build and maintain political commitment at global and national levels for the prevention and control - and ultimately, the eradication and elimination - of dracunculiasis and other targeted communicable diseases. To reduce the negative impact of communicable diseases on health and on the social and economic well-being of all people worldwide. To create an environment in which Member States and their international and national partners are better equipped, both technically and institutionally, to reduce morbidity, death and disability through the control and, where appropriate, eradication or elimination of selected communicable diseases.

GOAL

WHO OBJECTIVE(S)

Indicator • Number of national programmes functional, focusing on targeted diseases, and significantly reducing morbidity, death and disability due to these diseases

STRATEGIC APPROACHES

Formulation of evidence-based strategies; provision of support to countries; involvement of relevant partners for implementation

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COMMUNICABLE DISEASE PREVENTION, ERADICATION AND CONTROL

EXPECTED RESULTS • Evidence-based policies and global and regional strategies formulated for the prevention, control and elimination of targeted diseases; countries adequately supported to adopt and implement such policies and strategies at national and community levels • •

INDICATORS Global and regional strategic plans drawn up Number of targeted countries adopting and adapting for local use WHO policies and strategies (including social mobilization) Number of countries supported to implement interventions for targeted diseases at all levels Number of endemic countries supported to implement prevention, control and eradication activities

•

•

Adequate technical and policy support provided to endemic countries to improve access to and delivery of crucial public health interventions targeting communicable diseases More alliances and greater mobilization for countrylevel activities through innovative global, regional and local partnerships Control of communicable diseases in countries facing complex emergency situations New drugs, vaccines, diagnostics or cost-effective interventions developed for the prevention and control of those diseases for which they are still lacking

•

•

•

Magnitude of overall increases in funding and support due to participation 0 f existing and new partners

•

•

Number of complex-emergency countries supported to prevent and control communicable diseases New or improved drugs for prevention and control, vaccines, and/or diagnostics and guidelines for at least two diseases for which these are still lacking Number of countries reaching elimination targets at national, regional or global level Number of endemic countries in which interruption of transmission of diseases targeted for elimination has been verified Number of endemic countries in which eradication of dracunculiasis has been certified

•

•

•

Diseases eliminated as major public health problems, according to respective global or regional targets Interruption of transmission verified for diseases targeted for elimination at global or regional level, and eradication of dracunculiasis certified

•

•

•

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 32792 24316 43% 27% 30% Other sources 122000 104500 30% 40% 30% All funds 154792 128816 32% 38% 30%

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PROPOSED PROGRAMME BUDGET 2004-2005

RESEARCH AND PRODUCT DEVELOPMENT FOR COMMUNICABLE DISEASES ISSUES AND CHALLENGES

Recent major accomplishments include: taking the first step towards the creation of a transgenic mosquito; producing evidence that the antimalarial drug artemether can protect against schistosome infection and that the veterinary drug moxidectin might be suitable for use as a macrofilaricide in human onchocerciasis and lymphatic filariasis; demonstrating that appropriate packaging of antimalarial agents for home treatment improves compliance and cure rates and that combination therapy in malaria results in significant gains in overall cure rate; registration of artenimol for use in severe malaria; proof of the principle that iron supplementation and preventive antimalarial therapy delivered through regular immunization services reduce infant morbidity and mortality; development of rapid mapping tools for Loa loa for use in filariasis control; and transfer of good clinical and laboratory practice procedures to disease-endemic countries. Nevertheless, communicable diseases still constitute most of the burden of disease in developing countries, disproportionately affecting poor, vulnerable and marginalized populations and continuing to impede social and economic development. Rapid urbanization, population displacement and ecological change create new patterns of transmission; furthermore, control tools, methods and strategies once considered sufficient are becoming less effective owing to development of resistance to drugs and insecticides. Finally, successful immunization-based control programmes have shifted the major burden to diseases that are currently not vaccine-preventable. The evolution of the global economy has widened the gap between the rich and the poor. In many countries, decentralization, the reduced role of the State and the increased part played by the private sector have fundamentally changed the context in which communicable diseases can be controlled. Capital requirements to develop and market new products, combined with the limited purchasing power of the poor make it less attractive for industry to invest in what for them is a marginal market. However, experience shows that the public and private sectors and networks of researchers can, through appropriate mechanisms, work together to design and improve tools and approaches for disease control. One such time-proven mechanism is the UNDP/World BanklWHO Special Programme for Research and Training in Tropical Diseases. The major challenges are: to develop new public health solutions, including drugs, vaccines, diagnostics that are acceptable, affordable and applicable to the settings in which they will be used; to involve disease-control programmes, industry, researchers and financial partners from developing and developed countries in priority-setting and development of these products; to orchestrate the required broad range of scientific disciplines, to strengthen research capabilities of the disease endemic countries, and to translate research results into policy and practice; and to mobilize funds for research and research-capacity strengthening sufficient to implement the work plan of this area of work.

GOAL

To foster action essential for reducing the negative impact of communicable diseases on health and on the social and economic well-being of all people worldwide.

WHO OBJECTJVE(S)

To generate new knowledge and tools (including vaccines, drugs and diagnostics, intervention methods and implementation strategies) for the prevention and control of communicable diseases, whose application is gender sensitive and oriented towards poverty reduction and which can be incorporated into the health systems of disease-endemic countries; and to build local health research capacity for better tackling the complicated health problems in these countries.

Indicators

• •

Increase in level of knowledge on and number of new solutions to public health problems of the disease-endemic countries produced from research and development Increase in level of participation of researchers from disease-endemic countries in international efforts to generate new knowledge and solutions to the public health problems affecting these countnes

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RESEARCH AND PRODUCT DEVELOPMENT FOR COMMUNICABLE DISEASES

STRATEGIC APPROACHES

Knowledge management, partnership building, and networking with disease-control and research and development communities for setting priorities and identifying feasible solutions; mobilizing and managing resources for contracting of public and private research and development/training organizations and industry in developing and developed countries

EXPECTED RESULTS • New basic knowledge about biomedical, social, economic, health systems, behavioural and gender detenninants, and other factors of importance for effective prevention and control of infectious diseases, generated and accessible New and improved tools, including drugs, vaccines and diagnostics, devised for prevention and control of infectious diseases •

INDICATORS Number of new, significant and relevant scientific advances in the biomedical, social, economic and public-health sciences

•

• •

Number of new candidates (drugs, vaccines and diagnostics) ready to enter into development Number of new or/and improved drugs, vaccines and diagnostics receiving regulatory approval Number of new or improved intervention methods validated for prevention, diagnosis, treatment and rehabilitation Number of new or improved control policies and strategies formulated, tested and validated Number of new and improved tools adopted for disease control Number of active partnerships in developed and developing countries Proportion of research findings from disease-endemic countries Number of partners using technical information and research guidelines Number of visits to appropriate WHO web site pages Amount of increase in funding overall Number of new donors

•

New and improved intervention methods for applying existing and new tools at clinical and population levels developed and validated New and improved public health policies for full-scale implementation of existing and new strategies for prevention and control framed and validated; guidance for application in national control settings accessible Partnerships established and adequate support provided for strengthening capacity for research, product development and application in disease-endemic countries Adequate technical information and research guidelines accessible to partners and users

•

•

• •

•

• •

•

• •

•

Resources for research, product development and capacity building efficiently mobilized and managed

• •

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 4589 3565 9% 11% 80% Other sources 84500 101 500 5% 50/0 90% All funds 89089 lOS 065 5% 5% 90%

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PROPOSED PROGRAMME BUDGET 2004-2005

MALARIA ISSUES AND CHALLENGES

Malaria causes 300-500 million cases of acute illness with more than a million deaths each year, and contributes to an ever-widening gap in prosperity between endemic countries and the malaria-free world. Some 90% of the burden is in sub-Saharan Africa, where the "malaria growth penalty" may be as high as 1.3% of economic growth per annum, and the disease is a major cause of poor child development. Annually, 24 million pregnancies in Africa are put at risk through malaria, yet few pregnant women have access to effective interventions. Primarily, it affects impoverished, disadvantaged communities: almost 60% of all malarial deaths are concentrated in the poorest 20% of the world's population, the highest association of any disease with poverty. Even though the greatest burden lies in Africa, other parts of the world are facing significant challenges to control the disease and need continued support from WHO. Despite inadequate monitoring systems, few signs indicate a decrease in the burden of disease due to malaria. Resistance to formerly effective treatment is increasing, and the proportion of cases due to Plasmodium falciparum, which causes the most deadly form ofthe disease, is on the rise globally. Roll Back Malaria was initiated in 1998 as a global partnership with the goal of halving the global malaria burden by 2010. WHO provides a secretariat to develop partnerships, raise awareness, nurture innovation, and increase coverage of effective interventions, bringing together interested parties such as ministries of health, donors and the private sector to focus their relative advantages on a common strategy. The political will to roll back malaria is strong. The development goals of the United Nations Millennium Summit include combating malaria as one of the global targets for 2015 and 2001-2010 has been declared the "Decade to Roll Back Malaria in Developing Countries, Particularly in Africa". The Roll Back Malaria partnership has set the stage for massively expanded action against malaria. It has supported many African countries to develop evidence-based strategic plans, an approach that is designed to increase access to high-quality cost-effective interventions, while promoting operational research and the development of new tools. The creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria represents a good opportunity to make these plans operational. Roll Back Malaria now faces the challenge of a global effort to scale up proven strategic approaches. To halve the burden of malaria by 2010 and to reduce it further by 2015. (Millennium Development Goal: By 2015 "halt and begin to reverse the incidence of malaria ... ") To encourage and support the scale up of effective action to roll back malaria.

GOAL

WHO OBJECfIVE(S)

Indicators • • Malaria prevalence rate and malaria-related death rate in children under five Proportion of children under five in malaria-risk areas using effective malaria prevention (primarily insecticide-treated nets) and proportion having access to appropriate treatment

STRATEGIC APPROACHES

In areas endemic for malaria, substantially increased use of combination of prevention, particularly for young children and pregnant women, primarily with insecticide-treated nets, prompt access to treatment and intermittent preventive treatment in pregnancy, and prediction and appropriate response to epidemics

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MALARIA

EXPECTED RESULTS • National authorities able to scale up cost-effective and sustainable malaria-control measures, as part of or closely linked to health systems development •

INDICATORS Proportion of malaria-affected countries: that have functional partnerships for Roll Back Malaria; that have substantially reduced (>25%) malaria burden in the most vulnerable groups since 1998; implementing antimalarial treatment policies based on evidence, both in public and private sectors; in which over 80% of patients receive effective treatment within 24 hours of onset of symptoms; and that have increased use of insecticide-treated nets to reach the target coverage of 60% among vulnerable groups Proportion of malaria-affected countries in which majority of endemic districts have people aware of how malaria can be controlled, and responsibilities and accountabilities for supporting control that are defined and communicated, and a system in place for monitoring whether these are fulfilled Proportion of malaria-affected countries that have a system of monitoring and evaluation of rolling back malaria in place, and reporting at least yearly on progress and outcomes Magnitude of increase in overall resources available to roll back malaria Proportion of malaria-affected countries with approved proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria Number of countries that have received a technical support mission or consultancy Number of countries having adopted recommendations of consultancies For each technical guideline, the number of members of the main target audience at country level who use it Increase in the global investments in research and development for rolling back malaria Number of new tools and strategies validated through ap;>lied research Number of countries incorporating results of research and development into n.tion.l plans Proportion ofm.lari.-.ffected countries with technical capacity to implement plan to roll back malaria

•

Mechanism established that empowers communities to take appropriate action to increase and sustain contro 1 of malaria

•

•

A system for routine monitoring of malaria and control measures established in all countries endemic for malaria

•

•

Both global advocacy on the importance of malaria and efforts to increase resources available for its control supported

• •

•

Technical standards established for malaria control and provision of technical support to countries ensured

• • •

•

High-priority research and development areas supported, including combination treatment, diagnostic tests, treated nets with longer-lasting insecticidal activity, and intermittent preventive treatment, and

• • •

results incorporated into national plans

•

Capacity developed within countries for policymaking, programme management, and social mobilization

•

RESOURCES (US$ thousand) Regular budget TOT AL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 15767 17 176 40% 25% 35% Other sources 110000 131500 35% 40% 25% All funds 125767 148676 36% 38% 26%

17

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Malaria is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature ofthose efforts.

18

MALARIA

Areas of work Communicable disease surveillance Communicable disease prevention, eradication and control Health promotion Research and product development for communicable diseases Child and adolescent health Research and programme development in reproductive health Making pregnancy safer Sustainable development Health and environment Emergency preparedness and response Essential medicines: access, quality and rational use Evidence for health policy Organization of health services Resource mobilization, and external cooperation and partnerships Country cooperation strategy Immunization and vaccine development

Nature of contribution Mapping of data and risk factors of malaria, monitoring of drug resistance Strategies and guidelines for vector control and management; development oflong-lasting insecticide-treated nets; strategy for capacity development Social marketing and advocacy of malaria prevention and treatment Support and encouragement of research to develop new interventions and products Linking of malaria prevention and control to integrated management of childhood iIlness Strategies and guidelines for prevention and management of malaria during pregnancy Incorporation of malaria prevention into maternal health care Linking of malaria control with poverty reduction and human development Evaluation of environmental impact of pesticide and insecticide use; identification of alternatives to pesticidal control of vectors Integration of malaria control in humanitarian action in complex emergencies Equitable access to good-quality antimalarial agents Disease burden statistics to provide evidence for defining strategy and the baseline for monitoring and evaluating impact Integration of Roll Back Malaria into health sector development and reform Innovative approaches or strategies to resource mobilization and partnership building for malaria prevention and control Inclusion of Roll Back Malaria in WHO Country Cooperation Strategy Development of ways oflinking malaria control measures to expanded programmes of immunization

19

PROPOSED PROGRAMME BUDGET 2004-2005

TUBERCULOSIS ISSUES AND CHALLENGES

Despite recent progress in tuberculosis control, eight million new cases occur every year causing two million deaths worldwide. Directly observed treatment, short-course (DOTS) is a widely proven and highly cost-effective control strategy. Although 148 countries had introduced DOTS by 2000, only 27% of all tuberculosis patients were being so treated, despite the cost of the standard drug regimen having fallen to as little as US$ 10. Many small- to medium-sized countries are achieving global control targets (70% detection of infectious cases and 85% treatment success by 2005), but most populous countries with high burdens of tuberculosis are not, because they either adopted the strategy only recently or have been slow to expand it. Common reasons for slow progress are lack of political commitment and/or resources. Furthermore, the HIV/AIDS epidemic, economic and social disruption in many poor countries, and the emergence of multidrug-resistant tuberculosis have undermined tuberculosis control. In countries with high prevalence of HIV, the number of tuberculosis cases has tripled or quadrupled in the past IS years. Drug resistance is now a serious problem (over 3% prevalence) in at least seven countries. The global movement to Stop TB now has over 125 partners, including organizations in countries with a high burden of disease, bilateral and multilateral agencies, nongovernmental organizations, academic institutions and the private sector. The Washington Commitment to Stop TB (October 2001) endorsed the need for rapid expansion of DOTS to reach the global targets by 2005 and the development goals of the United Nations Millennium Declaration for 2010 (50% reduction of mortality and prevalence). The Global Plan to Stop TB, launched in October 2001, sets out the actions to be undertaken to reach these goals. The Global TB Drug Facility, also launched in 2001, has already provided free drugs to 17 countries. New strategies are needed to tackle the epidemics of tuberculosis and HIVI AIDS, engaging communities and private practitioners in national control programmes. The respiratory element of peripheral health care services needs to be strengthened. The UNDP/World BanklWHO Special Programme for Research and Training in Tropical Diseases is coordinating research efforts into new tools for the control of tuberculosis. The contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria are rapidly and substantially increasing the resources available in countries to tackle those diseases. WHO will continue to collaborate closely with the Fund and countries at national, regional and global levels to ensure effective use of these new resources.

GOAL

Countries to reach the global control targets by 2005 and to sustain this achievement in order to halve the prevalence and death rates associated with tuberculosis by 2015. (Millennium Development Goal: By 2015 "halt and begin to reverse the incidence 0/. .. other major diseases ".) To strengthen technical and financial support to countries, based on the global DOTS expansion plan; to increase access to high-quality drugs through the Global TB Drug Facility; to facilitate Stop TB partnership operations; to accelerate the development of specific interventions, strategies and policies for DOTS expansion, dual tuberculosislHIV infection, multidrug-resistant tuberculosis, and increased involvement of communities, private practitioners and primary care workers; to lead global surveillance, monitoring and evaluation; and to promote, and act as a catalyst for, research on new diagnostics, drugs and vaccines. Indicators • • • DOTS implementation rates and global DOTS coverage Global case detection and cure rates Global financial resources available for tuberculosis control activities

WHO OBJECTIVE(S)

20

TUBERCULOSIS

STRATEGIC APPROACHES

Expansion of DOTS coverage throughout all countries through the global DOTS expansion plan; global advocacy and national mobilization campaigns to sustain political commitment and identify resources for tuberculosis control through the Global Stop TB Partnership; implementation of innovative approaches, creation of new policies and strategies to deal with joint tuberculosislHIV infection, multi drug-resistant tuberculosis and other challenges

EXPECTED RESULTS • Global DOTS expansion plan maintained and expanded, underpinned by the Global Plan to Stop TB, comprising shared goals and values National partnerships in the fonn of country coordination mechanisms operational, supporting implementation of long-tenn national plans to expand DOTS Global TB Drug Facility maintained, with expanded access to treatment and cure Political commitment sustained and mobilization of adequate resources ensured through nurturing of the Stop TB partnership and effective communication of the concept, strategy and progress of the Global Plan to StopTB •

INDICATORS Global case detection and cure rates

•

•

Proportion of high-burden and other targeted countries reaching global targets

•

•

Number of additional patients treated with support from the Global TB Drug Facility Proportion of countries with agreed national strategy for stopping tuberculosis with supporting advocacy International financial resources available for tuberculosis control activities Number of additional partners for tuberculosis control Proportion of countries submitting accurate annual surveillance, monitoring and financial reports for inclusion in the annual global report on tuberculosis control Proportion of targeted countries implementing combined interventions between national tuberculosis and AIDS control programmes Proportion of targeted countries implementing DOTS revised to cope with multidrug-resistant disease Proportion of all countries surveying drug resistance Pcoportion of targeted countries implementing privatepublic mix and community care interventions Proportion of targeted countries (with adequate health systems) implementing integrated respiratory care at primary level

•

•

• • •

•

Global surveillance and evaluation systems maintained and expanded to monitor progress towards global targets, specific resource allocations for tuberculosis control, and impact of control efforts New policies and strategies to tackle multidrug resistance and to improve tuberculosis control in countries with high HIV prevalence fonnulated

•

•

• • • New policies and strategies to improve participation of private practitioners and community care workers and to increase case detection through integrated respiratory care at primary level fonnulated • •

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 10288 II 980 44% 34% 22%

Other sources 100000 162000 25% 20% 55%

All funds 110288 173 980 26% 21% 53%

21

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Tuberculosis is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

22

TUBERCULOSIS

Areas of work Communicable disease surveillance Communicable disease prevention, eradication and control Research and product development for communicable diseases Mental health and substance abuse Child and adolescent health Women's health Sustainable development Emergency preparedness and response Essential medicines: access, quality and rational use Immunization and vaccine development WHO's presence in countries HIV/AIDS

Nature of contribution Interventions for containment and surveillance of tuberculosis; international regulatory action Specification of new technologies and tools to control and eradicate tuberculosis Technical information, guidelines, mobilization of resources for research and product development Tools to assess need of vulnerable groups exposed to risk of tuberculosis Identification of physical and social factors that protect adolescents from tuberculosis Tools for assuring that health care systems address the needs of impoverished and neglected women Promotion of better health as a means of reducing poverty; urban and rural development that furthers elimination of tuberculosis Temporary interventions, including tuberculosis programmes in emergencies or disasters Access to affordable and efficient therapeutic drugs Promotion of tuberculosis vaccine development Technical support to Member States for expanding DOTS Collaborative tuberculosis/HIV programme activities to improve general health care services and access to care for people living with HIV/AIDS Preparation of guidelines on syndromic approach to lung disease Training of health care workers in counselling on tobacco cessation

Surveillance, prevention and management of noncommunicable diseases Tobacco

23

PROPOSED PROGRAMME BUDGET 2004-2005

SURVEILLANCE, PREVENTION AND MANAGEMENT OF NONCOMMUNICABLE DISEASES ISSUES AND CHALLENGES In 2000, 59% of deaths in the world and 46% of the global burden of diseases were due to noncommunicable diseases and mental health. Overall, chronic illness accounts for almost 70% of all medical spending, and in some developed countries for 80% of hospital days and over 80% of treatment prescriptions (although adherence to such treatments can be as low as 20%). Home and long-term care have neither been integrated into countries' health and social systems nor closely linked to preventive, acute and chronic health services. Disabling visual and hearing impairment is estimated to affect over 180 million and 250 million persons respectively. Many of these diseases and disabilities are a consequence of failed prevention, diagnosis and incorrect management. These challenges require a comprehensive response combining surveillance, prevention and management. Surveillance. Countries are implementing a common framework of defined core variables for surveys, surveillance and evaluation, linked to health promotion and disease prevention efforts. WHO's STEPwise approach to surveillance, being implemented in four WHO regions, encourages countries to collect information for policy on major risk factors with standardized methods. Prevention. The global strategy for prevention and control of noncommunicable diseases, endorsed by the Health Assembly (resolution WHA53.17) in 2000, is being implemented through national programmes linked by regional and global networks. This linkage provides a stronger framework within which existing and new initiatives can be implemented in countries and the experience disseminated regionally and globally. A global strategy on diet and physical activity is being elaborated along with a plan for implementation at national, regional and global levels, and supported by the established networks. Successful prevention of noncommunicable diseases is based on a life-course approach, and needs appropriate interventions to start in childhood and adolescence and to continue throughout the life span, resulting in healthy ageing. Management. This part of the response supports the implementation of both disease-specific and generic programmes and aims at integrating primary and secondary prevention into health services. It supports the application of policies, practical tools and instruments designed for countries to adapt their health systems to deal with chronic conditions and to resolve issues related to long-term care, and the provision of comprehensive visionlhearing care and rehabilitation services. It strengthens health systems' capability to deliver basic drugs and diagnostic technology for treatment and prevention of noncommunicable diseases. It pays particular attention to genetic services and community genetics. To reduce the burden of premature mortality and morbidity related to noncommunicable diseases. To ensure that governments are better equipped technically and institutionally to reduce people's exposure to the major risk factors and that health systems are prepared to deal with the rising burden of chronic conditions, and to promote standards of health care for people with noncommunicable diseases.

GOAL

WHO OBJECTIVE(S)

Indicators • • • STRATEGIC APPROACHES Number of countries adopting prevention and control policies on noncommunicable diseases Number of demonstration sites on prevention and control of noncommunicable diseases Number of global and regional networks supporting implementation of programme

Comprehensive response in surveillance, prevention and management of main diseases and their shared risk factors

24

SURVEILLANCE, PREVENTION AND MANAGEMENT OF NONCOMMUNICABLE DISEASES

EXPECTED RESULTS 0

INDICATORS 0

WHO surveillance framework, standardized methods and materials for simplified surveillance systems for noncommunicable diseases in order to inform policy and programmes widely adopted in countries and regions

Percentage of countries within each region that have conducted a training workshop on the WHO STEPwise approach to Risk Factor Surveillance Percentage of countries within each region that have successfully implemented the STEPwise approach Number of countries participating in each regional network Number of countries in the networks with specific national demonstration programmes Proportion of targeted countries initiating model projects

0

National integrated prevention and control programmes for noncommunicable diseases established, including community-based demonstration projects, health promotion, health services and national policy development, and linked by strengthened regional networks and the global forum for prevention and control of such diseases Multisectoral strategies and plans of action on diet and physical activity adopted

0

0

0

0

0

Proportion of targeted regions and countries with mullisectoral strategies and plans on diet and physical activity Proportion of targeted countries adopting policies on improving care for chronic conditions Proportion of targeted countries adopting strategies for enhancing adherence to long-term therapies Number of countries with a health care system beller adapted to prevention Number of countries implementing recommended WHO guidelines on main noncommunicable diseases Number of countries with an expanded array of clinical preventive services being financed Proportion of targeted countries integrating genetic services into health care Proportion of targeted countries documenting adequately the burden of visual and hearing impairments Number of countries adopting and implementing WHO strategies on blindness and deafness

0

Comprehensive policies and strategies adopted by regions and countries in order to strengthen the capability of health systems to deal with chronic conditions, to enhance adherence to therapies and behaviours and to reinforce long-term care

0

0

0

0

Secondary prevention and clinical preventive and treatment interventions identified; evidence-based guidelines disseminated for management of cancer, diabetes, cardiovascular diseases and chronic respiratory disease; and guiding principles available for integrating genetic services into health care

0

0

0

0

Strategies for prevention and control of blindness, deafness and hearing impairments developed, and countries supported in their implementation; burden of visual and hearing impairment, and programme implementation regularly monitored

• 0

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 23088 22258 44% 25% 31% Other sources 7000 23000 20% 30% 50% All funds 30088 45258 32% 27% 41%

25

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Surveillance, prevention and management of noncommunicable diseases is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

26

SURVEILLANCE, PREVENTION AND MANAGEMENT OF NONCOMMUNICABLE DISEASES

Areas of work Tobacco

Nature of contribution Negotiation of the WHO framework convention on tobacco control; support to regional and country offices for legislation and implementation Development of community-based interventions for primary and secondary prevention Guidelines on integrating the management of noncommunicable diseases, including mental disorders, into primary health care Strategies to prevent establishment of risk factors; technical involvement in drawing up guidelines on noncommunicable diseases in children (asthma, type I diabetes) Guidelines for screening or early detection of cervical cancer; integration into reproductive health programmes of public health approaches for prevention of congenital and genetic disorders Strategies to prevent and control diabetes in pregnancy and hypertension during pregnancy Study of gender issues in prevention and control of common noncommunicable diseases Assessment of links between noncommunicable diseases and poverty; elaboration of control strategies to promote sustainable development Assessment of nutrition patterns; nutrition guidelines to control noncommunicable diseases Formulation of strategies for assuring in emergencies basic health services for noncommunicable diseases; development of surveillance systems

Health promotion Mental health and substance abuse Child and adolescent health

Research and programme development in reproductive health Making pregnancy safer Women's health Sustainable development

Nutrition Emergency preparedness and response

27

PROPOSED PROGRAMME BUDGET 2004-2005

TOBACCO ISSUES AND

CHALLENGES

WHO's first global treaty, the framework convention on tobacco control, is scheduled to be adopted by May 2003, with negotiation of the initial protocols expected to begin in 2003 and to continue throughout 2004-200S, The adoption of the convention will mark the beginning of a new phase in building an effective international legal system to counter the increasing use of tobacco globally, During 2004-200S, WHO will work to build awareness and political support for ratification of the convention by Member States, with entry into force expected during 2004-2005, This phase will require close collaboration with Member States to build national capability, According to a recent assessment, less than 30% of Member States have a tobacco-control work plan in place, The major task facing the Tobacco Free Initiative in 2004-2005 will be to work with countries to strengthen and support their institutional and human capability to draw up, monitor and evaluate comprehensive tobacco-control policies in a way that reflects national priorities and realities. WHO will provide technical assistance, training and preparation of guidelines in the areas of surveillance, research, legislation, economics, health promotion, smoking cessation and advocacy through public policy, with particular emphasis on women and youth. The United Nations Ad Hoc Interagency Task Force on Tobacco Control, of which WHO holds the Chair, will continue to play an important role in the Organization's multisectoral work at country and global levels. Following the Report of the Committee of Experts on Tobacco Industry Documents in 2000 that revealed tobacco companies' efforts to discredit and impede WHO in carrying out its mission, the Health Assembly in resolution WHAS4.18 called on WHO "to continue to inform Member States of activities of the tobacco industry that have negative impact on tobacco control efforts". In 2004-200S WHO will work to ensure that the influence of the tobacco industry on public health policy continues to be held up to public scrutiny.

GoAL

To reduce substantially the prevalence of tobacco use, the harm caused by use of tobacco products and exposure to tobacco smoke,

WHO OBJECTIVE(S)

To ensure that governments, international agencies and other partners are equipped effectively to implement national and transnational approaches to tobacco control.

Indicators • • Number of countries that ratifY the framework convention on tobacco control Number of countries with effective tobacco-control plans and policies that take account of the provisions of the convention

STRATEGIC APPROACHES

Work to ensure that as many countries as possible ratifY and implement the convention; maintenance of countries' awareness of tobacco-industry activities nationally and internationally; reinforcement of countries' ability to implement and monitor the convention through national capacity building in the areas of surveillance, research, legislation, economics, health education, smoking cessation, advocacy and the strengthening of monitoring and assessment systems

EXPECTED RESULTS • Number of Member States with comprehensive tobacco-control policies and national plans of action increased •

INDICATORS Proportion of Member States with a comprehensive national plan of action detailing tobacco-control strategies and programmes that reflect the provisions of the convention, as well as a designated tobaccocontrol budget at govemmentallevel Number of convention's elements reflected in national

•

plans of action

28

TOBACCO

EXPECTED RESULTS • Number of multisectoral strategies in support of tobacco control increased among relevant bodies of the United Nations system, nongovernmental organizations and private sector groups at regional and global levels •

INDICATORS Number of best practices in tobacco control focusing on educational, legislative, economic and environmental aspects and regulatory mechanisms Number of new projects initiated under the umbrella of the United Nations Ad Hoc Interagency Task Force on Tobacco Control Number of institutions, networks and WHO collaborating centres by region and priority area working in andlor financing tobacco control Number of countries that complete internationally standardized surveys on tobacco use Number of countries covered by the National Tobacco Information Online System Number of countries that integrate tobacco control into public health research Number of countries that integrate tobacco cessation into health care systems and disease-control programmes Number of countries that have local nongovernmental organizations andlor civil-society bodies undertaking media/education campaigns on the harmful effects of tobacco use Number of countries that have comprehensive and sustained advocacy in the media Number of countries that have formal mechanisms to regulate and report on tobacco products and tobaccoindustry activities Number of countries that have completed country studies/public inquiries on tobacco-industry activities Number of countries that ratify the convention

•

•

0

Improved surveillance in the areas ofhealth, economics, legislation, environment, and behaviour in support of tobacco control

0

0

0

Accelerated integration of strategies for tobacco control into public health programmes

0

• .

•

Greater awareness and understanding globally of the increased use of tobacco and its consequences through stronger media coverage and information systems, and decreased social acceptability of tobacco use

• •

•

Increased transparency, public knowledge and regulation of tobacco-industry activities

• •

•

Entry into force of the WHO framework convention on tobacco control, and adoption of initial protocols

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 9024 9536 28% 31% 41% Other sources 19500 27500 40% 30% 30% All funds 28524 37036 37% 30% 33%

29

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Tobacco is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

30

TOBACCO

Areas of work Tuberculosis Surveillance, prevention and management of noncommunicable diseases Health promotion

Nature of contribution Tobacco use as a cause of tuberculosis; approaches to treatment of tobacco use Reduction of tobacco use as a major risk factor for cancers, ischaemic heart disease, respiratory diseases Promotion of non-smoking as the desirable norm; media, legislative and economic interventions; development of model school curricula on tobacco Integrated approaches to treatment of all forms of substance dependence; regulation of tobacco products In- and out-of-school programmes; entertainment and media work aimed at increasing the participation of young people Work on women and tobacco use linked to five-year review of Fourth World Conference on Women (Beijing, 1995), to the Convention on Elimination of All Forms of Discrimination against Women (CEDAW), and to follow-up of the Commission on the Status of Women Strategies to prevent or reduce tobacco use during pregnancy Work on sustainable livelihoods based on tobacco production; links to trade agreements and to poverty Reduction of passive smoking as a component of indoor air pollution Consideration of nicotine-replacement therapy in the essential medicines list; regulation of tobacco products Epidemiology and economics of tobacco control; support for tobacco surveillance systems Organization of sessions of the Intergovernmental Negotiating Body on the WHO framework convention on tobacco control Chairing of the United Nations Ad Hoc Interagency Task Force on Tobacco Control; support for the WHO Office at the United Nations (New York) and at the European Community (Brussels) Legal support for negotiation of the WHO framework convention on tobacco control and for complex interaction between WHO and the tobacco industry

Mental health and substance abuse Child and adolescent health Women's health

Making pregnancy safer Sustainable development Health and environment Essential medicines: access, quality and rational use Evidence for health policy Governing bodies Resource mobilization, and external cooperation and partnerships Director-General, Regional Directors and independent functions

31

PROPOSED PROGRAMME BUDGET 2004-2005

HEALTH PROMOTION ISSUES AND CHALLENGES Increasing urbanization, demographic, environmental and other changes stimulated by globalization of markets and communication, and complex emergencies in many countries all require different approaches to health actions in order to deal with the broader determinants of health. Promotion of health in settings where people of any age live, work, learn and play is a creative and cost-effective way of fostering environments supportive of health and of improving health and quality of life. The major task will be implementing intersectoral action and integrated comprehensive approaches to promote health, particularly for poor and marginalized groups. Advocacy of prevention and health promotion is also vital, especially among decision-makers, so as to ensure the necessary political commitment and resources.

The world health report 2002 documented the public health impact of several major risks that can be reduced through health promotion, such as poor diet and nutrition, tobacco use, alcohol consumption, physical inactivity, poor hygiene, lack of safety and unsafe sex. Failure to avoid these risks has led to cardiovascular and chronic respiratory diseases, diabetes, injuries and violence, several mental disorders, substance dependence, HIV infection and AIDS and sexually transmitted diseases becoming major constraints to improvement of health. Risks to health are interrelated and influenced by sociocultural determinants, such as gender, and spiritual beliefs. Effective policies need therefore to be multisectoral, and to draw upon a wide array of potential partners for their successful implementation. Thus the health sector, and globally WHO, plays an important stewardship role in cooperation with concerned partners. The policies need to be based on the best available evidence of effectiveness and sustainability, within a life-course perspective. The continued efforts of countries to decentralize and democratize have opened new opportunities to strengthen local government and health authorities, as well as to improve the health of marginalized groups, and to include health as an important investment for social and economic development. Effective health promotion still does not receive adequate financial and political support compared to expensive curative health care. For funding, excise taxes on sales of tobacco (and alcohol) are a valuable and largely untapped source of funding for health promotion activities and will be encouraged. All WHO programmes are expected to integrate health promotion into their strategies and plans. Thus, readers of this section should bear in mind the expected results on health promotion formulated under other areas of work.

GOAL

To reduce risks to people's health through gender- and age-sensitive policies and actions that deal with the broader determinants of health.

WHO OBJECTIVE(S)

To create an environment in which governments and their partners in the international community are better equipped to develop and implement multi sectoral public policies for health and integrated gender- and age-sensitive approaches that facilitate community empowerment and action for health promotion, self-care and health protection throughout the life course.

Indicators • • • • Production and dissemination of evidence of effective health promotion Increase in institutional capacity to promote health in Member States Formulation of healthy public policies Improvement in health of marginalized groups

32

HEALTH PROMOTION

STRATEGIC APPROACHES

Increasing partnership and community participation, raising awareness about the broad determinants of health, fostering health-supportive environments, and promoting intersectoral action and integrated approaches to public health, through cooperation with Member States and the international community in strengthening the capacity, policies, financial support and evidence for health promotion EXPECTED RESULTS

INDICATORS

•

Evidence through global review of the effectiveness of health promotion collected and disseminated

• •

Increase in number of projects demonstrating the effectiveness of health promotion Dissemination of results and lessons learned through the sixth Global Conference on Health Promotion and other channels Number of regions and countries that have integrated health-promotion strategies into regional and national health and development plans, and effectiveness of networks at all levels to implement such strategies Increase in the number of health-promotion courses established and personnel trained in Member States Number of countries that have healthy-ageing policies and programmes and mechanisms for monitoring the impact of such policies Number of countries that have integrated health promotion and oral health into their health system with specific focus on reducing known health risk factors Collection and dissemination of accurate and up-todate information related to major risk factors and healthy lifestyles for strong health promotion and media advocacy Design of approaches to health promotion that influence youth as a whole, with links to communitybased, national and international programmes Number of countries that monitor the major healthrelated behavioural risk factors among students, and have networks and alliances to foster concerted efforts to improve school-health programmes Healthy public policies, and promotion of the health of marginalized groups Number of health-promotion foundations or other mechanisms for financing health promotion

•

Capability strengthened at national and regional levels for the planning and implementation of multisectoral health promotion policies and programmes across the life course and as populations age

•

• •

•

Opportunities and mechanisms defined for reorienting health services towards health promotion and oral health Advocacy and health communications strengthened at all levels in relation to health promotion and the major risk factors, as defined in The world health report 2002

•

•

•

•

Approaches to health promotion that reach young people in- and out-of school strengthened

• •

•

Programmes implemented for capacity building for and financing of health promotion at local and community levels, workplace and other settings, with particular focus on improving the health of disadvantaged people

• •

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 17874 16326 65% 19% 16% Other sources 28000 33000 15% 15% 70% All funds 45874 49326 32% 16% 52%

33

PROPOSED PROGRAMME BUDGET 2004-200S

INJURIES AND DISABILITIES ISSUES AND CHALLENGES

Violence and injuries account for II % of the global mortality and 13% of all disability-adjusted life years lost every year. Seven of the IS leading causes of death for people between the ages of 15-44 years are injury-related. Children and young adolescents are particularly susceptible to traffic accidents, drowning, burns and violence. Injury rates vary greatly by sex: for most types of injuries, death rates are higher for males, whereas women are at higher risk for some types of non-fatal injuries such as those resulting from sexual or intimate-partner violence or suicide attempts. The burden imposed by violence and injury is particularly heavy in low-income families, communities and societies. The traditional view of injuries as "accidents", suggesting that they are random unavoidable events, has resulted in their historical neglect. Research has shown that injuries are preventable. Innovative solutions have resulted in cost-effective prevention of injuries at work, at home or in the street. Interventions such as the use of motor-cycle helmets, seat belts, designated drivers, occupational safety devices, flame-resistant clothing and smoke detectors are among many cost-effective actions that have been proven to prevent injuries. Many others show promise in reducing violence-related injuries, including programmes on substance abuse, parental training, prevention of school-based violence, weapons control, and landmine clearance and awareness. Some 7% to 10% of the world's population have disabilities, the major causes of which include rising life expectancy, survival of children born with disabilities and noncommunicable diseases, besides injuries and violence. Less than 10% of those in need have access to appropriate rehabilitation services, mainly because of the scarcity of resources in developing countries. Several United Nations and Health Assembly resolutions have dealt with these issues. For instance, resolutions WHA27.S9 (on road traffic accidents), WHA45.10 (on disability prevention and rehabilitation), WHA49.25 (on prevention of violence), and WHASl.8 (on anti-personnel mines) called on WHO for support to confront them, as have regional committee documents, the United Nations Millennium Declaration and the Programme of Action adopted at the United Nations Conference on the Illicit Trade in Small Arms and Light Weapons in All Its Aspects (New York, 9-20 July 2001). Recent WHO achievements in this area of work include the World Report on Violence and Health, the publication of a multidisciplinary framework for violence prevention and of guidelines for the surveillance of injuries, the development of a five-year strategy to prevent traffic injuries, and technical cooperation with several countries. Challenges in designing and implementing prevention programmes include the lack of ownership, with uncertainty about who is responsible for developing solutions and the duties of the public health sector remaining ill-defined. Therefore there are often no focal points, no national public health policies on injury prevention and/or training programmes. Another challenge is to overcome the lack of political will due to ignorance about the magnitude of the problem and/or the potential for prevention, both of which mean an insufficiency of resources to find and implement solutions. The response should include: surveillance systems and research to understand better the magnitude ofthe burden and the causes and prevention of violence and injuries; national policies; training for public health personnel; the establishment of global and regional networks for advocacy and exchange of information; and better services.

GOAL

To prevent violence and unintentional injuries, promote safety and enhance the quality of life for people with disabilities.

WHO OBJECTIVE(S)

To equip governments, and their partners in the international community, so that they can formulate and implement cost-effective, gender-specific strategies to prevent and mitigate the consequences of violence and unintentional injuries and disabilities.

Indicators • • Number of countries that have formulated policies on disabilities or prevention of violence and injuries Number of countries implementing programmes to prevent violence and injuries

34

INJURIES AND DISABILITIES

STRATEGIC APPROACHES

Compilation of information on the magnitude and determinants of injuries, violence and disabilities; support for research and gathering of evidence on effective prevention strategies in developing countries; support to Member States to formulate and implement policies and strengthen services for victims; advocacy for increased attention and a stronger focus on primary prevention; support for network development and capacity building

EXPECTED RESULTS • Support provided to high-priority countries for the implementation and evaluation of surveillance systems for the major determinants, causes and outcomes of unintentional injuries and violence Support provided to selected countries on research to identifY effective programmes and policies to prevent violence and injuries Guidance available for multisectoral interventions to prevent violence and unintentional injuries •

INDICATORS Proportion of targeted countries that use WHO guidelines to collect data on the determinants, causes and outcomes of unintentional injuries and violence

•

•

Evaluated interventions in targeted countries

•

•

Proportion of targeted countries that have national plans and implementation mechanisms to prevent unintentional injuries and violence Proportion of targeted countries that have strengthened their health system response to unintentional injuries and violence

•

Support provided for policy formulation in selected countries for pre-hospital, hospital and integrated longterm care for victims of unintentional injuries and violence Support provided to high-priority countries to build capacity for prevention of injuries and violence, research and policy formulation Global, regional and national initiatives taken to strengthen collaboration between health and other sectors involving organizations in the United Nations system, Member States and nongovernmental organizations Ability of countries to integrate rehabilitation services into primary health care, for early detection and management of disabilities

•

•

•

Proportion of targeted countries that have trained professionals on the prevention and management of unintentional injuries and violence Number of global, regional and national multisectoral initiatives in place to prevent violence and injuries

•

•

•

•

Proportion of targeted countries implementing strategy for integrating rehabilitation services into primary health care

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 5973 5 132 35% 23% 42% Other sources 8500 13000 25% 20% 55% All funds 14473 18 132 28% 21% 51%

35

PROPOSED PROGRAMME BUDGET 2004-2005

MENTAL HEALTH AND SUBSTANCE ABUSE The portion of the global burden of disease attributable to mental and neurological disorders and substance abuse is expected to rise from 12.3% in 2000 to 15% by 2020. The 2000 figure does not include the significant 1.3% of the burden due to suicide attempts and completed suicide. Additionally when alcohol consumption is analysed as a risk factor contributing to the global burden, it alone is responsible for 3% to 4%. Moreover, there is strong evidence that mental disorders impose a range of consequences on the course and outcome of comorbid chronic conditions, such as cancer, heart disease, diabetes and HIV/AIDS. The rise in the burden of mental and neurological disorders and substance abuse will be particularly sharp in developing countries, primarily because of the projected increase in the number of individuals entering the age of risk for the onset of disorders. These problems pose a greater burden on vulnerable groups such as people living in absolute and relative povertY, and those in difficult conditions as a result of coping with chronic diseases such as HIVIAIDS. Mental health has been raised much higher up the international health agenda owing to WHO's international campaign during 2001, with its unprecedented series of events, including World Health Day, which was celebrated in more than 130 countries, the round tables at the Fifty-fourth World Health Assembly, in which more than 110 ministers of health participated, and The world health report 2001, which was devoted to mental health. Governments are now much more aware of major mental health disorders and substance abuse, recognizing their impact on the health and well-being not only of individuals but also of families and communities. Although effective treatments for mental and neurological disorders exist, however, there is a big gap between their availability and widespread implementation; even in developed countries only a few of those suffering from serious mental illness receive treatment. Improving treatment rates for those disorders and substance abuse problems will not only reduce the burden of disease and disability and health care costs but also increase economic and social productivity. The burden of disease attributable to, for example, major depression could be more than halved if all affected individuals were treated. Countries are ill-equipped to deal with the burden: a WHO survey, the Atlas project, showed that 41 % of countries do not have a mental health policy, 25% of countries have no legislation on mental health and 28% have no separate budget for mental health. Among countries reporting a specific mental health budget, 36% allocate less than I % of their health budget to mental health. As a response to these issues and challenges, the Director-General in 2002 launched the mental health Global Action Programme. The same year, following resolutions adopted by regional committees, the Executive Board adopted a resolution on "Strengthening mental health" (resolution EB109.R8) and the Health Assembly, in its resolution WHA55.1O, affirmed its provisions.

ISSUES AND CHALLENGES

GoAL

To reduce the burden associated with mental and neurological disorders and substance abuse, and to promote good mental health worldwide. To assure that governments and their partners in the international community place mental health and substance abuse on the health and development agenda in order to formulate and implement cost-effective responses to mental disorders and substance abuse.

WHO OBJECTIVE(S)

Indicators • • Proportion of targeted countries that have implemented reforms in the area ofmental health Number of countries that have increased their budget for mental health

STRATEGIC APPROACHES

Dissemination of information on the magnitude, burden, determinants and treatment of mental and neurological disorders and substance abuse; provision of support to Member States for formulating and implementing coherent and comprehensive policies and services; provision of support to countries for fighting against stigmatization and discrimination; growth in research capability in developing countries

36

MENTAL HEALTH AND SUBSTANCE ABUSE

EXPECTED RESULTS I

INDICATORS 0

0

Appropriate strategies developed and support provided to countries in reducing stigmatization and violations of human rights associated with mental and neurological disorders and substance abuse

Proportion of targeted countries in each region that, in consultation with WHO, have initiated a strategy to develop mental health legislation and promote human rights Proportion of targeted countries in which at least one active advocacy group has been created Number and proportion of targeted countries in each region for which information or data have been translated and adapted according to country needs Number and proportion of targeted countries that received technical assistance from WHO in developing and implementing policies and plans Proportion of targeted countries that adapt alcohol policy guidelines according to their needs Proportion of targeted countries that have undertaken research on alcohol-related topics in line with those promoted by WHO Proportion of targeted countries that received WHO support to incorporate WHO's tools and materials for assessment and management of clinical situations and needs, and for staff development, into national health services Proportion of countries by region in which WHO either promoted or helped to coordinate support to the mental health needs of the most vulnerable population groups Number (and regional representation) of countries for which data are included in epidemiological databases Number and proportion of targeted countries receiving WHO's technical assistance in drawing up protocols for cost-effective interventions Number of meetings to mobilize resources for building capability for research in developing countries Number of meetings on priority setting for mental health research in developing countries

0

0

Information and support given to countries in formulating and implementing policies and plans on mental health and substance use

0

0

0

Global and regional alcohol research and policy initiatives established and implemented

0

0

0

Instruments, guidelines and training packages available in countries for the management of mental and neurological disorders and substance abuse; adequate support provided to countries for their implementation, with the needs of vulnerable groups (e.g. poor people, injecting drug users and those living with HIV /AIDS) as well as gender-specific needs taken into account

0

0

0

More valid and reliable scientific, epidemiological and resource data available for planning and development of cost-effective interventions in the mental health and substance abuse area; measures of the burden attributable to such disorders accessible to countries Appropriate support provided for building capability in developing countries for policy development and research on mental and neurological disorders and substance abuse

0

0

0

0

0

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 15718 14007 30% 37% 33% Other sources 17000 19000 35% 25% 40% All funds 32718 33007 33% 30% 37%

37

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Mental health is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

38

MENTAL HEALTH AND SUBSTANCE ABUSE

Areas of work Tobacco Surveillance, prevention and management of noncommunicable diseases Child and adolescent health HIV/AIDS Nutrition Emergency preparedness and response Essential medicines: access, quality and rational use Evidence for health policy Organization of health services Injuries and disabilities

Nature of contribution Partnerships on the management of nicotine dependence Management of mental health consequences of disabilities Promotion of healthy child and adolescent development, including reduction of risk behaviour Partnerships to tackle substance abuse and HIVI AIDS Partnership to address mental retardation Partnerships and mobilization of resources to meet mental health needs in natural or complex disasters Guidance for control and use of psychotropic and narcotic substances Evidence to allow appropriate distribution of health system resources to mental health Strategies, methods and guidance enabling countries to deliver good-quality mental health services Evidence on links between injuries, alcohol and mental health

39

PROPOSED PROGRAMME BUDGET 2004-2005

CHILD AND ADOLESCENT HEALTH ISSUES AND CHALLENGES The process of growth and development is cumulative and intergenerational; gains (or losses) at any stage of life affect health later, or the health of the next generation. The major health and development needs and challenges evolve as a child grows. All age groups need safe and supportive environments in which to develop to their full potential. Neonates, children and adolescents make up nearly 40% of the world's population and their health problems are well documented. In 2000, 99% of the 10.9 million childhood deaths were in developing countries. Preventable communicable diseases (such as acute respiratory illness, diarrhoea, malaria, measles and most HIV infections transmitted from mother to child) accounted for half those deaths, and malnutrition was a causal factor in 60%. Young people aged 15 to 24 years continue to have the highest rates of sexually transmitted infections (e.g. more than 40% of all new HIV infections in 2000). In addition, up to 70% of premature adult mortality has its roots in the adolescent period. Improving the health, growth and development of children and adolescents entails a broad range of activities that require maximum support to countries for policy and programme implementation, including research, development of guidelines and design of tools to introduce, monitor and evaluate public health interventions and health sector reforms. To this end, WHO needs to maintain strong partnerships with other organizations of the United Nations system, bilateral agencies, nongovernmental organizations, governments, the private sector and communities. It must guide international and national policies, through, for example, support to the Convention on the Rights of the Child. Furthermore, to meet the Millennium Development Goals it must focus on reaching the poor, providing equitable access to care, maintaining a gender perspective, and promoting sustainable interventions. The child survival movement of the past two decades promoted a specific set of interventions that benefited primarily older infants and children up to five years of age rather than infants. Consequently, although child mortality has declined significantly, neonatal mortality has nol. Many neonatal deaths are preventable through interventions that are effective and affordable even in countries where resources for health care are limited. WHO supports integrated approaches to ensuring the health and development of children up to the age of 19 years. Integrated management of childhood illness (endorsed by the Health Assembly in resolution WHA48.12) is cost-effective and supports and complements other global activities such as rolling back malaria, expanding immunization coverage and fighting malnutrition. Increased attention is being provided, with partners, to infant and young child feeding, including breastfeeding and complementary feeding. The major health problems of adolescents (sexual and reproductive health including HIV infection, substance abuse including tobacco use, injuries, nutrition and endemic diseases) share common determinants. WHO, UNICEF and UNFPA are cooperating to improve adolescents' access to information, skills, health, education and other services, to assure a safe and supportive environment and to participate in decisions that affect their lives. Implementation of these strategies for children and for adolescents takes on the challenges of improving health services, empowering families and communities, and strengthening the link between the health system and the community.

GOAL

To reduce by two-thirds the rate of infant and child mortality by the year 2015 from the 1990 rate. (In line with corresponding Millennium Development Goal.) To enable countries to pursue evidence-based strategies in order to reduce health risks, morbidity and mortality along the life course, promote the health and development of newborns, children and adolescents, and create mechanisms to measure the impact of those strategies.

WHO OBJECTlVE(S)

Indicator • Number of countries receiving technical support from WHO to build capacity to implement interventions and to apply measurement tools

40

CHILD AND ADOLESCENT HEALTH

STRATEGIC APPROACHES

Elaboration by WHO of cost-effective mechanisms and guidelines to deal with diseases and conditions that represent the greatest health burden to popUlations; implementation of such tools in countries with feedback for further research

EXPECTED RESULTS

INDICATORS • Proportion of countries that have initiated implementation of child and adolescent health-related recommendations resulting from WHO support to the reporting process of the Convention on the Rights of the Child Number of research projects supported by WHO that resulted in formulation of strategic norms and standards applicable to policy and programming in developing countries for protecting adolescents from the major diseases and health risk behaviours and conditions Proportion of countries with national adolescent health policies and programmes Proportion of countries implementing integrated management of childhood illness that have expanded geographical coverage and activities

I •

Adequate technical and policy support provided to an increased number of countries to give effect to the health-related articles of the Convention on the Rights of the Child

I •

Improved policies, strategies, nonns and standards for protecting adolescents from disease and health risk behaviours and conditions established through research, technical and policy support

•

•

•

Guidelines, approaches and tools in place for more effective and expanded implementation of integrated management of childhood illness, and monitoring of progress validated and promoted Support provided for research and for the development of guidelines, approaches and tools for better implementation of interventions to reduce newborn mortality and improve newborn health

•

•

•

Number of research projects supported by WHO that resulted in the formulation of strategic nonns, standards and guidelines for reducing newborn mortality and improving newborn health Proportion of countries with high neonatal mortality adopting the guidelines Agreement on global agenda for action throughout the life course, including issues such as infant feeding, child development, adolescent reproductive and sexual health (including HIV infection) and gender, and a framework for its implementation in countries

•

•

Consensus reached on definition of global goals in raising healthy children and confident, competent adolescents, and progress towards their attainment

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 14929 14307 44% 27% 29% Other sources 64000 65000 20% 35% 45% All funds 78929 79307 24% 34% 42%

41

PROPOSED PROGRAMME BUDGET 2004-2005

Activities under "Making pregnancy safer and children's health", an Organization-wide priority, are carried out in two areas of work: Child and adolescent health and Making pregnancy safer. The nature of support to Child and adolescent health from other areas of work is shown in the following table.

42

CHILD AND ADOLESCENT HEALTH

Areas of work Communicable disease surveillance

Nature of contribution Surveillance of HIV/ AIDS, childhood infectious diseases

Communicable disease prevention, eradication, Control of helminthiases in children and control Research and product development for communicable diseases Malaria Tuberculosis Surveillance, prevention, and management of noncommunicable diseases Tobacco Health promotion Injuries and disabilities Making pregnancy safer Research on malaria control and on antimicrobial resistance Integration of malaria and integrated management of childhood illnesses activities, at facility and community levels Tuberculosis control in children Asthma management in children Prevention of tobacco use among young people Health promoting schools, healthy lifestyles Injury prevention among children; definition of magnitude of specific injuries; prevention and detection of child abuse and neglect Interventions to improve newborn health, low birth weight; early initiation of exclusive breastfeeding; mother-to-child transmission of HI V Female genital mutilation; gender mainstreaming Prevention of mother-to-child transmission of HI V; care of people living with HIV /AIDS; care of AIDS orphans Collaboration with civil society; child rights Promotion of early and exclusive breastfeeding; adequate complementary feeding; micronutrient supplementation; infant and young child feeding strategy; growth reference Indoor air pollution; water sanitation and supply; child environmental health Adaptation of integrated management of childhood illnesses guidelines for emergency situations; infant feeding in emergencies Compatibility of essential drugs lists with integrated management of childhood illnesses requirements; drug supply management; drugs and breastfeeding Linking Expanded programme on immunization and integrated management of childhood illnesses; vitamin A supplementation and immunization; vaccine development Disease burden statistics to provide evidence for strategy development; HealthMapper Pre-service education of health professionals; district management of integrated management of childhood illnesses

Women's health HIV/AIDS Sustainable development Nutrition

Health and environment Emergency preparedness and response Essential medicines: access, quality and rational use Immunization and vaccine development

Evidence for health policy Organization of health services

43

PROPOSED PROGRAMME BUDGET 2004-2005

RESEARCH AND PROGRAMME DEVELOPMENT IN REPRODUCTIVE HEALTH ISSUES AND CHALLENGES

All the almost 1000 million couples of reproductive age in the world today are potential users of sexual and reproductive health services. In the past three decades contraceptive use has increased more than sixfold to about 62%, but at least 120 million couples that want to plan the growth of their families are not using any method of contraception and a further 350 million do not have access to the full range of reliable contraceptives available. As a result, about 40% of pregnancies are unplanned and some 46 million deliberately aborted each year. About 20 million of these abortions are unsafe and cause complications that account for about 13% of the nearly 500 000 deaths resulting annually from pregnancy and childbirth. In addition, an estimated 340 million new cases of curable sexually transmitted infections occurred in 1999. Millions of people are infected sexually with viruses, principally HIV (about five million new infections in 200 I) and Human papillomavirus, the major cause of cervical cancer, which claims more than 230 000 lives annually (80% in developing countries). Sexual and reproductive ill-health including HIV/AIDS accounted in 2000 for an estimated 9.5% of disability-adjusted life years lost, mostly in the poorer countries. The International Conference on Population and Development (Cairo, September 1994) defined a Programme of Action for universal reproductive rights and reproductive health within the next two decades. It called for the adoption of a life-cycle approach to sexual and reproductive health, highlighting such cross-cutting issues as gender, adolescent sexuality and men's roles in sexual and reproductive health. Since that meeting, new programmes, some targeted at previously neglected groups such as adolescents and men, have been drawn up by governments and intergovernmental agencies. New partnerships have been formed to promote reproductive health and health rights, and new evidence is emerging on hitherto neglected issues such as the sexual and reproductive health needs of young people, sexual coercion and optimal care after abortion. In many of these areas WHO research and normative guidance have been important. But much remains to be done. The concept of comprehensive reproductive health care is still inadequately understood and applied. Debate continues about the content of reproductive health services, the involvement of men in reproductive health, the provision of information and services to adolescents, issues surrounding unsafe abortion and its prevention, and challenges attendant on health sector reforms. Good sexual and reproductive health services are urgently needed. Since HIV is predominantly spread through sexual intercourse, services including appropriate information aimed at sexually active people can prevent new infections. They can also playa critical role in the fight against poverty. As the Commission on Macroeconomics and Health states: "Investments in reproductive health, including family planning and access to contraceptives, are crucial accompaniments to investments in disease control." To ensure that by 2015 the widest achievable range of safe and effective reproductive health services is being provided across the health system and integrated into primary health care. To contribute, through research and support for elaboration of policies and programmes, to a reduction in morbidity and mortality related to sexual and reproductive health and to implementation of accessible, equitable, gender-sensitive and high-quality reproductive health services in countries.

GOAL

WHO OBJECTIVE(S)

Indicators • • Number of completed studies of causes, determinants, prevention and management of sexual and reproductive morbidity and mortality Number of countries provided with technical support to assess the scope and quality of their current reproductive health care services and identify possible approaches to improving services, including integration of HIV prevention and care activities

44

RESEARCH AND PROGRAMME DEVELOPMENT IN REPRODUCTIVE HEALTH

STRATEGIC APPROACHES

Stimulation of design and testing of new technologies, tools and guidelines; setting, validation, monitoring and pursuance of the proper implementation of norms and standards; catalysis of change through provision of policy and technical support

EXPECTED RESULTS

INDICATORS

•

New knowledge available on high-priority issues in sexual and reproductive health throughout the lifecycle, including cross-cutting themes such as the role of men, integration ofHIV/AIDS prevention and care in reproductive health services, adolescent sexual and reproductive health, and the impact of health care reforms on reproductive health care

•

Number of completed studies of selected priority issues in reproductive health with appropriate dissemination of results Number of systematic reviews and consultations on best practices, policies and standards of care Proportion of national institutions and organizations that received support to build research capability that are generating new information relevant to local, regional or national needs Number of countries completing operational research studies to evaluate new or improved approaches to provision of high-quality reproductive health care (including client perspectives on and satisfaction with the new services being provided) Proportion of above-mentioned countries that draw up plans for scaling-up interventions Availability of tested materials to support national efforts to improve maternal and newborn health within the framework of safe motherhood and making pregnancy safer initiatives Number of countries receiving technical support for the adaptation of evidence-based standards for essential care practice in reproductive health Number of countries receiving support to prepare and implement plans to strengthen access to, and availability of, high-quality reproductive health care Proportion of such countries that adopt policies and programmes to strengthen reproductive health care Number of countries receiving support to examine their existing national laws, regulations and policies relating to reproductive health and rights Number of countries receiving support to incorporate rights-based approaches in reproductive health policies, programmes or services

• •

•

Cost-effective interventions that promote high-quality reproductive health care that is client-centred and gender-sensitive designed, applied and validated through operational research

•

• • Appropriate set of evidence-based standards and related policy, technical and managerial guidelines for high-quality reproductive health care defined, validated and disseminated

•

• •

Adequate policy and technical support provided to selected countries for the implementation of comprehensive plans for strengthening access to, and availability of, high-quality reproductive health care, human resources, and monitoring and evaluation Technical support provided to selected countries to examine their national laws, regulations and policies for conformity with articles of existing legal

• • • •

•

instruments, conventions, and international consensus documents related to sexual and reproductive health and rights

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 11205 9162 42% 20% 38% Other sources 61000 59500 15% 5% 80% All funds

72 205 .

68662 19% 7% 74%

45

PROPOSED PROGRAMME BUDGET 2004-2005

~KINGPREGNANCYSAFER ISSUES AND CHALLENGES Each year around 210 million women become pregnant; over 20 million women experience iIIhealth as a result, and for some the suffering is permanent. The lives of eight million women are threatened, and according to latest statistics, close to 500 000 women die each year as a result of causes related to pregnancy and childbirth. Women from the world's least developed countries are at least 150 times more likely to die from pregnancy-related causes than women in the more developed countries. Pregnant women who are refugees or displaced by civil conflict and strife are also particularly vulnerable as they are often homeless and do not have access to good-quality health care. In addition, 3.8 million babies are stillborn and over three million newborn babies die within the first week of life, mostly in developing countries and countries in transition. Furthermore, communicable diseases such as malaria, tuberculosis and HIV/ AIDS pose threats to the health of mothers. Most of this suffering is preventable, and cost-effective interventions are known, affordable and can be made available even when resources for health care are seriously limited. Trends in maternal mortality ratios show that only a few countries, mostly those where the ratios are already relatively low, have been able to sustain reduced levels between 1990 and 2000. Some progress has been made, however, in increasing the use of skilled attendants at delivery in most parts of the world, with an average annual increase of 1.7% in 1989-1999, except for sub-Saharan Africa where, despite progress in a few countries, in general their use has stagnated or, in several countries, declined. In July 1999, the United Nations General Assembly, reviewing five years of implementation of the Programme of Action of the International Conference on Population and Development, urged WHO to fulfil its leadership role within the United Nations system by collaborating with countries to reduce the risks associated with pregnancy. The high priority of this objective was re-emphasized in the United Nations Millennium Declaration in 2000, with its development goal of reducing maternal deaths, and by the WHO Commission on Macroeconomics and Health, which declared "the control of communicable diseases and improved maternal and child health remain the highest public health priorities". The Making pregnancy safer initiative, WHO's strengthened contribution to the global safe motherhood movement, emphasizes the importance of improving health systems in order to gain long-term, sustainable and affordable improvements in the health and well-being of pregnant women and their infants. Reducing maternal and newborn deaths and illness implies policy changes and interventions in the health care system and other relevant sectors. Interventions need to strengthen the role of the family, including men, and to include the community. These actions will ensure fewer unwanted pregnancies, their appropriate management, and that women have access to and use the care they need when they need it. The challenges remain how to accelerate the implementation of appropriate interventions to make maternal health and newborn services available and accessible to the needy; to reorient the health care system from outdated routines to good-quality, evidence-based practices; to reduce substantially perinatal mortality; and to engage other sectors in achieving common goals in maternal and newborn health, thereby contributing to the alleviation of poverty.

GOAL

To reduce, by 2015, the maternal mortality ratio by 75% of its 1990 level and contribute to lowering infant mortality through reduction of neonatal deaths.

WHO OBJECTIVE(S)

To provide support to Member States and the international community in elaborating and implementing cost-effective interventions to make pregnancy safer.

Indicator • Number of countries receiving technical and policy support to review or fonnulate comprehensive policies and programmes for reduction of maternal and perinatal mortality and morbidity

46

MAKING PREGNANCY SAFER

STRATEGIC APPROACHES

Articulation of consistent, ethical and evidence-based policy and advocacy positions; negotiation and maintenance of national and global collaboration and partnerships; provision of technical and policy support to build sustainable national capabilities

EXPECTED RESULTS • Technical and policy support provided to countries for fonnulating and implementing cost-effective gender-sensitive national plans of action for making pregnancy safer that include infonnation and services for evidence-based, good-quality maternal and newborn care and which respect women's rights Appropriate evidence-based guidelines adapted and introduced in national policies, strategies, programmes and standards for maternal and newborn care, family planning and post-abortion care (where abortion is not illegal) Adequate support provided to countries for strengthening health systems interventions and management so that infonnation and services for maternal and newborn health are made available, accessible and acceptable to all, especially to those from poor and disadvantaged communities •

INDICATORS Proportion of countries receiving technical and policy support that develop adequate plans of action for maternal and newborn health

•

•

Proportion of countries receiving support that adapt and introduce standards, guidelines and/or tools recommended by WHO

•

•

Number of countries that have received adequate support to design, implement and evaluate evidencebased health systems interventions to improve maternal and newborn heal th

RESOURCES (US$ thousand)

! I ,

Regular budget TOTAL 2002-2003 TOTAL 2004-2005 12572

Other sources 31500 26000 45% 10% 45%

All funds 44072 38507 47% 19% 34%

\2 507 country 52% 38% 10%

!

level at which estimated percentage spent

regional global

47

PROPOSED PROGRAMME BUDGET 2004-2005

Activities under "Making pregnancy safer and children's health", an Organization-wide priority, are carried out in two areas of work: Child and adolescent health and Making pregnancy safer. The nature of support to Making pregnancy safer from other areas of work is shown in the following table.

48

MAKING PREGNANCY SAFER

Areas of work Communicable disease surveillance

Nature of contribution Surveillance of communicable diseases related to pregnancy and childbirth

Communicable disease prevention, eradication, Interventions to prevent communicable diseases during pregnancy and control Tuberculosis Malaria Tobacco Health promotion Interventions to prevent tuberculosis complicating pregnancy and childbirth Strategies and interventions for reducing malaria during pregnancy Strategies to prevent or reduce tobacco use during pregnancy Promotion of behaviour in the community that fosters appropriate responses to pregnant women and their newborns, including timely access to care Strategies for prevention of violence during pregnancy Strategies and technical support for breastfeeding, newborn care, monitoring and evaluation, pregnancy care for adolescents Research on and support to programme development for maternal and perinatal health Strategies and support to meet gender concerns and health needs of women throughout their life span Strategies to promote protection against HIV and to prevent motherto-child transmission Interventions to reduce malnutrition and to improve nutrition in vulnerable pregnant and lactating women, and infants Support to safe motherhood in emergencies Improved access to good-quality essential drugs for pregnancy and childbirth, including those for prevention of mother-to-child transmission of HIV and malaria prophylaxis Strategies to prevent maternal and neonatal tetanus Improved availability, safety and use of blood-transfusion services, injections, diagnostics and clinical services for essential obstetric care Strategies and tools to improve quality and accessibility of maternal health services

Injuries and disabilities Child and adolescent health Research and programme development in reproductive health Women's health HIV/AIDS Nutrition Emergency preparedness and response Essential medicines: access, quality and rational use Immunization and vaccines development Blood safety and clinical technology

Organization of health services

49

PROPOSED PROGRAMME BUDGET 2004-2005

WOMEN'S HEALTH ISSUES AND CHALLENGES

Numerous resolutions of the General Assembly and other bodies of the United Nations system as well as the Beijing Platform for Action have called for acceleration of efforts to achieve equity and equality between women and men, effective integration of gender into policies and programmes in the United Nations system, and greater attention to broadening the global agenda of women's health throughout the life course. None the less, despite these efforts and other calls for action on women's health in resolutions of the Health Assembly, general levels of health remain unacceptable for many women in many parts of the world. Much remains to be learned and more action is needed to confront the specific health risks and vulnerabilities and meet the health needs of women throughout the life span. Differences in the roles and responsibilities of men and women and the unequal power between them, discrimination and violation of human rights are all important factors influencing health and the burden of ill-health for women and men. Gender factors can also interact with biological characteristics and other social and economic variables, leading to different and sometimes inequitable patterns of exposure to health risk, differential access to and utilization of health information, care and services, and health outcomes. Accordingly, and in line with its long-standing concern with health equity, WHO adopted in 2002 a policy calling for all its departments and programmes to work towards integration of gender perspectives into their work in order to improve health outcomes for women and men. Since then, WHO has made some progress in introducing gender considerations in research, policies and programmes. Attention has been given to the collection and dissemination of evidence demonstrating the impact of gender on health; the creation of methods and materials for gender analysis and gender-responsive programming, monitoring and evaluation; advocacy; and the provision of support to regional and country programmes in these areas. However, work is needed to translate the growing understanding of the impact of these issues into more effective, gender-responsive health programmes. Gender influences the lives of both men and women, but it often imposes particularly heavy burdens on women, limiting decision-making, mobility, and access to and control of resources throughout their lives, with consequent effects on health and well-being. Consideration of gender concerns, therefore, is particularly important for women's health. WHO will continue to give special attention to work on diseases of global importance to women, health issues needing special attention such as smoking and gender-based violence, and to effective monitoring of women's health. To improve the health of women of all ages and contribute to achievement of health equity.

GOAL

WHO OBJECTIVE(S)

To support Member States in the development of policies, strategies and interventions that effectively address high-priority and neglected health issues of women throughout the life span, and in the creation of a body of evidence on the impact of gender on health and of tools, norms and standards to improve gender responsiveness of health interventions and promote gender equity in health.

Indicator • Increase in financial and human resources devoted to issues of women's health and incorporation of gender considerations throughout the work of WHO

STRATEGIC APPROACHES

Enhancement of knowledge of neglected subjects important to the health and well-being of women and of ways in which gender affects different aspects of women's and men's health; development, testing and dissemination of tools, guidelines, norms and standards with the aim of strengthening policy and health-sector response to selected issues; collaboration and consultation with other technical departments, regional and country offices and other partners to assure consistency in work on gender and health and on the health of women

50

WOMEN'S HEALTH

EXPECTED RESULTS • Standards, training modules, information tools and guidelines on specific women's health issues updated or produced and used to support regions and countries in the formulation and implementation of policies and programmes and in monitoring progress •

INDICATORS Number of relevant documents (standards, training modules, information tools and guidelines) produced or updated Proportion of regions and targeted countries having used or adapted those instruments in developing or implementing policies or programmes Number of countries systematically monitoring women's health Number ofprojects initiated, providing evidence on the impact of gender on various aspects of health Number of products developed and activities undertaken to disseminate results to regions and countries and to professional and general audiences Number of tools for gender analysis and centring gender considerations in technical work produced, tested and being used Proportion of WHO's high-priority programmes using the tools developed Numbers of technical programmes, regions and countries launching initiatives incorporating gender perspectives in their work on a regular basis Number of reports, leaflets and other materials produced at regional. country and global levels documenting those initiatives Number of workshops and other meetings to exchange findings with different audiences

•

•

•

Evidence-based reviews and collection of new data on the impact of gender on health and on specific women's health issues carried out by WHO, with information so generated disseminated and applied in advocacy and policy Tools and guidelines developed and processes in place to facilitate incorporation of gender considerations in the technical work of WHO

• •

•

•

•

•

New initiatives incorporating gender perspectives in technical programmes undertaken, with results and analyses documented and disseminated

•

•

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country I

Other sources 12000 11 000 20% 15% 65%

All funds 16847 IS 132 21% 21% 58%

4847 4132 24% 38% 38%

level at which estimated percentage spent

regional global

I

51

PROPOSED PROGRAMME BUDGET 2004-2005

HIV/AIDS ISSUES AND CHALLENGES Over 20 years after the first clinical cases were reported, HIV /AlDS is the leading cause of death in sub-Saharan Africa and the fourth worldwide. By 2002, an estimated 60 million people had been infected with HIV, 95% of them in developing countries, and over 20 million people have died. Africa remains hardest hit, with 2.3 million AIDS deaths in 2001 and prevalence rates exceeding 30% in several parts of southern Africa. Eastern Europe, however, and especially the Russian Federation, is experiencing the fastest growing epidemic, accompanied by high rates of sexually transmitted infections and injecting drug use among young people. In Asia and the Pacific, where over seven million people have already been infected, relatively low national HIV prevalence rates mask immature localized epidemics, which have the potential to expand horrifically in the world's most populous countries. Even in high-income countries, rising infection rates suggest that advances in treatment and care have not been matched consistently by progress in prevention. The increasingly apparent overlap between commercial sex work and injecting drug use is fuelling transmission of HI V in some parts of the world. In many developing countries, most new infections occur in young adults, especially young women. About one-third of those currently living with HIV/AIDS are aged 15-24 years; most do not know they are infected. Many millions more know nothing or too little about HIV to protect themselves. Because HIV continues to affect disproportionately the most vulnerable in society and perpetuates a cycle of poverty that is crippling national and regional development, improved epidemiological and behavioural surveillance, together with approaches that promote human rights, contribute to gender equity, and strengthen community capabilities, remain essential. Interventions directed at vulnerable populations and those with higher-risk behaviour, as well as at the broader population, can lower infection rates in specific groups and reduce the risk of extensive spread ofHIV. Examples have been seen, for example among injecting drug users in central Europe and among men with high-risk behaviour in Cambodia. In Uganda, HIV prevalence in pregnant women has fallen eight years in a row, illustrating how sustained political commitment, community mobilization, strategic partnerships with clearly-identified roles and adequate resources can bring even a rampant HIV/AIDS epidemic under control. The world has recently shown new resolve to meet the challenge of expanding the scale and reach of successful approaches, and to develop a vaccine against HIV. The United Nations Millennium Summit in 2000 and the General Assembly special session on HIV/AIDS in 2001 set new targets in national and international accountability in the fight against the epidemic and its drivers. The creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria and decisions by the pharmaceutical industry to lower drug prices offer the first real hopes that health systems can be strengthened to expand greatly proven prevention interventions against HIV and sexually transmitted infections and care for people infected or with AIDS, including voluntary counselling and testing, treatment of opportunistic infections and highly active antiretroviral therapy. To have halted and begun to reverse the spread ofHIV/AIDS by 2015. (In line with corresponding Millenium Development Goal.) To support the implementation, integration and intensification of essential health system interventions against HIV/AIDS in countries and communities.

GoAL

WHO OBJECTIVE(S)

Indica/or • Increase in the number of targeted countries demonstrating competence and capability across the health system to tackle HIV/AIDS.

STRATEGIC APPROACHES

Focus on important health sector interventions in prevention, treatment and care; collection and dissemination of evidence to support interventions and stimulation of the conduct and application of research; provision to countries of evidence-based tools and normative guidance

52

HIV/AIDS

EXPECTED RESULTS • Nonnative guidance developed and provided to countries to enhance essential HIV prevention, treatment, care and support services and interventions •

INDICATORS Number of targeted countries using and/or adapting WHO tools on management ofHIV and related conditions including tuberculosis and sexually transmitted infections, and on the procurement, manufacture, regulation and appropriate use of HIVrelated drugs and diagnostics Number of targeted countries that conduct surveillance studies in identified priority popUlations, including surveillance of behaviour and antiretroviral resistance patterns Number of evidence-based reviews to support strategies Number of targeted countries contributing to global research agenda and setting priorities through WHO mechanisms Number of collaborative research activities and projects with private sector Number of strategic collaborations and partnerships involving WHO, nongovernmental organizations and the private sector

•

More comprehensive and reliable national and global mechanisms for HIV surveillance, monitoring and evaluation fonnulated or in place

•

•

•

Dynamic and relevant global agenda and innovative partnerships stimulated for research, including vaccine and microbicide development and operations research

•

•

•

Role of WHO in HIV/AIDS advocacy and strategic planning enhanced through promotion and development of multisectoral partnerships and implementation of efficient infonnation systems Countries supported to build national capabilities and technical expertise for improving health system responses to mvI AIDS and sexually transmitted infections, including planning, resource allocation, delivery and evaluation of services and interventions

•

•

•

Number of targeted countries building health-sector competences in HIV/AIDS, including uptake of WHO nonnative tools and resources Number of countries accessing Global Fund to Fight AIDS, Tuberculosis and Malaria and/or other donor support with WHO technical assistance

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 16325 17930 34% 37% 29% Other sources 120000 142500 50% 30% 20% All funds 136325 160430 48% 31% 21%

53

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, mY/AIDs is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

54

HIV/AIDS

Areas of work Communicable disease prevention, eradication and control Mental health and substance abuse Child and adolescent health Research and programme development in reproductive health Women's health Essential medicines: access, quality and rational use

Nature of contribution Formulation and implementation of the HIV/tuberculosis strategy: review of evidence on disease interactions Partnerships, strategies and research on HIVIAIDS, harm reduction and substance use Capacity building in reproductive health needs of adolescents; increase in safer sex Integration with family planning; guides on HIV management in a maternity setting, including use of microbicides and condoms Centrally positioning gender issues in national HIV strategies and programmes Integration of AIDS drugs into WHO essential medicines list; collection of data on sources and antiretroviral drug prices; prequalification of antiretroviral drug manufacturers; procurement, manufacture, regulation and appropriate use of HIV -related drugs and diagnostics Innovation in HIVI AIDS vaccine development and preparedness Incorporating a human rights perspective into health sector responses to HIVI AIDS

Immunization and vaccine development Director-General, Regional Directors and independent functions

55

PROPOSED PROGRAMME BUDGET 2004-2005

SUSTAINABLE DEVELOPMENT ISSUES AND CHALLENGES Investing in health, particularly that of poor people, is central to the achievement of the Millennium Development Goals. It is becoming evident that good health status - an important goal in its own right - is central to creating and sustaining the capabilities that poor people need to escape from poverty. Recent international conferences set the context for the work in this biennium. The United Nations Millennium Summit (New York, 2000) provided a framework for what is to be achieved. The Third United Nations Conference on the Least Developed Countries (Brussels, 2001) highlighted the needs of the poorest States. The Fourth WTO Ministerial Conference (Doha, 2001) focused on the measures needed to ensure that people in the developing world can compete on equal terms in the global market. The International Conference on Financing for Development (Monterrey, Mexico, 2002) examined how to mobilize the resources needed to achieve the agreed development goals. The World Summit on Sustainable Development (Johannesburg, South Africa, 2002) looked at the concrete actions needed to enable poor people to improve their lives in ways that will not compromise the ability of future generations to meet their needs. Health was high on the agenda in all these processes. The WHO Commission on Macroeconomics and Health, which reported in 2001, consolidated the evidence for greater investment in health, estimated the cost of achieving the health-related Millennium Development Goals, and set out an agenda for action at global and national levels. The challenge for WHO is to find practical ways of translating intentions into actions that positively influence people's lives. In countries this will mean building the capacity to take advantage of new funding opportunities through debt relief, poverty-reduction strategies and the Global Fund to Fight AIDS, Tuberculosis and Malaria, while ensuring national ownership and greater coherence between initiatives. Globally, it will mean developing policies and incentives that enable more effective country action: for example, through ensuring the provision of needed global public goods. Within WHO, it means paying greater attention to how health cross-cuts poverty, trade and human rightsand to the fourth strategic direction of the WHO corporate strategy.

GOAL

To maximize the contribution that better health makes to reducing poverty and economic development - and thus to achieving the Millennium Development Goal of halving the proportion of people living in absolute poverty by 2015.

WHO OBJECfIVE(S)

To ensure that health has a central role in reducing poverty internationally and nationally and development policies and practices (including their economic, social, environmental and trade components).

Indicators • • STRATEGIC APPROACHES Increase in allocations to health both in absolute terms and as a proportion of financing for development assistance Overall increase in national allocations to health in developing countries

Provision of support to governments, civil society and development cooperation agencies in obtaining the knowledge, skills and capabilities to prepare, implement and monitor the health components of policies and strategies to reduce poverty and on development, in areas including globalization, cross-sectoral action and human rights, in particular: to act on the recommendations of the Commission on Macroeconomics and Health, particularly to bring together ministries of finance and other sectors to formulate and strengthen national strategies for health in the context of poverty reduction; to focus on development cooperation mechanisms, notably poverty-reduction strategies, sector-wide approaches and the Global Fund to Fight AIDS, Tuberculosis and Malaria; to build expertise and capability to enhance the links between health and the economic, social and environmental factors in sustainable development; to make policies coherent relating to international trade and public health in the context of globalization; to adopt a human rights approach to health development with heightened attention to the needs and rights ofvulnerable groups including indigenous people

56

SUSTAINABLE DEVELOPMENT

EXPECTED RESULTS • Enhanced capability in WHO at country, regional and global levels, and in Member States, especially the least developed countries. to shape the health content of national poverty-reduction strategies, including poverty-reduction strategy papers Programmes of capacity building implemented in Member States to protect and promote public health in the context of multilateral trade agreements • •

INDICATORS Independent evaluation and approval of health contenl of poverty-reduction strategy papers Application of training and communication tools, mechanisms and programmes in building capability of WHO and national and development agency partners Analysis and preparation of strategic and policy responses to the public health impacts of accession to WTO and multilateral trade agreements by selected countries in each WHO region Creation and updating of WHO web-based databases on evidence and indicators of links between globalization and health Application of health impact assessment tools in selected countries Number of WHO staff at counlry. regional and global levels trained in the application of cross-sectoral analysis, planning and decision-making processes in one or more areas of collaboration

•

•

•

•

In collaboration with partner agencies, including organizations in the United Nations system, knowledge and good practice in health gains from intersectoral policy and practice shared with Member States in all WHO regions; areas of collaboration covered: employment, education, macroeconomic policy, environment, transport, nutrition, food security and housing Systematic monitoring and assessment by WHO of process, impact and health outcomes of povertyreduction strategies, including progress towards Millennium Development Goals, established in all WHO regions Advantage taken of new funding opportunities for health WHO health and human-rights strategy developed and capability created in all WHO regions to provide technical support to Member States to integrate human rights in national health and poverty-reduction strategies

• •

•

•

•

•

Identifiable WHO influence on development and implementation of health and poverty-reduction strategies of partner institutions Improved quality of grant applications 10 Global Fund to Fight AIDS, Tuberculosis and Malaria due to WHO technical support to countries

•

• •

Inclusion of human rights in health and povertyreduction strategies and plans in selected countries Take up of WHO technical advice on health in humanrights assessments in selected countries in all WHO regions

RESOURCES (US$ thousand) Regular budget TOT AL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 15824 14787 49% 29% 22% Other sources 9500 11000 50% 20% 30% All funds 25324 25787 50% 25% 25%

57

PROPOSED PROGRAMME BUDGET 2004-2005

NUTRITION ISSUES AND CHALLENGES

Hunger and malnutrition are among the most devastating problems facing the world's needy, and are especially compromising for the health of the poorest nations. Millions are denied access to their fundamental right to adequate food and nutrition, and to freedom from malnutrition in its many forms. Food insecurity threatens 800 million people, many of whom depend on food aid for their survival. There has been some measurable success in reducing the global burden of malnutrition over the past decade, with a slow but continuous fall in the prevalence of underweight malnutrition, iodine deficiency disorders, and vitamin A deficiency in children. Nevertheless, malnutrition still kills, maims, cripples and blinds on a massive scale worldwide; it is both a major cause and effect - and an important indicator - of poverty and underdevelopment. Some 30 million low-birth-weight babies - 23.8% of the global total- are born every year, reflecting intrauterine growth retardation; fully 60% of the 10.9 million deaths among under-five children each year in developing countries are associated with underweight malnutrition; 161 million preschool children suffer chronic malnutrition. Iodine deficiency is the greatest single preventable cause of brain damage and mental retardation worldwide; vitamin A deficiency remains the single greatest preventable cause of childhood blindness, and significantly increases morbidity and mortality; and immense problems of iron and folate deficiency, and resulting anaemia, affect more than 60% of women of childbearing age and millions of young children in developing countries, further increasing morbidity, mortality and developmental retardation in these already susceptible populations. At the same time, in both industrialized and rapidly industrializing countries, obesity is emerging as a widespread condition among children, adolescents and adults, especially as a result of unhealthy diets and sedentary lifestyles. More than half the adult population is affected in some countries, increasing death rates from heart disease, hypertension, stroke, diabetes, some cancers and other chronic degenerative diseases. Many countries facing this nutritional transition of changing diets and lifestyles are weighed down by a dual burden of over- and undernutrition in their populations. WHO's fundamental role in tackling these vast nutritional challenges is to work with, and strengthen the ability of, Member States both to identifY and reduce all forms of malnutrition, and to promote healthy nutrition and lifestyles. It calls for focusing WHO's combined programmatic and normative strengths on these challenges through vigorous outreach in regions and countries, and strong collaborative action with the international community.

GOAL

To prevent, to reduce and, ultimately, to eliminate malnutrition in all its forms; to reduce other dietrelated illnesses; and to promote well-being through healthy diet, lifestyle and nutrition. To provide Member States and the international community with authoritative technical guidance and collaborative support for improving their effectiveness in identifYing, preventing, monitoring and reducing malnutrition and diet-related health problems, and in promoting healthy diet and nutrition.

WHO OBJECTIVE(S)

Indicators • Number, nature, and scope of authoritative technical guidance drafted and disseminated for prevention, management and monitoring of malnutrition and promotion of healthy diet and nutrition Number of Member States and international organizations that have collaborated with WHO in combating malnutrition and promoting healthy diet and nutrition

•

STRATEGIC APPROACHES

Promotion of evidence-based action to tackle malnutrition across the life-course including maternal, fetal, childhood and adolescent malnutrition; growth monitoring and nutrition surveillance; infant and young child feeding; action to combat iodine, vitamin A, iron, and other micronutrient deficiencies; healthy nutrition and lifestyles and reduction of obesity and diet-related disease; national nutrition policies and programmes; and adequate and appropriate food and nutrition in emergencies

58

NUTRITION

EXPECTED RESULTS • Appropriate strategies formulated, and support provided. for sustainable reduction of malnutrition in its different forms; for improved infant and young child feeding; and for promotion of healthy dietary intakes, particularly in collaboration with FAO and through the Codex Alimentarius Commission Global, regional and country nutrition surveillance strengthened through development and operation of WHO's nutrition databases and associated nutrition surveillance activities Adequate support provided to selected Member States for strengthening and implementing sustainable national nutrition plans, policies and programmes •

INDICATORS Number and proportion of targeted countries and regions that have developed strategies and programmes aimed at reducing major forms of malnutrition, and that are promoting appropriate dietary intakes

•

•

Number of countries that have nationally representative surveillance data on major forms of malnutrition, and the extent of the national and regional coverage of global nutrition data banks Number and proportion (regional and global) of targeted countries receiving technical support that succeed in strengthening their national nutrition plans, policies and programmes Number and nature of nutrition standards, guidelines and training manuals produced and disseminated to countries and the international community

•

•

•

Nutritional nonns, including references. requirements, guidelines, training manuals and criteria for assessing, preventing, managing and reducing the major global forms of malnutrition (under- and over-nutrition) and promoting healthy nutrition, produced and disseminated to countries and the international community Technical support provided to countries for meeting the needs of nutritionally vulnerable, food-insecure groups, particularly through collaboration with the World Food Programme and the food-assisted emergency and development projects of other international agencies

•

•

•

Adequacy of WHO's response to requests for technical support - from the World Food Programme, other international organizations and high-priority countries for nutritional emergency and food-assisted development work

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 9424 9643 32% 35% 33% Other sources 7500 16000 55% 20% 25% All funds 16924 25643 46% 26% 28%

59

PROPOSED PROGRAMME BUDGET 2004-2005

HEALTH AND ENVIRONMENT ISSUES AND CHALLENGES Environmental conditions are a major direct and indirect determinant of human health. Initial estimates indicate that one-quarter to one-third of the global burden of disease is attributable to environmental risk factors. In developing societies, modern forms of exposure to urban, industrial and agrochemical pollution add to the health burden caused by traditional household and community-based risks. The vicious cycle, intrinsically linking poverty, environmental degradation and ill-health, needs to be broken. Safe and sufficient drinking-water is still not accessible to 1.1 thousand million people, and 2.4 thousand million lack adequate sanitation. Reduced availability and degraded quality of water caused by population growth and exploitation of natural resources lead to 3.4 million deaths every year, mostly among poor people and children. Unchecked urban growth has its price in terms of environmental health: disposal of municipal and hazardous waste, particularly health care waste, remains a problem in many regions. Up to 60% of the global burden of acute respiratory infection is associated with indoor air pollution and other environmental factors. Use of biomass fuel for cooking and heating is estimated to be responsible for 1.9 million deaths every year. Occupational diseases and injuries, grossly underreported, are responsible for more than one million deaths annually; health care workers, miners and manufacturing workers are at highest risk. Working children - an estimated 250 million force mostly in informal employment - is the population group that suffers the most. Increased use of chemicals, their mismanagement and inappropriate disposal practices lead to adverse effects on health, causing more than six million poisonings annually, particularly from pesticides. Climate change and higher levels of ultraviolet radiation could have a significant impact on current health trends for vector-borne diseases; a change in precipitation patterns may increase frequency and magnitude of episodic forest fires, causing a dramatic increase in respiratory ailments. Accidental releases or deliberate use of biological and chemical agents, or radioactive material require effective prevention, surveillance and response systems to contain or mitigate harmful health outcomes. Essential health services and basic sanitary installations are often disrupted or devastated as a consequence of conflict or environmental disasters. Political, legislative and institutional barriers to improving environmental conditions are numerous and the human resources with adequate specialization in risk assessment and management are not yet available in many countries. National and local health authorities are thus often unable to collaborate with other socioeconomic sectors where the health-protective measures need to be taken. Agenda 21, adopted at the United Nations Conference on Environment and Development (Rio de Janeiro, 1992), together with the Millennium Development Goals, provide the necessary international policy framework for action.

GoAL

To achieve safe, sustainable and health-enhancing human environments, protected from biological, chemical and physical hazards, and secure from the effects of global and local environmental threats.

WHO OBJECTIVE(S)

To facilitate incorporation of effective health dimensions into regional and global policies affecting health and environment, and into national pOlicies and action plans for environment and health, including legal and regulatory frameworks governing management of the human environment.

Indicators • • Enhanced incorporation of environmental health aspects into international and national policy declarations and development programmes Increased use of WHO policy guidance by sectors other than health with responsibility for environmental management and socioeconomic development

60

HEALTH AND ENVIRONMENT

STRATEGIC APPROACHES

Contribution to diminishing the burden of excess mortality and disability by reducing risk factors to human health that arise from environmental causes, and by promoting environmental considerations within the health sector and interventions for health protection in other socioeconomic sectors

EXPECTED RESULTS • Adequate support provided to the health sector for building capacity in targeted institutions of highpriority countries in order to manage environment and health information and implement action plans Appropriate technology and logistic support provided for prevention, preparedness and response to chemical incidents and poisonings, radiation accidents and other technological or environmental emergencies Global, regional and country-level initiatives launched for addressing environmental health concerns of vulnerable and high-risk population groups, particularly children, workers and the urban poor Science-based health impact assessments undertaken of socioeconomic and technological developments, and of global change in climate, biodiversity, water resources, and disease-vector habitats and other ecosystems Occupational and environmental health risks assessed and communicated through national and international partnerships, alliances and networks of centres of excellence Evidence-based normative guidelines in key environmental health areas (air and water quality, workplace hazards, radiation protection) drawn up for the purpose of framing policy and setting national and international standards Good-practice tools and guidelines produced on costeffective interventions for reduction of health risk from exposure to harmful environmental agents, workplace hazards, new technological developments, and global change in climate •

INDICATORS Proportion of institutions in targeted countries in each region receiving support to exchange national or local information and to implement health and environment action plans Efficient response from WHO offices to requests for technical guidance and cooperation on preparedness and response to natural or manmade environmental emergencies Efficient response from WHO offices to the needs of identified target groups and to requests from national health authorities in high-priority countries

•

•

•

•

•

•

Availability of comprehensive assessment methodology; extent to which global health and environmental issues are addressed and the related environmental burden of disease quantified

•

•

Increase in number of intergovernmental bodies, nongovernmental organizations, professional associations and scientific institutions collaborating with WHO on health and environment issues Number of national and international legal and regulatory instruments making use of WHO environmental health criteria and guidelines

•

•

•

•

Access of national and local health authorities and environmental agencies to WHO guidelines in both electronic and printed format for the planning and implementation of health and environment protection

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 .

Other sources 28000 39500 30% 40% 30%

All funds 68792 77 552 37% 35% 28%

40792 38052 country 44% 30% 26%

level at which estimated percentage spent

regional global

61

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Health and environment is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

62

HEALTH AND ENVIRONMENT

Areas of work Communicable disease surveillance Surveillance, prevention and management of noncommunicable diseases Health promotion Mental health and substance abuse Child and adolescent health

Nature of contribution Surveillance of waterborne diseases; alert and response to chemical incidents; response to biological and chemical terrorism Assessment of carcinogenic risk from chemical or radiological environmental exposure Environmental health settings, including the Healthy Schools programme Occupational health problems due to stress and substance abuse at the workplace Integration of environmental risk factors into child health programmes; prevention and control of acute respiratory infections due to indoor air pollution; reduction of health impacts of child labour Incorporation of environmental conditions into development initiatives; breaking the cycle of poverty, environmental degradation and ill-health Assessment offood additives and pesticide residues within Codex Alimentarius; microbiological risk-assessment for food and water Response to and preparedness for technological and nuclear emergencies and disasters; basic sanitary measures in environmental disasters Handling and disposal of health care wastes Comprehensive assessment of environmental risk factors incorporated into estimates of global burden of disease; development of methodology for assuring the cost-effectiveness of environmental interventions Research methods for assessing risk of environmental hazards; capacity building and network among research institutions and WHO collaborating centres

Sustainable development

Food safety Emergency preparedness

Blood safety and clinical technology Evidence for health policy

Research policy and promotion

63

PROPOSED PROGRAMME BUDGET 2004-2005

FOOD SAFETY ISSUES AND CHALLENGES Foodborne diseases take a major toll on health worldwide. Thousands of millions of people fall ill and many suffer from serious complications or die as a result of eating unsafe food. Food and waterborne diarrhoeal diseases, for example, are leading causes of illness and kill an estimated 2.1 million people annually, most of whom are children already suffering from malnutrition in developing countries. Up to one-third of the population even in developed countries is affected by microbiological foodborne diseases annually, and foodborne chemical hazards still cause significant public health problems. In many countries the incidence of certain foodborne diseases has increased significantly over the past few decades and some national and international incidents of chemical and microbiological contamination of foods have had a major political impact. However, knowledge of and experience in reducing the burden of foodborne diseases exist and should be extended and applied globally. All WHO regions now have strategies and food safety activities coordinated with WHO's global strategy for food safety. New tools and instruments for risk analysis have been developed, including specifically assessment of microbiological and biotechnological risk. A major review ofthe Codex Alimentarius has been initiated. Structures have been set up to provide support to developing countries so that they can participate in standard setting and implementation of standards. A global forum for food safety regulators has been launched, and new training efforts are under way. Until recently, most food safety regulations were based on inefficient end-product testing. Risk analysis provides a new, preventive basis for regulatory measures from farm to table at both national and international levels. Detailed and accurate knowledge about foodborne diseases and associated contamination in food is a prerequisite for action to lower their incidence. A surveillance system is needed in order to provide reliable data on such diseases and to link them to food contamination, for evidence-based interventions. The risk-based approach being developed by WHO will bring together surveillance and food contamination data. Foodborne diseases impose a substantial burden on health care systems and markedly reduce economic productivity. Food-safety problems in general could affect potential for food exports. In the case of many developing countries, such exports provide the foreign exchange indispensable for economic development. International consensus on the assessment of foods derived from biotechnology needs to be established, and a more holistic approach adopted, taking into consideration safety, nutrition, and other factors. A continuing challenge is to strengthen food safety in the public health functions of countries. The strengthening of technical capability to formulate and implement efficient food laws, and the transfer of knowledge and skills are of paramount importance, especially in developing countries.

GOAL

To reduce the health and social burden of foodborne disease.

WHO OBJECTIVE(S)

To create an environment that enables the health sector, in cooperation with other sectors and partners, effectively and promptly to assess, communicate and manage foodborne risk.

Indicators • • Number of countries presenting or providing data on foodbome diseases and food hazards in order to launch and evaluate risk-based intervention strategies Number of countries initiating risk-reduction strategies

STRATEGIC APPROACHES

Promotion of surveillance offoodbome diseases, better risk assessment, safety of new food-related technologies, public health in Codex Alimentarius, and methodology for risk communication, and international coordination of and capacity building related to food safety in public health

64

FOOD SAFETY

EXPECTED RESULTS • Foodbome disease surveillance and food hazard monitoring programmes strengthened • •

INDICATORS Number of countries that routinely collect and transmit to WHO foodbome disease data Number of countries participating in regional disease reporting or hazard monitoring initiatives Number of risk assessments finalized by FAO and WHO, with national involvement Number of national authorities that have adequate capability to assess risk Number of countries adopting safety assessment and broader evaluation methodology developed by WHO Number of national authorities that have adequate capability in safety assessment methodology Number of countries participating actively in international standard setting through WHO's fund for improving participation in the Codex Alimentarius Percentage of delegations to meetings of Codex Alimentarius Commission from developing countries and/or that include health authorities Number of countries adopting health and safety recommendations of Codex Alimentarius Number of countries that have food-safety curricula and a strategy for communication of foodbome risk Number of countries that have capacity to handle outbreaks offoodbome disease

•

Chemical and microbiological risk assessed internationally; national capacity to assess risk strengthened

• •

•

Methods developed and disseminated for assessing the safety of products of new technology

• •

•

Effective participation of health authorities from all countries in international standard setting and food safety work

•

•

•

•

Risk communication, food-safety education and responsiveness to foodbome disease outbreaks, disasters and emergencies strengthened

• •

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 8009 9346 37% 25% 38% Other sources 5000 11500 35% 35% 30% All funds 13009 20846 36% 30% 34%

65

PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Food safety is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

66

FOOD SAFETY

Areas of work Communicable disease surveillance Making pregnancy safer Sustainable development Nutrition

Nature of contribution Surveillance systems for foodbome diseases; response systems for outbreaks of foodborne disease Tools to avoid specific foodbome risk for pregnant women Assessment of sustainability of food production methods; tools to assess economic impact of health-related trade restrictions Nutritional assessments related to food safety; tools to relate consumption data to exposure; nutritional assessment of foods produced through biotechnology Assessment of environmental risks to foodstuffs and water; tools to characterize food- and water-borne hazards; support for Joint FAOIWHO Expert Committee on Food Additives and Joint F AOIWHO Meeting on Pesticide Residues; assessment of chemical risks Tools to incorporate food safety in educational systems Tools to evaluate effect of food-safety management initiatives Tools for research guidance in assessment of biotechnology

Health and environment

Health promotion Evidence for health policy Research policy and promotion

67

PROPOSED PROGRAMME BUDGET 2004-2005

EMERGENCY PREPAREDNESS AND RESPONSE .

ISSUES AND CHALLENGES

For unacceptable numbers of people, surviving emergencies is the only daily objective. During the past 20 years, natural disasters have killed at least three million people, adversely affecting 800 million more, with 96% of the deaths occurring in developing countries. Since \990, six million people have died as a result of 49 armed conflicts and the global burden of disease attributable to such a cause is expected to increase. Each year, one Member State out of five faces a major crisis. In emergencies, health is on the front line: 65% of epidemics reported to WHO occur in complex emergencies. They result in the worst famines and the highest child and maternal mortality by preventable causes. They also present the highest risk for HIV/AIDS and the greatest obstacles to eradication of poliomyelitis and to control of malaria and tuberculosis. Preparedness makes a difference, for, even in complex emergencies, well known, crucial and cost-effective public health measures can save lives. Resolutions of the Health Assembly (WHA48.2 on emergency and humanitarian action) and all the regional committees reflect the demand of Member States for more input from WHO, which also responds to the decisions of the United Nations General Assembly and Economic and Social Council. A global public health network of expertise and activities for preparedness and response is taking shape, linking WHO, Member States and operational or scientific partners. WHO needs to mobilize better its resources to support countries facing extraordinary circumstances, especially as the risks increase, with, for example, more people living in disaster-prone areas, rapid industrialization and poverty. Terrorist action is also a threat. Public health is perceived as an essential component of the political imperatives of security and national preparedness. At the same time, humanitarian action is becoming more complex, with the need to balance relief and rehabilitation against sustainable development. WHO has to deliver under difficult circumstances, coordinating a growing number of partners and meeting demands for accountability, high quality and provision of accurate and timely information. Disaster prevention and mitigation of their effects are integral to improving and maintaining health. The vital public health measures that can save lives in emergencies provide a solid framework for action in such situations and form the basis of plans for preparedness and reducing the impact of disasters. In this context, WHO promotes building of institutional capabilities and linkages in Member States and partner agencies.

GoAL

To reduce suffering, and immediate and long-term avoidable mortality, morbidity and disability related to emergencies, and to contribute to development. To ensure that Member States and the international community are better equipped to prevent disasters and mitigate their health consequences, balancing relief against sustainable health development through appropriate coordination mechanisms and emergency response.

WHO OBJECTJVE(S)

IndicatoT • Evidence of national disaster-reduction policies and plans that address preparedness and relief taking into account longer-term development perspectives

STRATEGIC APPROACHES

Bringing activities closer to field level by devolving functions and capacities to subregional and subnationallevels; ensuring technical and financial resources, up-to-date information and institutional knowledge

68

EMERGENCY PREPAREDNESS AND RESPONSE

EXPECTED RESULTS • Policies and supporting advocacy promoting healih in emergencies in place •

INDICATORS Number of countries and agencies adopting policies that recognize health as a major factor needing attention in emergency situations Number of tools elaborated and systems, including health information for emergency response, preparedness and vulnerability reduction, in place in Member States Inclusion of disaster mitigation in technical cooperation at country level including in health facilities Amount of external resources mobilized in support of health priorities identified and/or endorsed by WHO Rate of funding coverage of health components in consolidated appeals Number of joint projects and memoranda of understanding with partners for disaster reduction at country level Number of external evaluations recognizing the relevance of WHO technical assistance in emergency work Number of guidelines and technical publications disseminated both electronically and in print

•

Reliable, independent and timely public health information produced and promoted for decision-making and resource allocation at national and international levels Local ability to reduce vulnerability of people and health facilities and to prepare for and act in emergencies institutionalized through provision of effective support to the health sector of Member States Leadership of WHO in coordination of effective international health disaster reduction and response efforts enhanced

•

•

• •

•

• •

•

•

Authoritative and up-to-date scientific information available on best health practices and policies for disaster reduction and humanitarian assistance

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 7978 8072 49% 30% 21% Other sources 43000 64500 75% 15% \0% AIl funds 50978 72572 72% 17% 11%

69

PROPOSED PROGRAMME BUDGET 2004-2005

ESSENTIAL MEDICINES: ACCESS, QUALITY AND RATIONAL USE ISSUES AND

CHALLENGES

In collaboration with WHO and other partners, an increasing number of countries have been strengthening the area of pharmaceuticals, including traditional medicine, by framing, implementing and monitoring of national drug policies, reinforcing drug regulation, and updating national lists of essential medicines. WHO's most significant recent contribution included establishment of a practical framework to improve access to essential medicines, adopted and applied by those concerned; revision of procedures for updating WHO's Model List of Essential Medicines; monitoring and provision of guidance on the impact of international trade agreements as related to access to medicines; promotion of access to high-quality drugs through the quality assessment project for HIV -related medicines; formulation and implementation of a strategy for traditional medicine, focusing on safety and efficacy; and development of a network of national programme officers for pharmaceuticals, especially in African countries. Yet inequities in terms of access to essential medicines remain widespread. It is estimated that onethird of the world's population lacks regular access to essential medicines, more than half in the poorest parts of Africa and Asia, often because of inadequate financing and poor health-care delivery. Poor quality and irrational use of medicines is also a cause of concern. Even when medicines are available, they may be substandard or counterfeit if drug regulation is weak. The use of traditional or complementary and alternative medicine, widespread in developing countries, is becoming increasingly popular in developed countries, and a source of growing expenditure globally. Policy-makers have to tackle the questions of safety, efficacy, preservation, and further development of this type of health care. WHO's medicines strategy has four objectives: to frame and implement policy, to ensure access, to ensure quality, safety and efficacy, and to promote rational use of medicines. Strongest emphasis will be laid on securing access to essential medicines for high-priority health problems, including malaria, tuberculosis, HIVI AIDS and childhood illnesses. Special attention will also be given to developing sustainable drug-financing mechanisms, addressing the health implications of trade issues, strengthening health care services and drug supply management, integrating traditional medicine in health systems, monitoring the impact of national drug policies, promoting effective drug regulation, and devising pragmatic approaches to quality assurance.

GoAL

To ensure equitable access to affordable essential medicines on a sustainable basis, and the efficacy, safety and rational use of medicines; to help to save lives and improve health by closing the gap between the potential of essential medicines and the reality that for millions of people - particularly the poor and disadvantaged - medicines are unavailable, unaffordable, unsafe or improperly used. To work with countries to frame, implement and monitor national drug policies; to increase equitable access to essential medicines, particularly for priority health problems; to ensure the quality, safety and efficacy of medicines through effective drug regulation; to improve rational use of medicines by health professionals and consumers.

WHO OBJECTlVE(S)

Indicators • • Percentage of the global population that has access to essential medicines Number of countries that have a national drug policy, either new or updated within the past 10 years

STRATEGIC APPROACHES

In collaboration with major partners, gathering and dissemination of knowledge based on experience gained in countries, and strengthening of national capability to put it into practice

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ESSENTIAL MEDICINES: ACCESS, QUALITY AND RATIONAL USE

EXPECTED RESULTS • Adequate support provided to countries to frame, implement, and monitor the impact of national drug policies, including monitoring of and advice on the impact of relevant trade agreements and globalization on access to medicines •

INDICATORS Percentage of targeted countries that have plans for implementing national drug policies, either new or updated within the past five years Number of countries with increased capacity to monitor the implication of relevant trade agreements on access to essential medicines Establishment of a global evidence network and monitoring system on safety and efficacy of traditional medicine and complementary and alternative medicine Percentage of targeted countries with laws and regulations on herbal medicine Dissemination of guidelines on public health insurance covering medicines Number of countries with generic substitution allowed in private pharmacies Percentage of targeted countries with public-sector procurement based on a national list of essential medicines Percentage of targeted countries with at least 75% of public-sector procurement subject to competitive tender Number of international nonproprietary (generic) names assigned Number of psychotropic and narcotic substances reviewed for classification for international control Percentage of targeted countries operating a basic drug regulatory system Percentage of targeted countries with basic quality assurance procedures in operation Percentage of targeted countries that have a national list of essential medicines updated within the past five years Percentage of targeted countries that have clinical guidelines updated within the past five years Percentage of targeted countries that have started implementing a public education campaign on rational drug use

•

•

Adequate support provided to countries to promote the safety, efficacy and sound use of traditional medicine and complementary and alternative medicine

•

•

•

Guidance provided on financing the supply, and increasing the affordability, of essential medicines in both the public and private sectors

• •

•

Efficient systems for drug-supply management promoted for both the public and private sectors, in order to ensure continuous availability of medicines and contribute to better access to medicines

•

•

•

Global norms, standards and guidelines for the quality, safety and efficacy of medicines strengthened and promoted

• •

•

Instruments for effective drug regulation and quality assurance systems promoted, in order to strengthen national drug regulatory authorities

• •

•

Guidance on cost-effective and sound use of medicines promoted, with a view to improving rational use of drugs by health professionals

•

•

•

Guidance on promoting patient and consumer awareness of rational drug use drawn up and promoted

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 19434 18006 41% 23% 36% Other sources 31000 34500 30% 20% 50% All funds 50434 52506 34% 21% 45%

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PROPOSED PROGRAMME BUDGET 2004-2005

Activities under Health systems, an Organizationwide priority, are carried out in three areas of work: Essential medicines: access, quality and rational use, Evidence for health policy and Organization of health services. The nature of support to Essential medicines: access, quality and rational use from other areas of work is shown in the following table.

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Areas of work Malaria

Nature of contribution Increased access to high quality antimalarial agents; quality-control specifications; pre-qualification of antimalarials; provision of support to national clinical studies of herbal antimalarials Promotion of DOTS and DOTS-Plus strategy; increased access to high quality anti-tuberculosis medicines; quality-control specifications; regulatory guidance on use of four-drug fixed-dose combination, including bioequivalence guidelines; pre-qualification of tuberculosis drugs Revision/development of evidence-based clinical guidelines for the essential medicines list Joint representation of WHO to the International Narcotics Control Board on issues related to drug abuse; development of evidencebased clinical guidelines Compatibility of essential medicines list with requirement for Integrated management of childhood illness; drug supply management Guidelines for quality assurance of tablets; clinical guidelines for contraceptives and treatment of sexually transmitted infections Increased access to, pre-qualification of and quality-control specifications of HIV /AIDS-related medicines; technical guidance on clinical validation of use of traditional medicine and complementary medicine in HIV/AIDS care Work on biodiversity and preservation of medicinal plants related to health issues Promotion of emergency health kit; good medicines-donations practices and disposal of unwanted medicines General principles of standard setting; development of WHO guidelines for assessing safety for herbal medicines with special reference to contaminants and residues Joint assessment of regulatory capacity; collaboration on European Community procedures for neglected diseases; cross-cluster coordination for quality and safety assurance Cross-cluster coordination for quality assurance and safety; collaboration on injection safety and essential diagnostics Information on pharmaceuticals expenditure for national health accounts; assessment and provision of pharmaceutical price information; coordination of policy advice on health financing Assessment of spending on pharmaceutical research and development spending in context of overall health research and development Cooperation on issues related to patient safety; development of coverage and access indicators; cost effectiveness of traditional medicine and complentary/altemative medicine Development and implementation of strategy to increase country ability to overcome obstacles to health

Tuberculosis

Surveillance, prevention and management of noncommunicable diseases Mental health and substance abuse

Child and adolescent health

Research and programme development in reproductive health HIV/AIDS

Health and environment Emergency preparedness and response Food safety

Immunization and vaccine development

Blood safety and clinical technology Evidence for health policy

Research policy and promotion

Organization of health services

WHO's presence in countries

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PROPOSED PROGRAMME BUDGET 2004-2005

IMMUNIZATION AND VACCINE DEVELOPMENT .

ISSUES AND CHALLENGES

In 2001, no more than 1000 cases of poliomyelitis were reported and only 10 countries remained endemic. In addition to the Region of the Americas and the Western Pacific Region, already certified as poliomyelitis free, the European Region will be certified by mid-2002. The Global Alliance for Vaccines and Immunization (GAVI) and the Vaccine Fund have given prominence to immunization. The strategic objectives of WHO and GA VI lay particular emphasis on low-income countries and populations which suffer most from the lack of access to immunization. A total of 135 countries have now introduced hepatitis B vaccine, and 89 have introduced Haemophilus injluenzae type b (Hib) vaccine in their routine immunization services. Support provided by the Vaccine Fund will enable at least 50 additional countries to introduce these antigens over the next biennium. These two mechanisms have also reinforced WHO's drive for safe immunization injections. Many countries have adopted the joint WHOIUNICEFIUNFPA policy and are routinely using autodisable syringes. With regard to development, one pneumococcal conjugate vaccine has been licensed, but does not contain serotypes that would make it effective in Africa and Asia. The only licensed rota virus vaccine was removed from the market because of adverse events. Despite progress, over 34 million children born every year still do not have access to immunization services. Vaccine-preventable diseases cause over two million deaths, mostly in the poorest countries. Measles alone causes over 750 000 deaths, even though an efficient, low-cost vaccine has been available for decades. Should new vaccines become available, lack of financial resources would impede their introduction into low-income countries. Financial and human resources are therefore required to facilitate and coordinate research and development on vaccines against diseases which primarily affect the poor; to strengthen routine immunization services and surveillance of vaccine-preventable disease; to identify and implement mechanisms for long-term financial sustainability; to certify the world free of poliomyelitis and to tackle the technical challenges of the post-eradication period; and to accelerate efforts to reduce vaccine-preventable mortality and control diseases through supplemental immunization activities.

GOAL

To protect all people at risk against vaccine-preventable diseases.

WHO OBJECTlVE(S)

To achieve substantial progress in the areas of: innovation - development of new vaccines, biologicals and immunization-related technologies, made available to countries to reduce the burden of diseases of public health importance; immunization systems - greater impact of immunization services, as a component of health delivery systems; accelerated control of disease - control, elimination or eradication of high-priority diseases in ways that strengthen the health infrastructure.

Indicators • Coverage of children less than one year of age with three doses of hepatitis B vaccine • Coverage of children less than one year of age with three doses of diphtheria-tetanus-pertussis vaccine • Number of cases of poliomyelitis reported globally STRATEGIC APPROACHES Advocacy and coordination of global research and development; policy framing; technical and strategic support to strengthen national capacity

EXPECTED RESULTS

INDICATORS • Number of vaccine candidates against tuberculosis, malaria, shigellosis, HIV/ AIDS and dengue advancing to phase I clinical trials

•

Research and development promoted and preclinical evaluation facilitated for new candidate vaccines (in collaboration with the Special Programme for Research and Training in Tropical Diseases) and HIV/AIDS (in collaboration with UNAIDS)

•

Proportion of WHO support for vaccine research and development allocated to investigators from developing countries

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IMMUNIZATION AND V ACCINE DEVELOPMENT

•

Clinical trials (safety, immunogenicity and efficacy) facilitated for selected new HIV/AIDS, pneumococcal, meningococcal, enterotoxigenic E. coli, Japanese encephalitis, rotavirus and Human papillomavirus vaccines. and for vaccines against other infectious diseases, where appropriate Appropriate strategies promoted and support provided for accelerated introduction ofunderutilized vaccines, particularly hepatitis B and Hib vaccines

•

Number of vaccines against pneumococcal and rotaviral disease and Japanese encephalitis entering efficacy trials in developing countries where the diseases are endemic Percentage of high-priority countries with national plans or strategies to prepare for an HIVIAIDS vaccine Percentage of population under one year of age living in countries where hepatitis B vaccine has been introduced, and where Hib vaccine has been introduced and a substantial burden of disease exists Percentage of priority biological medicines for which necessary regulatory research is under way or which have production and control recommendations consistent with latest scientific developments Percentage of countries where the national immunization system uses only vaccines of assured quality (as per WHO criteria) Percentage of countries that have a budget line for vaccines and syringes Percentage of countries assuring sterile immunization injection practices (as per WHO algorithm)

•

•

•

•

Updated (or new) guidance on the standardization and control of biologicals finalized and promoted

•

•

Adequate support provided for implementing policies and building capacity to assure the sustainable supply and the quality of all vaccines delivered by national

•

immunization services

•

•

Adequate support provided for building capacity in priority countries to implement a comprehensive system to ensure safe immunization injection practices Adequate technical and policy support provided to priority countries to strengthen key immunization functions and managerial capacity at all levels Effective coordination and support provided for the eradication of poliomyelitis and the certification of all WHO regions as free of poliomyelitis Adequate support provided for building capacity to implement strategies for controlling and eliminating major vaccine-preventable diseases

•

•

•

Percentage of countries monitoring district-level immunization coverage (all routine antigens)

•

•

Number of WHO regions certified as free of poliomyelitis

•

•

Percentage of targeted countries consistently implementing strategies to eliminate maternal and neonatal tetanus Percentage of endemic countries including yellow-

•

fever vaccine in routine measles immunization • Adequate support provided to implement strategies to achieve a sustainable reduction in measles mortality and to interrupt transmission in areas where measleselimination goals have been set • Percentage of population under one year of age which live in countries where strategies for sustainable measles mortality reduction or for measles elimination are being implemented

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 19424 16726 31% 25% 44% Other sources 171000 428500 65% 20% 15% All funds 190424 445226 64% 20% 16%

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PROPOSED PROGRAMME BUDGET 2004-2005

BLOOD SAFETY AND CLINICAL TECHNOLOGY ISSUES AND CHALLENGES

Trained personnel, resources and government commitment and support are still lacking in many countries to ensure that blood and blood products and health technologies are safe, equitably accessible, readily available at reasonable cost, used appropriately, and provided within the context of a sustainable health care system. Over 60% of the world's population has no access to safe blood and blood products. This is the cause of significant mortality and high risk of infection associated with poor-quality blood transfusion services, stemming from inadequate blood-donor recruitment and use of untested blood or incorrect blood type. It is also estimated that over 30% of injections given each year are unsafe. Norms and standards are still lacking that would facilitate the exchange of medical technology between countries and promote high-quality health care. Around 95% of medical technology in developing countries is imported, most of which does not meet the needs of the national health care system. Diagnostic imaging and radiation therapy, laboratory services and clinical technology in these countries also suffer from a lack of finance and skilled human resources and from poor management. This is increasingly relevant for diagnostic support for treatment and care of HI VIA IDS and opportunistic infections. Quality of care is affected by inoperative or incorrectly used medical devices, insufficient quantities of consumables and reagents, and lack of infection control and waste-management systems. World Health Day 2000 increased public awareness of the importance of government commitment to national programmes for blood safety. WHO's distance-learning programme and quality

management project have ensured the training of good-quality managers in all regions, increased the number of safe blood donors, improved the quality of donated blood, and reduced risk through appropriate clinical use of blood. WHO hosts the secretariat of the Safe Injection Global Network in order to promote safe and appropriate use of injections. WHO's HIV diagnostic-support project has led to increased prequalification and bulk purchasing ofkits for the diagnosis, treatment and care ofHlV/AJDS patients. Its blood cold-chain project has been set up to help ensure safety of blood products. Sound practices in diagnostic imaging and laboratory services have been promoted through strengthening oflaboratory networks and training of professionals. To ensure that blood and blood products, injection practices, laboratory services, diagnostic and therapeutic support, medical devices and clinical technology are safe, equitably accessible, used appropriately and effectively, and are affordable, particularly in developing countries. To ensure that Member States are adequately equipped to improve access to safe blood, blood products and health care technologies that are used appropriately, and to promote high-quality health care services that are supported by safe and cost-effective technologies.

GOAL

WHO OBJECfIVE(S)

Indicators • • Number of countries implementing effective policies and plans for provision of safe blood, blood products, injections and medical devices and procedures, and their appropriate clinical use Number of countries that have appropriate diagnostic support, i.e. laboratory and diagnostic imaging and radiotherapeutical practices, equipment management and maintenance, and disposal of health care waste

STRATEGIC APPROACHES

Advocacy among health authorities of policies and plans for blood safety and clinical technology; promotion of quality management, including quality assessment schemes using WHO training materials; training of trainers and building of capacity in order to meet agreed strategic targets for blood safety and clinical technology

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BLOOD SAFETY AND CLINICAL TECHNOLOGY

EXPECTED RESULTS

INDICATORS

•

Global collaboration strengthened to improve access to safe blood and clinical technologies

•

•

Number of consensus statements on blood and blood products, injections, and medical devices and procedures, through global collaboration Proportion of targeted countries implementing effective policies and plans for safe and appropriate use of blood, blood products, injections and medical devices Proportion of targeted countries with documented uninterrupted access to safe blood and blood products that are used appropriately Proportion of targeted countries with appropriate diagnostic support, i.e. laboratory and diagnostic imaging and radiotherapeutical practices, equipment management and maintenance, and disposal of heallh care waste Proportion of targeted countries administering injections appropriately Extent of application of norms, standards and procedures for blood products and related biological substances Proportion of targeted countries with competent authorities for the control of blood products and related biological substances, medical devices and procedures Number of WHO international biological reference preparations produced and promoted Number of countries using WHO training materials, guidelines and recommendations for reducing risk associated with blood transfusion and injections and for improving diagnostic practice Number of countries linked to an information system on medical devices Proportion of targeted countries having implemented quality management systems for blood transfusion services Performance and number of national centres participating in external quality-assessment schemes Proportion of targeted countries having established diagnostic support for the diagnosis, treatment and care of people living with HIV/AIDS and opportunistic infections

•

Technical support, including models, provided in order to improve access to, and rational use of, transfusion therapy, injections, diagnostic imaging and radiation therapy, laboratory services, and medical devices and procedures

•

•

• • International norms, standards, procedures and biological reference preparations produced and promoted for blood products and related biological substances

• •

• • Validated materials and models available for development ofheallh care technology

•

• • Management of quality of blood and blood products strengthened; access assured to external qualityassessment schemes

• •

•

Guidelines and validated materials and models provided for diagnostic support for treatment and care ofHIV/AIDS and opportunistic infections

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 15118 13490 32% 31% 37%

Other sources 15500 8000 20% 10% 70%

All funds 30618 21490 28% 23% 49%

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PROPOSED PROGRAMME BUDGET 2004-2005

As an Organization-wide priority, Blood safety is supported not only by its own area of work, but also by activities carried out in other areas. The following table shows the nature of those efforts.

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BLOOD SAFETY AND CLINICAL TECHNOLOGY

Areas of work Communicable disease surveillance

Nature of contribution Operational networks of centres and laboratories able to administer diagnostics tests for hepatitis B and C, HIV infection and Chagas disease Provision of technical guidance on safe blood transfusions for gross anaemia Treatment strategies for haemophilia, thalassaemia and other inherited metabolic diseases Strategies for district health services that include guidance on minimizing the use of blood by reducing bleeding and avoiding unnecessary procedures that require blood Guidelines on appropriate use of blood in childhood and adolescent diseases and surgical procedures Implementation of screening for anaemia Technical support to countries to increase coverage in provision of safe blood, including use of cost-effective, simple and rapid tests to screen donated blood Dissemination of methods for screening for anaemia Waste management of blood and blood products Screening for anaemia and procedures for safe blood transfusions in emergencies, through institutionalized focal points Implementation of safe practices for therapeutic injections in priority countries Implementation of safe injection practices in priority countries Essential technology package disseminated to improve quality of blood services

Malaria Surveillance, prevention and management of noncommunicable diseases Injuries and disabilities

Child and adolescent health Making pregnancy safer HIV/AIDS

Nutrition Health and environment Emergency preparedness and response Essential medicines: access, quality and rational use Immunization and vaccine development Organization of health services

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PROPOSED PROGRAMME BUDGET 2004-2005

EVIDENCE FOR HEALTH POLICY ISSUES AND CHALLENGES The health needs of populations are in transition, and health systems and scientific knowledge are changing rapidly. In order to meet these challenges, decision-makers need the tools, capacity and information to assess health needs, choose intervention strategies, design policy options appropriate to their own circumstances, monitor performance and manage change. In addition, there is growing international support to scale up activities of health systems in order to improve the health of the poor within the framework of the Millennium Development Goals and poverty-reduction strategies at country level. Ifhealth systems are successfully to deliver better services to the poor, they will have to adjust approaches to financing, stewardship and resource generation as well as to delivery. Some of the greatest difficulties in enhancing performance of a health system are concerned with its overall design. Better evidence is needed on the relationship between the performance and organization of different health systems, in particular the effect on the health of poor population groups, and on ways to manage the complex process of change. As part of this process, decision-makers need reliable, timely and usable information on the cost, effectiveness and efficiency of interventions targeting the health of the poor. In addition, the policy debate needs information on ethical and gender dimensions of choice of intervention, design of the system, quality of care, and ways to encourage desirable and discourage undesirable interventions. Applying international evidence in the formulation and implementation of national policies to enhance health systems' performance depends on more than the development of common tools, norms and standards; the challenge is to ensure that policy-makers have access to the best evidence and tools, and the capability to use them to enhance the performance of their health systems. It is important to work with countries to identify the most useful evidence in their settings and to build the capacity to use the available evidence according to their needs. GOAL To foster the evolution of health systems to maximize their potential to promote health, reduce excess mortality, morbidity and disability, and respond to people's legitimate demands in a way that is equitable and financially fair.

WHO OBJECTIVE(S)

To improve the performance of health systems by the generation and dissemination of evidence, to build capacity to use this evidence, and to provide support for national and international dialogue on ways to improve health systems' performance.

Indicators • Availability of practical tools to help policy-makers and health professionals to analyse health situations and systems and formulate national policies for improving the performance of health systems Strengthened ability of countries to adapt and use these tools in their own settings Existence of functioning networks with regional and national institutions and active partnerships with international agencies supporting the analysis and development of more effective stewardship, financing, and resource generation and provision in countries

• •

STRATEGIC APPROACHES

Development and enhancement of the knowledge base for health systems; effective capacity building in health systems' assessment and development; establishment and maintenance of focused active health systems' networks

EXPECTED RESUL TS • Validated framework and practical policy tools used to support expansion of capacity of national health systems to obtain, analyse and use critical information,

INDICATORS • Availability and regular updating of databases and other practical tools to help policy-makers and health professionals to analyse health situations, major health outcomes, systems and possibilities for intervention

including that on health, responsiveness, fairness of financial contributions, risk factors and the costs and effectiveness ofimportant interventions

•

Strengthened ability to adapt the framework and tools to their own settings in selected countries

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EVIDENCE FOR HEALTH POLICY

EXPECTED RESULTS • National and international networks and partnerships in operation for epidemiological estimates and methods, monitoring of major health system outcomes, economic analysis, measurement of health system efficiency and international classifications •

INDICATORS Existence of functioning networks with regional and national institutions for devising methods of obtaining estimates on crucial health-policy parameters and ways to use them at national and subnationallevels Elaboration and use of mechanisms to promote access to and exchange of comparable data on health systems by countries and WHO Availability of selected norms, standards, tenninology and methods to meet high-priority needs of countries and regions for producing evidence on which to base health policy Strengthened ability of targeted countries to obtain and use this information in a way that complements existing routine statistical information systems

•

•

Norms, standards, terminology and methods for use by national decision-makers detennined and validated on main issues, including population health, responsiveness and fairness of financial contributions and their measurement, international classifications, economic efficiency, economic cost, ethical implications of resource allocation and costeffectiveness analysis for choosing efficient mixes of interventions An evidence base available to guide policy recommendations on critical areas including health care financing, stewardship, resource generation and service provision

•

•

•

• • •

Finalization of WHO policy on health system financing Availability of collected evidence on approaches to stewardship, resource generation and service provision Strengthened ability in selected countries to analyse and apply such evidence in national policy development Availability and use of practical tools for health systems' performance assessment at national and subnationallevels, with special attention to resourcepoor settings Formulation of agreed strategies for strengthening health information systems in order to obtain more timely and relevant information for national policymakers Availability of selected practical tools for policymakers to use in national policy and planning, within WHO framework Incorporation of these tools into policy process in selected countries

•

Operational mechanisms and validated tools available for updating information regularly and facilitating routine analysis of national and subnational health systems' performance; strategies to improve performance of health information systems in different settings formulated and operational, supporting and complementing routine statistical systems

•

•

•

Practical planning tools for policy-makers that support the implementation of alternative policies and strategies for improving health systems' performance designed and validated

•

•

•

Evidence base available to guide the development and implementation of pro-poor health policies and healthrelated interventions in line with poverty reduction strategies and the Millennium Development Goals

For all countries in the poverty-reduction strategy process: • availability of scientific evidence on what constitutes pro-poor health policies and interventions • ability to analyse national policies from an evidencebased pro-poor health perspective in targeted countries

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 29509 27976 24% 33% 43% Other sources 21000 54000 40% 20% 40% All funds 50509 81976 35% 24% 41%

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PROPOSED PROGRAMME BUDGET 2004-2005

Activities under Health systems, an Organizationwide priority, are carried out in three areas of work: Essential medicines: access, quality and rational use, Evidence for health policy and Organization of health services_ The nature of support to Evidence for health policy from other areas of work is shown in the following table.

Areas of work Communicable disease surveillance Communicable disease prevention, eradication and control Research and product development for communicable diseases Malaria

Nature of contribution Collaboration on estimates of incidence and prevalence, and strengthening of information systems Inputs on burden of disease. effectiveness of interventions and costs Collection of evidence on impact of health systems on prevention Information on effectiveness of interventions; estimates of burden of disease and cost of interventions; collaboration on health financing issues Estimation of burden of disease; work on costs and effects of interventions and on health information systems; collaboration on health financing topics Information on adherence to best practice guidelines; collaboration on health financing issues Estimates of costs and effects of interventions; estimates of tobaccorelated deaths; collaboration on responsiveness to tobacco-control efforts Information on effectiveness of interventions and costs; collaboration on responsiveness to health promotion Estimates and projections of burden of injuries Estimation of burden of disease; information on costs and effectiveness of interventions; collaboration on health financing issues

Tuberculosis

Surveillance, prevention and management of noncommunicable diseases Tobacco

Health promotion Injuries and disabilities Mental health and substance abuse

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EVIDENCE FOR HEALTH POLICY

Areas of work Child and adolescent health

Nature of contribution Information on costs of integrated management of childhood illnesses; estimates and projections of burden of disease and mortality Information on cost and effectiveness of interventions; collaboration on health financing matters Estimation of burden of disease; information on costs and effectiveness of interventions Collaboration on gender analysis and responsiveness to efforts to improve women's health Work on projections and assessment of burden of disease; information on cost-effectiveness of interventions; work on health information systems; collaboration on health financing matters Work on human rights approach as related to health systems assessment; collaboration on responsiveness and human rights and on health financing matters Assessment of burden of disease Assessment and projections of burden of disease; information on costs and effectiveness of interventions Information on best health practices Work on best practice guidelines and costs of interventions; collaboration on expenditures on drugs through national health accounts and household data on fairness in financial contribution Assessment of burden of disease; work on cost-effectiveness of interventions; collaboration on health financing aspects including the Global Alliance for Vaccines and Immunization Work on costs and effectiveness of interventions Assessment of health systems' performance; collaboration on health financing matters Provision of support to communication and capacity building in countries Provision of support for research framework on health systems' performance Information on donors and nongovernmental organizations active in providing technical support in areas of interest in health systems

Research and programme development in reproductive health Making pregnancy safer Women's health HIV/AIDS

Sustainable development

Nutrition Health and environment Emergency preparedness and response Essential medicines: access, quality and rational use Immunization and vaccine development

Blood safety and clinical technology Organization of health services Health information management and dissemination Research policy and promotion Resource mobilization, and external cooperation and partnerships

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PROPOSED PROGRAMME BUDGET 2004-2005

HEALTH INFORMATION MANAGEMENT AND DISSEMINATION ISSUES AND CHALLENGES

Reliable information is the cornerstone of effective health policies and a powerful tool for health and development in general. It is the basis for raising awareness of health matters, formulating strategies, and building up the expertise necessary to improve health. Yet many people, including health professionals, either have no access to relevant information or are overwhelmed by too much and cannot make optimal use of it. Thus, facilitating access to information that is relevant to people's needs is a continuing priority of WHO. Reliable information is one ofthe most important products of WHO; Member States and partners count on the Organization's authoritative advice. WHO draws on its unique network of information sources and health experts to gather and analyse available evidence on global health issues, and communicates the results through a range of information products. Advances in technology provide unprecedented opportunities for WHO to respond to the health-information needs of different audiences, in a form and with content that are relevant locally. WHO's long experience in providing health information has shown that the information it delivers must meet specifically identified needs if it is to have an impact, and that use of different languages, formats and means of dissemination is required in order to reach target audiences. None the less, there remains room for improvement. Information products do not always reach target audiences, nor do they always meet needs in terms of content or form. Even within WHO information is often fragmented, with cases of both duplication and gaps. Improved communication and coordination within WHO will help to improve efficiency and effectiveness. Processes and systems for planning, producing and disseminating information need streamlining and regular evaluation and refinement. New technology needs to be exploited in order to provide people with relevant information and to reduce the information gap. This can be done only by working with partners, taking advantage of their experience in applying new technology, and reaching all parts of the world, including the least developed areas. To create a framework of health knowledge in which the right health information is available at the right time to support informed decision-making at all levels. To facilitate access of governments, WHO's partners in health and development, and staff to reliable, up-to-date health information that is based on evidence and provides guidance for establishing health policy and practice both nationally and internationally.

GOAL

WHO OBJECTIVE(S)

Indicators • • A measurable increase in use of WHO information in all media Application of best practices for storage, management and accessibility of health information

STRATEGIC

APPROACHES

Provision of support to existing activities such as the Health InterNetwork Access to Research Initiative, with focus on access to information sources at country level; enhancement of WHO's web site, including uploading of country information pages, with monthly provision of information on CD-ROM being explored as a solution to telecommunication difficulties; preparation of a health knowledge framework through informational, technological and institutional change within WHO, including identification of main health-information assets and their delivery at country level; creation of an enabling environment that supports communities of practice and associated networks with information resources

84

HEALTH INFORMAnON MANAGEMENT AND DlSSEMINA nON

EXPECTED RESULTS • Organization-wide health-information management strategies and policy in operation and periodically evaluated and updated • •

INDICATORS Number of information products compliant with organizational strategies and policies Frequency of evaluation and updating of strategies and policy Availability of trend data on sales and distribution of health information products Availability of statistics on access to WHO web sites More re-use of existing health information in new products Increased dissemination through content licensing Availability of selected information products in relevant languages in high-priority countries Proportion of global WHO web content that follows guidelines for usability, accessibility and branding

•

planning, production and dissemination of health information products in appropriate media, including print, web, multimedia and CD-ROM, improved through streamlined production/dissemination processes, policies, and services

• • • •

•

Selected high-priority information products, including The world health report, the Bulletin of the World Health Organization, WHO web site content and regional information products, issued in appropriate languages An evaluation framework for WHO's healthinformation products introduced, including: policies on best practice such as standards for scientific and editorial quality; regular assessments oftargetaudiences' needs; and assessment of the products with feedback on lessons learned to the authoring units and executive management

• •

•

• • •

Number of evaluated health-information products Number of case studies and reports on lessons learned Number of plans for health-infonnation products changed to fit the evaluation framework

•

WHO's health knowledge framework established, including: the identification and organization of essential knowledge assets (such as documents and structured data sets) and ensuring better access by all WHO staff to the information they need; information and communication technology support to communities of practice within WHO; promotion and facilitation of best practice in management of WHO health data (e.g. data storage, decision-support tool sets); and strengthening ability of countries to access, use, and contribute to the framework

• • • • •

Number of health knowledge assets identified and statistics on usage Satisfaction of staff in different geographical locations with the infonnation support needed for their work Number of supported communities ofpractice Proportion of WHO health data sets that follow bestpractice criteria in information management Number of Member States actively participating in WHO's health knowledge framework

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 31829 28878 4% 50% 46% Other sources 16000 18000 15% 15% 70% All funds 47829 46878 8% 37% 55%

85

PROPOSED PROGRAMME BODGET 2004-2005

RESEARCH POLICY AND PROMOTION ISSUES AND CHALLENGES Research is the systematic process for generating knowledge, and global research efforts produced knowledge that underpinned the health revolution of the twentieth century. Based on unprecedented advances in biology (as exemplified by the recent sequencing of the human genome), the social sciences and information technology, new concepts will lead to innovations in diagnosis, prevention and therapy and have direct impacts on ethical and social aspects of human health and disease. Advances in knowledge, however, have not benefited developing countries to the full extent possible. It has been estimated, for example, that only 10% of financing for global health research is allocated to health problems that affect 90% of the world's population (the 10/90 gap). Clear disparities in economic strength, political will, scientific resources and capabilities, and the ability to access global information networks have, in fact, widened the gap in knowledge, and hence health, between rich and poor countries. The world health report for 2004 will examine how research has led to improvements in health, especially in the developing countries. WHO plays an important and unique role in correcting imbalances in the distribution of knowledge so that the fruits of research benefit everybody, including the poor, in a sustainable and equitable manner. As knowledge is a major vehicle for improving health, of poor people in particular, WHO will focus on stimulating research in the developing world, thereby underpinning other areas of work, such as reducing risk factors and the burden of disease, improving health systems and promoting health as a component of development. Building up and strengthening research capability is one of the more effective, efficient and sustainable strategies for developing countries to benefit from advances in knowledge, in particular through promotion of regional research networks. WHO will promote research and knowledge as global public goods through national and global partnerships and collaborations that are equitable and sustainable. It will foster a favourable health research environment to support equitable health research efficiency and advocate redirection of resources to narrow the 10/90 gap in health research funding. It will also promote the systems approach to health research in the belief that that drives health system improvement. WHO will keep abreast of relevant scientific advances through close contact with the scientific community. Mechanisms will be needed to incorporate advice from leading scientists into research policy and resource allocation. To narrow the existing gap and reduce inequalities between developed and developing countries in generation of, access to and utilization of scientific knowledge for improving health, particularly of poor people. To stimulate research for, with and by developing countries by identifying emerging trends in scientific knowledge with the potential to improve health; inciting the world research community to tackle high-priority health problems; and launching initiatives to strengthen research capability in developing countries so that health policy will be founded on solid evidence from research. Indicators • • Strong health research systems in countries Increased global emphasis on research into health problems of developing countries

GOAL

WHO OBJECTlVE(S)

STRATEGIC APPROACHES

Close interaction and consultation with the scientific community; working with countries to develop methods for assessing performance of health research systems; analysis of major global issues in health research; capacity building and advocacy initiatives in important areas

86

RESEARCH POLICY AND PROMOTION

EXPECTED RESULTS • WHO research policy updated to reflect emerging trends, contemporary scientific advances relevant to health, gaps in knowledge and ethical aspects of research in order to strengthen ability for rational decision-making on research priorities Mechanisms in operation for setting up networks and partnerships to improve international cooperation for health research, including practical and sustainable links between the global and regional Advisory Committee on Health Research •

INDICATORS Degree to which current trends, advances in knowledge and good ethical standards are reflected in WHO's research-policy positions Presence and prominence of WHO research policy in the global health-research agenda Number of regional Advisory Committees on Health Research with explicit operational and procedural links to the global Advisory Committee on Health Research Number of partnerships and networks set up to improve international cooperation between WHO and other organizations involved in health research Number of regional offices, country offices and WHO collaborating centres with real-time web access to the major global databases of scientific and policy information relevant to health research and other databases related to WHO research activities, expert advisory panels and WHO collaborating centres Analytical work and methods relating to performance assessment of health research systems Number of initiatives to strengthen health research capacity in selected areas Evidence of the importance given to health research issues in WHO reports, documentation and press releases Greater activity of WHO collaborating centres in highpriority areas of research as parts of national or regional networks of centres Level of technical support and support for resource mobilization provided to WHO collaborating centres for research-related activities in high-priority areas

•

•

•

•

•

Framework in operation for providing policy and technical support in order to strengthen health research and capability for such research in developing countries, including methods and strategies to assess performance of health research systems

•

• •

•

Support and advice provided within WHO on researchrelated activities

•

I

•

Mechanisms in place for increasing capability of WHO collaborating centres to engage in research in highpriority areas

•

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 9380 8887 26% 29% 45% Other sources 5000 10000 45% 15% 40% All funds 14380 18887 36% 22% 42%

87

PROPOSED PROGRAMME BUDGET 2004-2005

ORGANIZATION OF HEALTH SERVICES ISSUES AND CHALLENGES In many countries, national resources - human, financial and material - are still insufficient to ensure availability of and access to essential health services of high quality for individuals and populations, especially the poorest and most vulnerable. Many countries are now engaged in processes of change. Some are reforming the public sector as a whole. Others are reforming the health sector, by decentralizing public services, fostering private-sector participation, and modifying ways to finance and provide health services. The object of these changes is primarily to reduce inequities in access to health services, promote universal coverage and improve the efficiency of the health system in line with the Millennium Development Goals and poverty-reduction strategies. There is little evidence of the effectiveness of these reforms. Countries are asking for policy guidance on several of these areas, including human resources for health, financing, decentralization and tools to aid assessment and planning. The organization of services and delivery of effective interventions remain difficult for many countries. Problems include: the inability of governments to assure quality of providers and of service delivery; fragmented services, leading to inequitable coverage, inefficiencies in resource allocation and management; and imbalances in human resources. To tackle these challenges, countries need to build their management capability and devise management tools that ensure both efficiency and special safeguards for the health of the poor. Mechanisms need to be set up to align education and training with the needs of practice. Member States need to improve their ability to produce and use information, in other words, to strengthen systems as well as skills. Advances in both health technology and communications offer opportunities to accelerate improvements in service delivery, provided that Member States have the capability to use these technologies and tools to make suitable choices. GOAL To maximize the potential of a health system to promote health, reduce excess mortality, morbidity and disability, and respond to people's legitimate demands in a way that is equitable and financially fair. To work with Member States to improve their capacity to deliver high-quality health services affordably, efficiently and equitably to all their populations, especially the poorest and most vulnerable, by developing and enhancing systems for planning and delivery of health services and to gather evidence and design tools that support informed and participatory framing and implementation of policy.

WHO OBJECTIVE(S)

Indicators • Availability of practical tools to help policy-makers and health professionals to analyse the impact of health systems on access and health outcomes of the poor, and to improve the quality and performance of health services Strengthened ability of countries to adapt and use these tools in their own settings Functioning networks with regional and national institutions and active partnerships with international agencies supporting the analysis and development of more effective stewardship, financing, and generation and provision of resources in countries

• •

STRATEGIC APPROACHES

Development and enhancement of knowledge bases on health systems; effective capacity building for assessment and development of health systems; establishment and support of focused and active networks of health systems

EXPECTED RESULTS • Frameworks validated for use by countries to gather and analyse changes in health system organization and their effects on access to services and health outcomes of the poor •

INDICATORS Availability of practical tools (such as national health accounts) to help policy-makers to analyse health system changes and their effects on access and health outcomes of the poor

88

ORGANIZATION OF HEALTH SERVICES

EXPECTED RESULTS • Strategies formulated to strengthen national capacity for framing and implementing policies to improve health of the poor, focusing on high-priority health conditions and better stewardship (including legislation and regulation and accreditation) Knowledge bases, networks and partnerships maintained and extended in order to build capacity in countries to support improved health system stewardship, financing, and generation and provision of resources in countries, and the strengthening of management processes at national and subnational levels •

INDICATORS Strengthened national capability to formulate and implement policies to improve health of the poor in selected countries in all WHO regions

•

•

•

•

Functioning networks of regional and national institutions, supporting the development of more effective stewardship, financing, and generation and provision of resources in countries. Active partnerships with other international agencies, strengthening consistency of advice and support on health systems' functions that are provided to Member States Publicly accessible information bases on organization of health systems' functions Availability and implementation of policy options on health service provision and human resources development, based on validated evidence and best practices, in selected countries in all WHO regions Availability of strategies, methods and tools and ability to apply them in selected countries for assessing coverage and provider performance, and improving the delivery and quality of health services Evidence of application of tools at subnationallevel in selected countries in all WHO regions Methods and tools for improving the distribution, quality and performance of health workforce available and used in targeted countries in all WHO regions

•

Evidence and best practices validated and countries supported to define and implement their policy options on the provision of health services and development of human resources Strategies, methods, guidelines and tools devised in order to enable countries to assess coverage and provider performance and to improve the delivery and quality of health services to individuals and populations

•

•

•

•

•

Methods, guidelines and tools devised for planning, educating, managing and improving the performance of the health workforce, harmonizing participation of the private sector in achievement of national goals Technical and policy advice, based on evidence and best practices, provided to countries in order to improve provision of health services and investment in, and use of, human, material and capital resources Strategies, guidelines, tools and partnerships developed to strengthen WHO and countries' capabilities to articulate and implement equitable health policies in support of national poverty-reduction strategies and the Millennium Development Goals

•

•

•

Improvement in mechanisms, methods and capacity, in support of countries' requests for advice on policy and system improvement, compared with baseline established in 2002-2003 Strengthened institutional capacity in WHO and poverty-reduction strategy countries for the formulation of pro-poor health policies and interventions in the context of national povertyreduction programmes

•

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 113 133 104 049 66% 25% 9% Other sources 22500 56500 45% 15% 40% All funds 135633 160549 59% 21% 20%

89

PROPOSED PROGRAMME BUDGET 2004-2005

Activities under Health systems, an Organizationwide priority, are carried out in three areas of work: Essential medicines: access, quality and rational use, Evidence for health policy and Organization of health services. The nature of support to Organization of health services from other areas of work is shown in the following table

Areas of work Communicable disease surveillance Communicable disease prevention, eradication and control Research and product development for communicable diseases Malaria Tuberculosis

Nature of contribution Support to health systems to deal with communicable diseases Support to health systems in the improvement of access to health services Support to policy development to scale up interventions to improve health Support to health systems' development to scale up interventions to improve health Support to health policy development to scale up interventions to improve health Support to health systems' development to deal with chronic conditions Support for surveillance systems and stewardship strategies Support to reorienting health services towards health promotion Support to strengthen health systems to cope with violence to patients and health workers; collaboration on policy research Support to health systems' development for prevention and treatment Support to health systems' policies and service delivery strategies Support to strengthening stewardship in relation to reproductive health Support to health systems' development to scale up health outcomes

Surveillance, prevention and management of noncommunicable diseases Tobacco Health promotion Injuries and disabilities Mental health and substance abuse Child and adolescent health Research and programme development in reproductive health Making pregnancy safer

90

ORGANIZATION OF HEALTH SERVICES

Areas of work Women's health

Nature of contribution Support to the integration of gender in the analysis and implementation in health systems Support to health development to scale up health outcomes Support to the analysis and implementation of development instruments e.g. Poverty Reduction Strategy Papers and sector-wide approaches at country level Support to health systems' development for implementing nutrition strategies Support for health systems in assessing the impact of the environment on service delivery Support for health systems in managing associated tasks Support to the development of health systems' policies Support for health systems functions related to the provision of essential medicines Support for strengthening capacity for service delivery in countries Support to health systems' functions in relation to access and quality Provision of evidence for framing policy and developing policy options; collaboration on policy research Support to health systems' communication and capacity building in countries Support to health systems' functions through strengthening research capacity; collaboration on policy research Support to the formulation of resolutions that are focused on health systems' strategies Information on donors and nongovernmental organizations active in providing technical support in health systems areas of interest

HIV/AlDS Sustainable development

Nutrition

Health and environment

Food safety Emergency preparedness and response Essential medicines: access, quality and rational use Immunization and vaccine development Blood safety and clinical technology Evidence for health policy

Health information management and dissemination Research policy and promotion

Governing bodies

Resource mobilization, and external cooperation and partnerships

91

PROPOSED PROGRAMME BUDGET 2004-2005

GoVERNING BODIES ISSUES AND CHALLENGES

The fonnal contribution of Member States of WHO to its work takes place within a series of governing bodies at global and regional levels. Several additional mechanisms have been introduced, including extensive briefings of health ministers by WHO Representatives and of permanent missions in Geneva, retreats for members of the Executive Board and ministerial round tables at the Health Assembly. As the framing of appropriate public health policy becomes more complex and critical, WHO's governing bodies must be provided in the most efficient and effective way with both the input and the setting required for informed decision-making at global and regional levels. Careful and deliberate selection of the most pertinent issues, and greater participation and transparency, are essential in order to sharpen the focus of debate during shorter governing body sessions with less documentation. In drawing up agendas and prioritizing topics for consideration, dialogue between regional- and global-level governing bodies must be maintained in order to bring about consensus on technical and policy matters. As the number of governing bodies has grown, so has the burden of demanding, skilled and highly pressured work that needs to be performed by the language, documentation, document production, and meeting services. Moreover, in view of the importance of plurality of languages for giving all Member States access to accurate and concise scientific and technical information and for improving health policies in the world, a considerable volume of material has to be edited, translated and made available in all official languages of the Organization. New technologies facilitate the dissemination of documentation, making it possible, for example, rapidly to issue documentation for governing body sessions on the Internet; yet distribution of printed material is still needed in order to assure availability of documentation everywhere.

GoAL

To assure framing of sound policy on international public health and development that responds to the needs of Member States. To provide support to the regional and global governing bodies in the form of efficient preparation and conduct of their sessions, including timely dissemination of easily accessible, readable and high-quality documentation, and of post-session records and resolutions for policy-making.

WHO OBJECTIVE(S)

Indicator • Greater consensus in Health Assembly deliberations

STRATEGIC APPROACHES

Expansion and improvement of communication and coordination channels between Member States, regional and global governing bodies, and WHO's Secretariat; more effective use of technology and better control throughout preparation process in order to speed up provision of concise and accurate documentation

92

GOVERNING BODIES

EXPECTED RESULTS • Resolutions adopted that focus on policy and strategy and provide clear directions to Member States and WHO's Secretariat on their implementation Communication between Member States, Executive Board members and WHO's Secretariat improved •

INDICATORS Proportion of resolutions adopted that focus on policy and can be implemented at global, regional and national levels Frequency of effective use of communication channels between Member States and governing bodies at global, regional and country levels, concerning the work of WHO Proportion of governing body documents available to Member States on time and in the official languages of the Organization Degree of congruence of agendas and resolutions of the regional and global governing bodies

•

•

•

WHO documents and information products available and accessible in a timely manner in the official languages of the Organization Communication and coordination in establishing the work programmes of regional and global governing bodies improved

•

•

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 21439 21854 0% 15% 85% Other sources 1000 3000 0% 10% 90% All funds 22439 24854 0% 14% 86%

.

93

PROPOSED PROGRAMME BUDGET 2004-2005

RESOURCE MOBILIZATION, AND EXTERNAL COOPERATION AND PARTNERSHIPS ISSUES AND CHALLENGES In promoting integration of a health dimension in social, economic and environmental development, WHO seeks to achieve greater impact by collaborating with a range of institutions offering knowledge and experience in other fields. To that end, it has established and maintained operational linkages with intergovernmental, governmental and nongovernmental partners working in compatible sectors. For example, an exchange ofletters between WHO and the European Commission has been signed and cooperation with the institutions of the European Union strengthened. WHO has also led several major initiatives to coordinate health-related activities in the United Nations system, and has striven to assure the prominence of health on the agenda of the international community. In order to realize the potential of partnerships, coordination and exchange of information with partners need to be revitalized and reoriented in the light of changing priorities, and new avenues need to be explored, such as regional political bodies and parliamentary groups. Implementation of the corporate approach to voluntary contributions resulted in better alignment of government support to WHO's programme budget. Several governments moved to multiyear commitments, thereby assuring predictability and coherence. The Meeting ofInterested Parties was successfully organized as a formal consultative exercise, covering the work of WHO as a whole. WHO will continue to rely on its Members, organizations of the United Nations system and other intergovernmental bodies for its core and extrabudgetary support. In the rapidly changing environment for development cooperation, this donor base will be expanded in order to meet the requirements of WHO activities. The benefits of greater collaboration with the private sector in order to improve public health outcomes is increasingly being recognized. Targeted approaches to foundations, including in the context of global alliances, resulted in a significant increase in support, notably from the Bill & Melinda Gates Foundation and United Nations Foundation. WHO's future work on public-private interactions for health will emphasize cooperation with companies to improve access to health-related commodities; promotion of research and development; redressing of company practices that have a negative impact on public health; and provide support to Member States on interaction with the private sector. Guidelines have been drawn up and facilitated major in-kind contributions. The growing recognition that civil society organizations are important in shaping and implementing both global and national health policies, as exemplified by WHO's Civil Society Initiative, needs to be reflected more in WHO's work. The challenge for WHO is to contribute to advocacy at country level and to broaden the participation of civil society in its work.

GOAL

To ensure that health goals are incorporated in overall development policies, and that resources for health are increased. To negotiate, sustain and expand partnerships for health globally; to strengthen WHO's collaboration with intergovernmental and governmental bodies, civil society organizations, the private sector and foundations; and to secure the Organization's resource base.

WHO OBJECTIVE(S)

Indicator • Number of functioning partnerships established with bodies of the United Nations system, the private sector and civil society

94

RESOURCE MOBILIZATION, AND EXTERNAL COOPERATION AND PARTNERSHIPS

STRATEGIC APPROACHES

Respect of the programme and priorities adopted by the Health Assembly through harmonization of extrabudgetary resources with the regular budget; introduction of measures to manage conflict of interest with the private sector; facilitation of exchange of information between major target groups in health information marketplace; greater promotion of the health agenda in political and socioeconomic spheres

EXPECTED RESULTS • Sustained and expanded partnerships for health globally; strengthened collaboration with intergovernmental and governmental bodies, civil society organizations, the private sector and foundations; and secured resource base for WHO Effective mechanism for coordination of input to and feedback from important international forums, including major United Nations conferences and summits Dynamic and coordinated fundraising under way with current and potential donors, focused on the integrated resource base of the programme budget and unspecified funding by area of work New partners mobilized for WHO, notably through global alliances and improved interaction with the private sector Guidelines on interaction with commercial enterprises drawn up and applied Staff awareness raised of issues related to collaboration with private sector, including conflict of interest Policies and strategies for WHO interaction with civil society organizations revised Effective mechanisms, including knowledge base, in place for mutually beneficial collaboration, enbanced communication and policy dialogue between WHO and civil society organizations •

INDICATORS Number of consultation and briefing sessions with WHO's sister agencies, other organizations and interested parties in the health sector Number of policy areas where there is congruence with other stakeholders Final declarations and plans of actions of global, regional and national conferences, and development agendas that reflect WHO's health goals and priorities

•

•

•

•

• •

Level of extrabudgetary resources Extent of increase in unspecified funding support to WHO

•

• •

• •

Number of private-sector partners working with WHO to achieve public health outcomes Number of orientation and training sessions on management of conflict of interest

• •

• •

Policy papers, tools, and guidelines on interaction with civil society organizations in use Number of training sessions and seminars on interaction with civil society organizations

RESOURCES (US$ thousand) Regular budget Other sources All funds

TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global

25550 23870 12% 28% 60%

12000 11000 15% 40% 45%

37550 34870 13% 32% 55%

95

PROPOSED PROGRAMME BUDGET 2004-2005

PROGRAMME PLANNING, MONITORING AND EVALUATION ISSUES AND CHALLENGES A cornerstone of the Director-General's reform agenda has been the work towards a framework of results-based management. This has included improved processes for strategic planning, programme budgeting, operational planning, monitoring and reporting, and programme evaluation. The integration of these processes into the system represents a significant cultural change for the Secretariat, one which will take several bienniums to assimilate. After adoption by the Health Assembly of the General Programme of Work 2002-2005,1 steps were taken towards setting up a fully integrated and results-based planning, budgeting, monitoring and evaluation system across the Organization. A sharper focus on strategic planning, expressed through the programme budget for the biennium 2002-2003, has promoted a corporate "one WHO" approach. Further, a uniform system of operational planning, monitoring and reporting over the biennium was implemented, whereby all parts of the Organization report at fixed intervals on progress towards the expected results set out in the programme budget. Reforms in 2002-2003 produced further improvements and refinements to management processes, particularly in the area of evaluation, in terms of both assessing implementation of the programme budget, and of carrying out a schedule of planned programme evaluations, at country and regional offices and headquarters. For 2004-2005, the main challenge will be to incorporate the integrated system into the day-to-day operation of programmes at all levels. Its assimilatiop as an essential management tool will ultimately lead to better programme planning, implementation and accountability. In order to facilitate this process the Organization's administrative practices and procedures will need to be systematically aligned so that they support a results-based management framework. Linked to this is the need for a change in organizational culture, so that information and results emanating from improved practices are actually used in the day-to-day work of programme managers and decision-makers at all levels. To achieve this change will require, among other initiatives, a comprehensive training and coaching programme of staff throughout the Organization, extending well into the 2004-2005 biennium.

GOAL

To apply best practice in all aspects of programme planning, monitoring and evaluation, in support of WHO's leadership role in international health.

WHO OBJECTIVE(S)

To assure fully functional, Organization-wide mechanisms for results-based management and effective administration, anchored in WHO's corporate strategy.

Indicators • Increase in proportion of unspecified voluntary contributions to WHO, as an expression of donor confidence in the Organization's improved management practices and accountability for results Reduction in the number of ad hoc programme evaluations requested by stakeholders, as an expression of confidence in the Organization's evaluation framework

•

STRATEGIC APPROACHES

Drafting ofa General Programme of Work for the period 2006-2009. Preparation of Organizationwide guidelines for strategic budgeting, operational planning, monitoring and reporting, and programme evaluation; establishment of a regular system for the training and coaching of staff in the results-based management principles; strengthening of the Organization's programme management information system

1

Resolution WHA54.1

96

PROGRAMME PLANNING, MONITOlUNG AND EV ALVA TION

EXPECTED RESULTS • Unifonn and consistent processes for planning, budgeting, mODi toring, reporting and evaluating programmes operating at all levels of the Organization •

INDICATORS Areas of work at headquarters, and regional and country offices having developed work plans and prepared monitoring reports at regular intervals and following established guidelines Number of staff at all organizational levels trained in results-based management principles Day-to-day use by programme managers at all organizational levels of a remodelled and user-friendly management information system

•

A culture of results-based management practices introduced at all levels of tbe Organization

•

•

An effective programme managernentinfonnation system in operation, in support of efforts to achieve greater accountability and better perfonnance in tbe Organization Evaluation system in operation, covering botb implementation of successive programme budgets and specific areas of work or tbernes

•

•

•

Degree of governing body satisfaction with tbe deptb and breadtb of coverage and reporting on evaluations at all organizational levels Extent of application to future programme budgets and general programmes of work oflessons learned from evaluations

•

RESOURCES (VS$ tbousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 7338 6889 6% 57% 37% Other sources 1000 2500 20% 45% 35% All funds 8338 9389 10% 54% 36%

97

PROPOSED PROGRAMME BUDGET 2004-2005

HUMAN RESOURCES DEVELOPMENT ISSUES AND CHALLENGES

WHO recognizes that the right mix of staff is critical to carry forward the objectives of the corporate strategy and achieve organizational success. Key challenges are to provide the tools that will enable programme managers to identify their staffing requirements, plan accordingly, and recruit highly qualified staff; to support the continuous improvement of job performance at all levels of the Organization through well-targeted staff development; to provide effective, relevant and fair policies, processes and advice on human resources; to support and encourage a working environment where excellence and innovation are valued and recognized; and to ensure the security and safety of WHO staff worldwide. In order to meet the above challenges a number of reforms are under way that involve all stakeholders in their development and delivery. Future success will be largely dependent on the continued development of integrated information technology systems. Attention is being given to the design and development of such systems and to securing technology enablers to provide the levels of service required by the Organization. In order to refine and strengthen WHO's core management processes, an integrated approach within the framework of key competencies will be adopted for achieving excellence in recruitment, performance management, staff development and management and leadership improvement processes. In order to maintain WHO's position as an attractive employer, forward-looking policies and staff development programmes, rotation and mobility opportunities, and organizational tools and processes for human resources will need continued development and renewal. Competitive employment conditions should also be promoted within the United Nations common system to ensure excellence in core and support functions, and recruitment and retention of highly qualified staff. Promotion of gender parity and equitable geographical representation will require a sharper focus on diversity management. Active participation in the United Nations security management system will ensure policy input appropriate to WHO's mission. To apply best practice in all aspects of general management at all organizational levels, in support of WHO's leadership role in international health. In support of the corporate strategy, to provide effective and efficient human resources services in a timely manner. Indicator • Operational excellence in the delivery of high quality human resources services at headquarters and regional and country offices, measured using survey techniques

GOAL

WHO OBJECTIVE(S)

STRATEGIC APPROACHES

Delivery of human resources services to meet current and future organizational goals through continuous improvement of people-management capabilities, processes and systems

98

HUMAN RESOURCES DEVELOPMENT

EXPECTED RESULTS o Fundamental elements of a human resources strategic framework in place, including restructuring of human resources, contract refonn, streamlined recruitment and classification processes, construction of the key competencies framework, and identified requirements for further development o

INDICATORS Effectiveness of reform in organizational design, workforce planning, recruitment and retention of staff, in particular, increased recruitment of women and nationals from underrepresented countries, performance and career development, including rotation and mobility opportunities, and staffmanagement relations Users' acceptance of human resources reform Effectiveness of human resources information management at all levels of the Organization, including web-based management and employee self-service applications Improvement in job performance in support of organizational goals Effectiveness of key competencies framework and related applications Degree of compliance with security management processes

o

o

Core functions of a human resources information system developed and relevant processes re-engineered

o

o

o

Organization-wide strategy for leadership and staff development implemented, monitored and systematically evaluated Key competencies framework implemented globally Increased numbers of staff trained in United Nations security management system and personal securi ty

o

o

o

o

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global IS 678 16542 0% 48% 52%

Other sources 6000 20000 15% 25% 60%

All funds 21678 36542 8% 36% 56%

99

PROPOSED PROGRAMME BUDGET 2004-2005

BUDGET AND FINANCIAL MANAGEMENT ISSUES AND CHALLENGES

A major challenge is to refashion financial management, including implementation of appropriate new information technology systems, so that it responds efficiently to both changing programme requirements and the concerns of Member States, The financial framework of WHO as set out in the Financial Regulations and Financial Rules has been revised, Implementation of these revised regulations and rules now needs to continue in a consistent and efficient manner with sound internal controls in all locations of the Organization, Both flexibility and consistency are required in order to reflect the differing circumstances and needs in different locations, and to ensure that the correct balance is struck between service and controL The growth of extrabudgetary resources and increasing complexity of donor agreements places demands upon the capacity of the Organization, Staff involved in financial management must have the necessary skil1s, expertise and capability to handle the increased volume of financial resources, associated reporting and other demands this creates, Appropriate use of financial information to support the health activities of the Organization is a key to ensuring effective management by the technical areas, Financial information is one of the measures by which success in achieving objectives can be judged by Member States and others that provide financial resources or benefit from the output of the Organization,

GoAL

To apply best practice in all aspects of general management at all organizational levels, in support of WHO's leadership role in international health, To follow best practice in financial management with integrity and transparency, providing effective and efficient support for financial administration across the Organization for all sources of funds, including relevant financial reporting at all levels, both internally and externally,

WHO OBJECTIVE(S)

Indicators • • Acceptance by governing bodies of the biennial financial report, audited financial statements (including an unqualified audit opinion) and the interim financial report and statements Budget implementation and monitoring that enables Member States and other donors to judge financial performance

STRATEGIC APPROACHES

Assurance of a seamless budgetary and financial process and efficient, effective operations, with a sound accountability framework for all sources of funds and at all levels of the Organization; provision of a balanced response to the different, but equally important, requirements of Member States and donors as providers of funds, and of the Organization, at all levels

100

BUDGET AND FINANCIAL MANAGEMENT

EXPECTED RESULTS • Budget monitoring, accounting and financial reporting in operation on the basis of modem business rules and practices within a sound internal control framework in accordance with WHO Financial Regulations and Financial Rules, policies and procedures, making it possible to judge the Organization's output, in relation to budget, level of implementation, and expected results for all sources of funds Financial resOurces of the Organization effectively managed within acceptable liquidity and risk parameters in order to maximize their potential Effective and responsive financial administration of supplier contracts, claims, staff salaries, entitlements, benefits and retiree benefits • • •

INDICATORS Timeliness of provision of information Accuracy of information Acceptance by donors of timely and accurate financial reports

•

• • •

Level of earnings on liquidity as compared to benchmark Efficiency of banking operations Timeliness and correctoess of payments to staff and retirees according to their respective compensation! benefits package, suppliers and contractors in accordance with their respective contracts, and claims in accordance with entitlements rules User acceptance/sign-off on new systems Consistent services and information across all sources of funds and areas of work

•

•

New, integrated financial management and reporting systems established on the basis of modem business rules and practices that allow staff in all locations and at all levels to have access to the financial information necessary to enable them to meet their objectives

• •

RESOURCES (US$ thousand) , ,

Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 23318 22529 0% 45% 55%

Other sources 15000 26000 5% 30% 65%

All funds 38318 48529 3% 37% 60%

101

PROPOSED PROGRAMME BUDGET 2004-2005

INFORMATICS AND INFRASTRUCTURE SERVICES ISSUES AND CHALLENGES

The ability of WHO to deliver its health programmes throughout the world depends on the services it provides in infrastructure and information technology. Its diverse and decentralized environment means that staff working in information and communications technology must overcome physical and organizational boundaries in order to share knowledge and experience, systems and infrastructure. The Organization's various geographical locations affect the quality and choice of available technology services and infrastructure, and challenge the ability to provide equitable and affordable access to all WHO staff. As the Organization becomes more dependent on information technology infrastructure and application systems in the conduct of its work, the issue of security (protection) and assurance (reliability, stability) of all components becomes critical. Ensuring that "legacy systems" are adequately supported and that measures are in place to provide security and assurance of networks and other infrastructure will continue to be a priority. WHO staff are at times required to work in areas which pose high personal-security risk, and minimum telecommunications standards need to be implemented and continually reviewed to assist such staff in their work. Infrastructure services provide a range of logistical support functions, including production, printing and distribution of publications and technical, administrative and conference documents; provision of information on travel and travel policy; servicing of conferences and meetings; and general building management and maintenance. In addition to procurement of drugs and medical supplies goods and services have also to be procured and delivered worldwide. A significant portion of this work is related to emergency and humanitarian aid, when commercial alternatives are unavailable or unaffordable. Procurement services, therefore, have to be not only efficient and cost-effective, but also unusually flexible in order to cope with unpredictable demands.

GoAL

To apply best practice in all aspects of general management at all organizational levels, in support of WHO's leadership role in international health. To provide a well-managed information and communication technology environment responsive to the needs of all users. To ensure access to timely and effective infrastructure, procurement and logistical support in order to facilitate implementation of technical programmes at all organizational levels.

WHO OBJECTIVE(S)

Indicators • • • Increase in proportion of computerized systems commonly used in WHO offices based on approved global strategic and operational plans Quality of services at headquarters, regional and country offices, measured using survey techniques Appropriateness, cost-effectiveness and reliability of infrastructure and logistic support services at all organizational levels

STRATEGIC APPROACHES

Establishment of a regular Organization-wide governance mechanism to guide and monitor strategic information and communication technology plans. with phased development and delivery of systems; complementation of resources and skills at regional offices and headquarters by selective outsourcing; provision of effective infrastructure and logistic support, including accommodation, office supplies and concessions; building management; conference coordination and planning; documents production; archives, mail and security; customs, identity cards and removals; procurement; and information on travel and travel policy

102

INFORMATICS AND INFRASTRUCTURE SERVICES

EXPECTED RESULTS • APproved global strategic and operational plans in place for information and communications technology •

INDICATORS Strategic information and communication technology plans adopted for telecommunications and corporate systems in WHO, with operational plans available at headquarters and regional offices Secure access by WHO offices to common databases Electronic exchange of financial, administrative and health information between WHO offices

•

Communication network and administrative and technical systems in place linking WHO offices, in order to improve collaboration and coordination through shared information Health supplies of the highest quality at the best price procured for technical programmes and Member Stales, using mechanisms such as umbrella agreements and electronic commerce to promote a more autonomous method of purchasing

• •

•

•

Volume of direct procurement carried out by all WHO offices against centrally negotiated contracts, resulting in lower per-unit costs Level of increase of reimbursable procurement Frequency of use of mechanisms available at country level Degree of satisfaction with daily operations of all offices resulting from reliable and effective infrastructure support services Minimum time for delivery of goods from request to arrival in country of destination

• •

•

Continuing support provided for all areas of work in a rational and sustainable manner; appropriate and costeffective infrastructure and logistic support maintained for the smooth operation and security of established offices

•

•

RESOURCES (USS thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 93531 93899 0% 41% 59% Other sources 40000 64500 20% 30% 50% All funds 133531 158399 8% 37% 55%

103

PROPOSED PROGRAMME BUDGET 2004-2005

DIRECTOR-GENERAL, REGIONAL DIRECTORS AND INDEPENDENT FUNCTIONS ISSUES AND CHALLENGES A critical challenge for senior management in the biennium is to ensure the effective and creative implementation of the corporate strategy, drawing on the complementary strengths of headquarters, and regional and country offices. Such implementation will require sound stewardship of the technical agenda and upgrading of management processes in ways that are consistent with the corporate strategy, improvement of programme consistency and effectiveness, and raising awareness ofthe corporate approach. In doing so, an appropriate balance needs to be struck between the provision of global public goods and support to country-level action. Work will continue on improving the strategic basis of WHO's country work and its integration into the corporate strategy. Further, WHO has to provide the political and technical stewardship required to manage effectively an increasingly complex set of relationships with the growing number of organizations involved in international health. Innovative ways of working need to be encouraged, particularly with new partners in international health. The challenge is to trigger more effective action to improve health and decrease inequities in health outcomes, by encouraging partnerships and other forms of interaction, and by catalysing action on the part of others. Close contact will need to be maintained with Member States on carrying out the global and national health and development agendas. Another challenge is to help create, by example, an organizational culture that encourages strategic thinking, prompt action, creative networking, and innovation. The development funds of the Director-General and the Regional Directors serve as contingency financing in response to unforeseen needs and provide seed money for new initiatives. To advance global health and contribute to the Millennium Development Goals. To direct, inspire and lead all offices of WHO so as to maximize their contribution to achieving significant gains in the health status of Member States, aligned to the strategic directions of the corporate strategy, within the overall framework of WHO's Constitution.

GOAL

WHO OBJECTIVE(S)

Indicator • Extent of delivery of all areas of work set out in the Programme budget, as reflected in the endof-biennium performance evaluation

STRATEGIC APPROACHES

Interaction with government ministers and senior officials, supported by close collaboration of the seven offices through the mechanisms of the Global Cabinet (comprising the Director-General and Regional Directors) and the Global Programme Management Group (comprising Directors of Programme Management in the regional offices and senior staff at headquarters)

104

DIRECTOR-GENERAL, REGIONAL DIRECTORS AND INDEPENDENT FUNCTIONS

EXPECTED RESULTS • Resolutions and decisions of WHO's governing bodies implemented Greater coherence and synergy established between the work of the different parts of the Organization to implement the Programme budget Programme delivery carefully stewarded; and impact of the Organization's work evaluated •

INDICATORS Level of endorsement by governing bodies of regular reports on implementation of resolutions and decisions Degree of collaboration in defining expected results and work plans and use of cross-organizational systems in their implementation Extent of action undertaken on the basis of strategic reviews and programmatic, thematic and country evaluations Frequency of implementation of recommendations from internal and external audit Responsiveness to requests for legal advice and services, and frequency of implementation of this advice within the Organization's programmes

•

•

•

•

•

Organization optimally administered at all levels

•

•

Legal status and interests of the Organization better protected through timely and accurate legal advice and services

•

RESOURCES (US$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 country level at which estimated percentage spent regional global 21528 21295 0% 45% 55% Other sources 3500 4000 0% 0% 100% All funds 25028 25295 0% 38% 62%

I

105

PROPOSED PROGRAMME BUDGET 2004-2005

WHO's PRESENCE IN COUNTRIES ISSUES AND CHALLENGES WHO has offices in nearly 150 of its 191 Members States. In order to increase its impact on health development, the Organization has adopted a more strategic approach to its work at country level. WHO's country presence therefore needs to balance global and corporate policy lines and regional imperatives with national needs, realities and capacity. Heightening the role of WHO Representatives as managers, brokers, convenors and facilitators still represents a challenge and requires coherent support by all levels of the Organization. WHO's work in and with countries requires reliable information about the national context and specific health issues and involvement of key partners. Much has been done to improve WHO's country intelligence at different levels, but this information still needs to be organized, maintained, disseminated and used throughout the Organization. WHO's country cooperation strategies remain a key instrument for improving work at country level, streamlining inputs, and focusing cooperation. Formulating sound strategies based on clear policy analysis, and ensuring a strong country perspective in the allocation of technical and financial resources throughout the Organization, is a long-term process and a continuous challenge. Approaches to improving the effectiveness of cooperation at country level continue to evolve, as do relevant instruments and partnerships between agencies and countries. Although WHO is playing a key role in the dialogue on health, poverty and development, there is considerable scope for further strengthening this dialogue both within the United Nations system, and with other partners. The specific contribution of this area of work to the corporate agenda is to formulate strategies, and to catalyse coherent action for country support, including strengthening the ability of country staff for analysis, development cooperation, and partnerships. To provide support to countries for implementing sound public health policies and programmes as an integral part of overall development. To improve WHO's performance at country level through more coherent Organization-wide approaches to working in and with countries, and stronger alliances and partnerships with development agencies at country level.

GOAL

. WHO OBJECTIVE(S)

Indicator • Increase in donor support for country-based health and development initiatives as a result of WHO's contribution to work in this area at country level

STRATEGIC APPROACHES

Improving core competencies - both technical and managerial- of WHO Representatives and country teams; putting in place and maintaining country-supportive administrative and managerial systems and structures throughout WHO; increasing availability of country information and intelligence throughout the Organization; building and maintaining partnerships at country level within the United Nations system and the broader community of development agencies

106

WHO'S PRESENCE IN COUNTRIES

EXPECTED RESULTS • The Organization's presence and work in countries consistently guided by a clear counlly cooperation strategy Counlly profiles and policy briefs and information on WHO counlly presence and performance routinely available to all levels of the Organization •

INDICATORS Number of COootries implementing a WHO counlly cooperation strategy

•

• •

Availability of COoolIy profiles and counlly briefs upon request from WHO staff Availability of information on WHO counlly presence and performance for management purposes Proportion of regiona! office and headquarters staff who have worked at counlly level Mix of staff skills and presence in countries in line with COoolIy cooperation strategies

• •

Proportion of regional office and headquarters staff with counlly-level exposure increased Mix of staff skills eohanced at COoolIy level, to ensure capabilities as managers, brokers, convenors and facilitators Health components of nationa! development, poverty reduction, emergency relief and response strategies supported by clear WHO operational policies, in coordination with mechanisms such as the Common COOOIIy Assessment and United Nations Development Assistance Framework

• •

•

•

Number of coootries where national health strategies have been formulated with direct input from WHO counlly staff Availability of policies for WHO participation in joint United Nations coordination processes and mechanisms at counlly level

•

RESOURCES (U8$ thousand) Regular budget TOTAL 2002-2003 TOTAL 2004-2005 cooolly level at which estimated percentage spent regional global 92401 118830 97% 2% 1% Other sources 0 37500 80% 15% 5% All funds 92401 156330 93% 5% 2%

107

PROPOSED PROGRAMME BUDGET 2004-2005

MISCELLANEOUS

EXCHANGE RATE HEDGING PURPOSE

When the Health Assembly adopted the appropriation resolution for 2002-2003, it also adopted a new exchange rate hedging mechanism in place of the former exchange rate facility.' This new mechanism complies with the provisions of new Financial Regulation 4.4. Accordingly, a budget provision was approved in 2002-2003 for the purpose of protecting some local currency provisions from a fall in the value of the currency in which the budget and its adoption is expressed. It is proposed that a similar amount should be provided for 2004-2005.

REAL ESTATE FUND PURPOSE

The real estate operations of the Organization are financed by the Real Estate Fund, established by the Twenty-third World Health Assembly.' Funding of the Real Estate Fund used to be approved by the Health Assembly annually and separately from approval of the programme budget and its financing. After the major revision of the Financial Regulations by the Fifty-third World Health Assembly, the financing of this Fund is now part of programme budget preparation and approval (Financial Regulation 3.2). Details of requirements for the biennium 2004-2005 of US$ ... on this account and tentative plans for 2006-2007 are provided separately to the Executive Board.

INFORMATION TECHNOLOGY FUND PURPOSE

The Information Technology Fund was established by the Director-General in 2001 in line with Financial Regulation 9.3. In compliance with Financial Regulation 3.7, the amount proposed for transfer to the Information Technology Fund is reflected in the Proposed programme budget. Details of requirements for the biennium 2004-2005 in the area of information technology support for the Organization's programmes are provided separately to the Executive Board.

SECURITY FUND PURPOSE

In line with Financial Regulation 9.3 the Security Fund was set up by the Director-General for financing in 2002-2003 WHO's share of the costs of the increasingly important preventive protection of the field staff of the United Nations system. In pursuance of the concept ofa gross budget, as foreseen in Financial Regulation 3.2, this item has been included in the Proposed programme budget 2004-2005.

, Resolution WHA54.20, section A. 2

Resolution WHA23.14.

108

PROPOSED PROGRAMME BUDGET 2004-2005

DETAILED ALLOCA nON BY AREA OF WORK AND OFFICE (REGULAR Regular Area of work

Africa Country

The Americas Country

South-East Asia Country

Europe Country

Regional

Regional

Regional

Regional

Communicable disease surveillance Communicable disease prevention, eradication and control Research and product development for communicable diseases Malaria Tuberculosis Subtotal: Communicable diseases Surveillance, prevention and management of noncommunicable diseases Tobacco Health promotion Injuries and disabilities Mental health and substance abuse Subtotal: Noncommunicable diseases and mental health Child and adolescent health Research and programme development in reproductive health Making pregnancy safer Women's health mY/AIDS Subtotal: health Famil~

5365 3209 210 1927 1469 12180

I 795 I 141 380 I 131 981 5428

343 4230 0 41 0 4614

I 116 4118

2080 I 315 107 2088 1602 7192

797 333 25 707 383 2245

279 0

348 50

0 497 442 6173

0 96 325 700

0 50 828 1276

2355 241 4862 203 1346 9007 2891 1457 2906 546 2812

2457 701 692 275 I 351 5476 I 221 1666 2098 862 3017 8864 1632 932 2254 400 I 225

I 303 0 I 715 0 99 3117 36 1605 0 36 99 1776 1038 72 4416 429 0

528 400 478 0 I 536 2942 475 0 307 0 502 1284 770 I 120 I 741 463 0

3057 1508 I 545 976 996 8082 1441 636 2198 360 1858 6493 I 165 569 3502 903 1066

383 434 336 356 393 1902 797 50 523 333 708 2411 757 333 1024 298 333

495 239 284 41 592 1651 203 102 252 21 192 770 139 74 270 73 81

846 478 470 50 808 2652 528 0 558 50 I 128 2264 616 478 2706 448 490

and communi!}: 10612 2012 1880 4145 1233 2096

--

Sustainable development Nutrition Health and environment Food safety Emergency preparedness and response

Subtotal: Sustainable devel0l!ment and health~ environments Essential medicines: access, quality and rational use

11366 2072 1556 I 187 4815

6443 1609 415 1874 3898

5955 332 324 45 701

4094 249 I 338 617 2204

7205 2630 1325 891 4846

2745 433 445 469 1347

637 229 161 64 454

4738 478 578 329 1385

Immunization and vaccine development Blood safety and clinical technology Subtotal: Health technoloG~ and I!harmaceuticais

110

ANNEX

BUDGET) AND TOTAL ESTIMATE FOR OTHER SOURCES, budget Eastern Mediterranean Country Regional

2004·2005 (USS THOUSAND)

Western Pacific Country Regional

Subtotal Country Regional

Global

Total

Other sources

Grand total

1 715 743 0 1493 I 118 5069

447 650 0 640 433 2170

1334 946 0 1270 770 4320

869 199 0 I 171 997 3236

II 116 10443 317 6915 5284 34075

5372 6491 405 4196 4064 20528

9790 7382 2843 6065 2632 28712

26278 24316 3565 17176 II 980 83315

56500 104500 101500 131500 162000 556000

82778 128 816 105065 148676 173980 639315

I 154 274 1337 275 526 3566 I I I3 0 736 32 754 2635 2822 203 2559 367 669

480 417 700 357 472 2426 387 57 580 295 567 1886 508 261 I 521 372 265

I 334 444 850 326 633 3587 564 54 371 0 482 1 471 0 227 I 687 482 27

937 528 432 130 561 2588 544 52 646 40 666 1948 0 284 2149 367 108

9698 2706 10593 I 821 4192 29010 6248 3854 6463 995 6197 23757 7176 3025 16579 3487 3939

5631 2958 3 108 I 168 5121 17986 3952 1825 4712 I 580 6588 18657 4283 3408 I I 395 2348 2421

6929 3872 2625 2143 4694 20263 4107 3483 1332 I 557 5145 15624 3328 3210 10078 351 I 1712

22 258 9536 16326 5132 14007 67259 14307 9162 12507 4132 17930 58038 14787 9643 38052 9346 8072

23000 27500 33000 13000 19000 115 SOO 65000 59500 26000 I 1000 142500 304000 11000 16000 39500 I 1500 64500

45258 37036 49326 18 132 33007 182759 79307 68662 38507 15132 160430 362038 25787 25643 77 552 20846 72572

6620 I 147 1083 1406 3636

2927 517 449 655 1 621

2423 965 689 710 2364

2908 838 946 235 2019

34206 7375 5 138 4303 16816

23 8SS 4124 4171 4179 12474

21839 6507 7417 5008 18932

79900 18006 16726 13490 48222

142500 34500 428500 8000 471000

222400 52506 445226 21490 519222

111

PROPOSED PROGRAMME BUDGET 2004-2005

DETAILED ALLOCATION BY AREA OF WORK AND OFFICE (REGULAR Regular Area of work

Africa Country Regional

The Americas Country Regional

South-East Asia Country

Europe Country

Regional

Regional

Evidence for health policy Health infonnation management and dissemination Research policy and promotion Organization of health services Subtotal: Evidence and information for I!olicl Governing bodies Resource mobilization, and external cooperation and partnerships Subtotal: External relations and governing bodies Programme planning, monitoring and evaluation Human resources development

662 297 206 19649 20814 0 398 398 0 0 0 0 0 0

I 505

2676 0 0 11409 14085 0 0 0 0 0 0 0 0 0

1276 2162 402 4468 8308 280 I 148

1627 94 801 12256 14778 0 792 792 380 0 0 0 380 0

846 888 483 2578 4795 250 361 611 836 718 859 2928 5341 I 396

532 72 0 1445 2049 0 567 567 0 0 0 0 0 0

3781 4799 290 2926 11 796 656 528 1184 I 328 2271 I 528

3677 716 7512 13 410 1374 2 Oil 3385 807 2442 3600 12878 19727 1714

1428 0 639 I 616 2701 4956 771

Budget and financial management Informatics and infrastructure services

8703 13 830 I 195

Subtotal: General management Director-General, Regional Directors and independent functions Subtotal: Director-General, ReG!onal Directors and indel!endentfunctions WHO's presence in countries Subtotal: WHO's I!resence in countries Unallocated until after the regional committee meetings

0 54087 54 087

1714 1094 1094

0 10083 10083

771 0 0

0 18608 18608

1396 0 0

0 6398 6398

1195 786 786

TOTAL: Substantive areas of work Exchange rate hedging Real Estate Fund Information Technology Fund Security Fund Subtotal: Miscellaneous GRAND TOTAL Regional totals

123279 0 0 0 0 0 123279

69439 0 0 0 0 0 69439

40331 0 0 0 0 0 40331 72491

32160 0 0 0 0 0 32160

68376 0 0 0 0 0 68376 91 169

22793 0 0 0 0 0 22 793

13 226 0 0 0 0 0 13 226 54332

41106 0 0 0 0 0 41106

192718

112

ANNEX

BUDGET) AND TOTAL ESTIMATE FOR OTHER SOURCES, 2004-2005 (US$ THOUSAND) (continued) budget Eastern Mediterranean Country

Western Pacific Country

Subtotal Country Regional

Global

Total

Other sources

Grand total

Regiona.l

Regional

901 618 1269 12379 15167 0 183 183 0 0 0 0 0 0 .

959 1348 453 4771 7531 230 745 975 690 I 051 1 341 5372 8454 2568

431 10 59 11 390 11890 0 1 014 1014 0 0 0 0 0 0

878 1640 255 3602 6375 465 1780 2245 265 782 1 155 6143 8345 I 918

6829 1091 2335 68528 78783 0 2954 2954 380 0 0 0 380 0

9245 14514 2599 25857 52215 3255 6573 9828 3926 7903 10099 38725 60653 9562

11 902 13273 3953 9664 38792 18599 14343 32942 2583 8639 12430 55174 78826 11 733

27976 28878 8887 104049 169790 21854 23870 45724 6889 16542 22529 93899 139859 21295

54000 18000 10000 56500 138500 3000 11 000 14000 2500 20000 26000 64 500 113000 4000

81976 46878 18887 160549 308290 24854 34870 59724 9389 36542 48529 158399 252859 25295

0 14150 14150

2568 0 0

0 12505 12 505

1918 149 149

0 115831 115831

9562 2029 2029

11 733 970 970 5422

21295 118830 118830

4000 37500 37500

25295 156330 156330

5000 51026 0 0 0 0 0 51026 30558 0 0 0 0 0 30558 39574 0 0 0 0 0 39574 71305 31731 0 0 0 0 0 31731 340812 0 0 0 0 0 340812 227787 0 0 0 0 0 227787

10422 842654 10000 3000 0 0 13000 855654

0 1896000 0 0 0 0 0 1896000

10422 2738654 10000 3000 0 0 13000 2751654 .

274055 10000 3000 0 0 13000 287055

81584

113

PROPOSED PROGRAMME BUDGET 2004-2005

114

WPRlRC53/4 ANNEX 2

WORLD HEALTH ORGANIZATION

PROPOSED PROGRAMME BUD GET

2004 - 2005

PART

2

REGIONAL OVERVIEW

WORLD HEALTH ORGANIZATION

PROPOSED PROGRAMME BUD GET

2004 - 2005

PART 2

REGIONAL OVERVIEW

TABLE OF CON11:Nn

page Introduction to Part 2 Combating communicable diseases I. 2. 3. 4. 5. Expanded programme on immunization Malaria, other vectorborne and parasitic diseases Stop TB and leprosy elimination Sexually transmitted infections, including HIV/AIDS Communicable disease surveillance and response 3

iii

6 11 14 16

Building healthy communities and populations 6. 7. 8. 9. Healthy settings and environment Child and adolescent health and development Reproductive health Noncommunicable diseases and mental health 18 21

23 25

10. Tobacco Free Initiative Health sector development 11. Health systems development and financing 12. Health technology and pharmaceuticals 13. Human resources for health 14. Health information and evidence for policy 15. Emergency and humanitarian action Reaching out and programme management 16. Information technology 17. External cooperation and partnerships 18. Public information 19. Programme planning, monitoring and evaluation Administration and finance 20 Budget and finance 21. Personnel 22. General administration 23. Supply Regional Director's Office and Regional Committee 24. Regional Director's Office and Development Programme 25. Regional Committee

28 30 32 35

37 39

41

43 45

47 49 51 53 54

55

57

Appendices Appendix 1. Conversion table, Western Pacific regional focuses to global areas of work, 2004-2005, regular budget (regional and intercountry allocations) Appendix 2. Conversion table, global areas of work to Western Pacific regional focuses, 2004-2005 regular budget (regional and intercountry allocations) 61 63

The designations employed and the preparation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities,or concerning the delimitation of its frontiers or boundaries.

ii

IN1RODUcnON70PART2

INTRODUCTION TO PART 2

The regional overview presented in this Annex explains the main issues and challenges facing the Region and the strategies that WHO intends to employ to address them. This document is intended to inform the Regional Committee and to facilitate the process of preparing the country and intercountry strategic programme budgets, which will commence in late 2002. In preparing this overview, the General Programme of Work 2002-2005 and WHO in the Western Pacific Region: A framfMork for action (WPRlRC50/2) have provided the global and regional orientations respectively. Headquarters and the six regions contributed to the preparation of the global proposed programme budget 2004-2005 (Part I), which has been used as a framework for this regional overview. Throughout Part 2 there are strong links to the global proposed programme budget. For example, the goal for the corresponding area of work has generally been used as a reference for the goal for the relevant focus and frequently the regional WHO objective has been derived from the global WHO objective, taking into account regional needs. As for the 2002-2003 biennium, the programme budget for the Region is presented under themes and focuses. However, for the 2004-2005 biennium, the focus on Health systems reform has been split into two new focuses: Health systems development and financing, and Health technology and pharmaceuticals. Another new focus, Programme planning, monitoring and evaluation, has been added. Additional details are provided for Administration and finance, Regional Director's Office and Regional Committee. The relationship to the corresponding area(s) of work is clearly indicated under the heading for each focus. Appendix 1 also provides a conversion table showing the relationship of the focuses in the Western Pacific Region to the 35 global areas of work. Appendix 2 provides a conversion table showing the relationship of the 35 areas of work to the focuses and the regional and intercountry financial allocations for each of the 35 areas of work.

•

Budgetary aspects

The regional allocation for the Western Pacific Region for 2004-2005 is US$ 71305000, which is 2.7% less than the allocation for 2002-2003. The reduction is a result of resolution WHA51.31, which recommended that regional allocations in future budgets be guided by a model and that implementation of the revised allocation should take place over a period of three bienniums, beginning in 2000-2001. As a result of this resolution, the regional allocation has decreased from US$ 80 279 000 in 1998-1999 to USS 71305000 in 2004-2005, a reduction of about US$ 9 million. Of the total regional allocation, 55.5% has been allocated to country activities. The remaining 44.5% has been allocated to regional and intercountry activities (Table I). Since 1998-1999, the distribution of the regional allocation between country activities and regional and intercountry activities has remained relatively constant (e.g. in 1998-1999, the ratio was 55.4:44.6).

111

PROPOSED PROGRAMME BUDGET 2004-2005.. PART 2

Table 1. Distribution of regional allocation 2002-2003 and planning figures for 2004-2005 by organizatlonalleyel (regular budget)

2002·2003 Approved Budget US$ % of total budget

2004-2005 Proposed Budget US$ % oltolll budget

I.

DISTRIBUTION OF REGIONAL AlLOCATION Country activities (including WHO's presence in countries) Regional and intercountry activities Total

40660 000 32602000 73262000

55.50 44.50 100.00

39574000 31731000 71305000

55.50 44.50 100.00

II.

DISTRIBUTiON OF COUNTRY ACTIVITIES Country programmes WHO's presence in countries Total

32275000 8385000 40660000

44.05 11.45 55.50

27069000 12505000 39574000

37.96 17.54 55.50

III.

DISTRIBUTION OF REGIONAl AND INTERCOUNTRY ACTMTIES Regional DirectOl's development programme Regional Committee Regional Office and intercountry activities Total

1000000 465000 31137000 32602000

1.37 0.63 42.50 44.50

900 000 465000 30366 000 31731000

1.26 0.65 42.59 44.50

iv

INTRODUC110N TO PART 2

Table 2. Allocation of resources to themes, 2002-2003 and 2004-2005 Regular budget Themes Other SOUI'I:es

ROnCp USS

2002·2003 Country US$

Total US$

RO/ICP USS

2004-2005 Country" US$

Total" US$

2002·2003 2004-2005* US$ US$

Combating communicable diseases Building healthy communities and populations Health sector development Reaching out and programme management Administration and flnance Regional Director's office and Regional Committee TolIl

4629000 6406 700 11035 700 4848000 7255000 9068000 16323 000 6670000 6135000 16529300 22 664300 5916000 4901000 8656000 13557000 4691000 7132000 2550000 0 7132000 7223000 0 2550 000 2383000

24220 000 7550000

7500000 2000 000 1800000

32602000 40660 000 73262000 31731000 39 574 000 71305000 43 070 000

*To be provided for the fifty-fourth session of the Regional Committee

v

PROPOS£[) PROGRAMME BUDGET 2004-- 2005: PART 2

Table 3. Allocation of funds from the regular budget to themes and focuses for Regional Office and intercountry programmes

Regular budget Themes and focuses

2002·2003 US$

2004-2005 % US$

Increase (Decrease)

%

US$

%

THEME: COMBATING COMMUNICABLE DISEASES Expanded programme on immunization Malaria, other vectorbome and parasitic diseases Stop TB and leprosy elimination Sexually transmitted infections, including HIV/AIDS Communicable disease surveillance and response Sub·total THEME: BUILDING HEALTHY COMMUNITIES AND POPULATIONS Healthy settings and environment Child and adolescent health and development Reproductive health Noncommunicable diseases and mental health Tobacco free initiative Sub·total THEME: HEALTH SECTOR DEVELOPMENT Health systems development and financing Health tecihnology and pharmaceuticals Human resources for health Health information and evidence for policy Emergency and humanitarian action Sub-total

1 051 000 980000 1107000 645000 846000 4629 000

3.22 3.01 3.40 1.98 2.59 14.20

946 000 1306 000 1 061 000 666000 869000 4848000

2.98 4.12 3.34 2.10 2.74 15.28

( 105000) 326000 (46000) 21000 23000 219000

(9.99) 33.27 (4.16) 3.26 2.72 4.73

3615000 993000 793000 1604 000 250 000 7255000

11.09 3.04 2.43 4.92 0.77

3078000 828000 738 000 1498 000 528000 6670000

9.70 2.61 2.33 4.72 1.66 21.02

(537000) (165000) (55000) (106 000) 278000 (585 000)

(14.85) (16.62) (6.94) (6.61) 111.20 (8.06)

22.25

1950 000 1015000 1974000 1099000 97000 6135000

5.98 3.11 6.06 3.37 0.30 18.82

1632000 1073000 1970000 1133000 108000 5916000

5.14 3.38 6.21 3.57 0.34 18.64

(318000) 58000 (4000) 34000 11000 (219000)

(16.31) 5.71 (0.20) 3.09 11.34 (3.57)

vi

INTRODUCTIONTOPART2

Table 3. Allocation of funds from the regular budget to themes and focuses for Regional Office and intercountry programmes (confd) Regular budget Themes and focuses

2002·2003 US$ %

2004-2005 US$

Increase (Decrease)

'/0

US$

%

THEME: REACHING OUT AND PROGRAMMEMAHAGEMENT Information lechnology Extemal cooperation and partnerships Public information Programme planning, monitoring and evaluation Sub-iotal

1622000 1176000 1 855 000 248000 4901000

4.98 3.61 5.69 0.76 15.04

1187000 1146000 1944000 414000 4691000

3.74 3.61 6.13 1.31 14.79

(435000) (30000) 89000 166000 (210000)

(26.82) (2.55) 4.80 66.94 (4.28)

ADMINISTRATION AND FINANCE Budget and finance Personnel General administration Supply Sub-total

1409000 686 000 4397000 640000 7132 000

4.32 2.10 13.49 1.96

1 155000 782000 4689000 597000 7223000

3.64 2.46 14.78 1.88 22.76

(254 000) 96000 292000 (43000) 91000

(18.03) 13.99 6.64 (6.72) 1.28

21.87

REGIONAl DIRECTOR'S OFFICE AND REGIONAl COMMITTEE Regional Director's Office and development programme Regional Committee Sub-total Total

2085000 465000 2550000 32602000

6.40 1.42 7.82 100.00

1 918000 465000 2383 000 31731000

6.04 1.47 7.51 100.00

( 167000) 0 (167000) (871 000)

(8.01) 0.00 (6.55) (2.67)

VJl

Focuses

1. EXPANDED PROGRAMME ON IMMUNIZATION

1. EXPANDED PROGRAMME ON IMMUNIZATION (Global area of work: Immunization and Vaccine Development)

Maintaining the Region's polio-free status and developing more aggressive control strategies for other diseases such as measles and neonatal tetanus remain programme priorities. The efforts that led to certification of polio-free status must be built on to ensure that the systems, networks and skills developed for poliomyelitis eradication are carried through to routine services and other disease control initiatives. Since the Western Pacific Region was certified as polio-free on 29 October 2000, all countries have continued activities to sustain the Region's polio free status. As a result, most countries are able to report on continued high-quality surveillance, inununization and laboratory containment. However, the quality of surveillance remains less than optimal at the subuational level in some countries. It should also be noted that routine inununization with oral poliovirus vaccine (OPV) at the national and subnational levels and the extent of supplementary inununization activities may not always provide sufficient population inununity among all high-risk groups in order to prevent the spread of imported wild poliovirus, or the emergence of circulating vaccine-derived poliovirus. This was the situation in the Philippines in 2001 when three cases of acute flaccid paralysis (AFP) associated with circulating vaccine-derived poliovirus (cVDPV) isolates were reported. The circulation ofVDPV represents a challenge to the polio-free status of the Philippines and of the Western Pacific Region. VDPV can occur only when pockets of unvaccinated children provide an opportunity for the vaccine-derived virus to circulate over a sustained period of time and eventually to mutate. VDPV is very similar to wild poliovirus in the way it is transmitted and in its neurovirulence characteristics. Because of the threat posed by both the importation of wild poliovirus and the potential for VDPV outbreaks, it remains imperative that AFP surveillance quality and laboratory performance continue to be maintained at high levels in the future. This will be a challenge, as countries may become complacent following certification. In year 2001, 175567 measles cases were reported in the Region. WHO continues to work towards the global goal of halving the annual number of measles deaths by 2005 from 1999 estimates and maintaining interruption of indigenous measles transmission in large geographic areas with established elimination goals. Most countries and areas in the Region have reached the elimination goal for neonatal tetanus (NT). However, neonatal tetanus is still a public health problem in Cambodia, China, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, and VietNam. Hepatitis B vaccine has been successfully introduced in all countries in the Region, but some countries still do not have countrywide coverage. At the same time other new vaccines are becoming available. Appropriate vaccines need to be integrated into inununization programmes wherever they are needed. The Global Alliance for Vaccines and Immunization (GA VI) and its Vaccine Fund have provided funds for adding new vaccines and strengthening inununization services.

ISSUES AND CHALLENGES

3

PROPOSED PROGRAMME BUDGET 2004-2005: PART2

Substantial progress has been made in implementing immunization safety strategies in the Region. WHO recommendations for the use of auto-disable syringes and safety boxes followed by appropriate waste disposal have been adopted (to various degrees) by most Member States. However, it is estimated that up to one-third of vaccination injections are still not carried out in a way that can guarantee sterility. One of the main challenges to immunization programmes in the Region is the continuing need for financial and human resources to strengthen routine immunization services and vaccine-preventable disease surveillance as well as to support special supplementary immunization services.

REGIONAL GOAL

To protect all people at risk against vaccine-preventable diseases.

WHO REGIONAL OBJECTIVE(S)

(1)

To ensure that Member States control and, where feasible, eradicate vaccinepreventable diseases. To enable governments to sustain national immunization programmes and improve quality. To facilitate expansion of the scope of immunization services.

(2) (3)

INDICATORS

(1)

Number of countries and areas supported that have adopted national EPI disease control and safe injection activity plans. Number of countries and areas reporting poliomyelitis cases. Number of countries and areas that report reductions in measles cases. Number of countries and areas that have eliminated neonatal tetanus as a public health problem. Number of countries and areas that have good routine immunization coverage, as indicated by over 90% DPT3 coverage of children under one year. Number of countries and areas supported that have fully integrated hepatitis B vaccine into their EPI programmes.

(2) (3) (4) (5) (6)

STRATEGIC APPROACHES

(1)

Strengthen the sustainability of services through advocacy for adequate national funding and for appropriate funding mechanisms, as well as for resources from partner agencies, and maximize the benefits of the Global Alliance for Vaccines and Immunization/Global Fund for Children's Vaccines (GAVIIGFCV). Improve disease surveillance systems by supporting the extension of active surveillance, developing national laboratories, and integrating other surveillance for vaccine-preventable diseases in the acute flaccid paralysis surveillance system. Support strengthening of planning and management of national programmes to improve sustainability, disease control capacity, and the delivery and monitoring of immunization services. Work with governments to develop medium-term plans for national immunization programmes. Support improvements to the quality of immunization services by: (a) improving the safety of immunization; (b) establishing and maintaining an effective cold chain and good vaccine handling procedures; and (c) ensuring that vaccines used are of good quality and that safety is well monitored.

(2)

(3)

(4)

4

1. EXPANDED PROGRAMME ON lMMUNIZA770N

(5)

(6)

Maintain support for high levels of routine immunization coverage and for supplementary activities, including large-scale campaigns, to reduce susceptible populations rapidly, decrease the focal areas of risk, and respond to outbreaks of all vaccine-preventable diseases. Assess new vaccines and interventions for their potential use in disease control, and examine the operational implications.

1. Expanded programme on immunization: proposed resources by source of funds Regular budget Other sources Increase (Decrease)

Organizational level

2002·2003

2004-2005

2002·2003 %

2004-2005

US$ Country or area Regional and intercountry Total

US$

US$

USS

US$

844 500 1051 000 946000 (105000)

(9.99) (5.54) 8000 000

1895500

946 000

(105000)

5

PROPOSEDPROGlUMME BUDGETZOO4-2005: PARTZ

2. MALARIA, OTHER VECTORBORNE AND PARASITIC DISEASES (Global areas of work: Communicable disease prevention, eradication and control; Malaria)

.

ISSUES AND CHALLENGES

The focus covers several major public health problems: malaria, dengue, intestinal parasitism, lymphatic filariasis, schistosomiasis, foodborne trematodes and some other parasitic and vectorborne diseases. All these diseases have a major impact on health and are closely associated with poverty. In the Western Pacific Region malaria was greatly reduced in the 1990s as a result of increased investment in malaria control, general economic progress and other contextual changes. However, the disease is still endemic in 10 countries, causing an estimated 20 000 deaths per year. In the Pacific, it is widespread in Papua New Guinea, Solomon Islands and Vanuatu. In the endemic South-east Asian countries, malaria is found mainly in remote hilly areas among ethnic minorities and migrants, but also in some coastal areas. In the Pacific and tropical Asia, falciparum malaria and vivax malaria co-exist, the former being more important, because it is frequently fatal, and more common. Vivax malaria persists as a focal problem in some areas of central China and re-emerged in 1992 in the Republic of Korea, where it had been eradicated in the 1970s. The main challenge to malaria control in the Pacific is to increase coverage with selective vector control, especially in the form of insecticide-treated mosquito nets, in particular in Papua New Guinea, where little progress has been made during the last 10 years and to maintain coverage in the Solomon Islands, which has been plagued by serious security problems since 2000. It is hoped that the introduction of long-lasting nets will make these tasks easier. In the epidemic-prone highland areas of Papua New Guinea, it is necessary to reestablish surveillance and response capacity mainly with residual house spraying. In Southeast Asian countries, multi-drug resistance is steadily increasing; the emerging solution is to treat falciparum malaria cases immediately with effective combination treatment preceded by specific diagnosis by rapid tests or microscopy. As most at-risk populations are ethnic minorities or migrants, it is necessary to pay more attention to communication and to innovative methods for service delivery as well as to improve the situation assessment and monitoring of coverage with services. One example of this would be to combine the use of geographic information systems with traditional information systems. In several countries, malaria control programmes have been negatively affected by health systems reform that has often included decentralization without increasing allocations for the poorest people at highest risk. Malaria control progranunes need to articulate their needs more clearly to general health planning and poverty reduction programmes and to communicate the dangers of malaria resurgence if investment in malaria control is reduced. Dengue is increasing and spreading because of increasing urbanization that has led to a proliferation of breeding places. Every year approximately 15 countries and areas report cases of the disease. In 2000 there were 24 000 cases with 52 deaths reported to WHO. The case fatality rate is above 4% in some parts of the affected countries, because of delays in admitting people with dengue to hospitals. Far fewer cases were reported in 1999 and 2000 than in 1998, but an epidemic like that in 1998 could occur at any time. In 200 I and 2002, the numbers of cases have increased again, without reaching 1998 levels at the time of writing. Poor environmental hygiene in many urban areas makes it extremely difficult to carry out effective vector control; control progranunes and municipalities continue wasting money on space spraying activities, which are popular and almost ineffective. More research is needed to determine transmission thresholds to improve anti-vector activities.

6

2. MALARIA, OrnER VEcroRBORNE AND PARAsmC DISEASES

Lymphatic filariasis causes a disfiguring and debilitating disease. It is endemic in many Pacific countries and in parts of Cambodia, Lao People's Democratic Republic, Malaysia, the Philippines and Viet Nam. In China, however, the disease has been virtually eliminated. In the Pacific island countries, previous attempts to control the disease using mass drug administration were only partially successful and once the campaigns stopped, transmission resumed. The challenge to control is to maintain mass drug administration in endemic areas for five years with very high population coverage. Soil-transmitted helminth infections are almost universal in tropical and subtropical areas, especially among the rural poor. They contribute to anaemia, chronic ill health and reduced school performance. School-age children and women are at highest risk. Control measures including twice-annual administration of inexpensive drugs to high-risk groups have proved to be highly effective in reducing the disease burden. The main challenge is to increase the coverage of this simple intervention to cover all populations at risk. A recent Pacific survey of school children in the age group of 5-12 revealed wide variations in the prevalence of intestinal helminths. Prevalence ranged from 9%-95% and this clearly highlights the challenges ahead, especially in improving the sanitation and hygiene practices in communities and schools. There is scope for combining helminth interventions with the Pacific Programme for the Elimination of Lymphatic Filariasis since the drug albendazole has an impact on both diseases. Foodbome trematodes, including paragonimiasis, clonorchiasis and opisthorchiasis, are major problems in Viet Nam, the Lao People's Democratic Republic, the Philippines and parts of China where eating raw or undercooked fish and shellfish is common. In the same countries, zoonotic infections such as cysticercosis and echinococcosis are also increasing in importance. These problems are local and mainly rural and povertyassociated, but are becoming more common in urban areas as a result of changes in lifestyle linked with economic growth.

(I) (2)

To eliminate mortality from malaria and dengue. To reduce morbidity from all parasitic and vectorborne diseases to such an extent that they are no longer major public health problems.

REGIONAL GOALS

Malaria (1)

WHO REGIONAL OBJECTIVES

To reduce morbidity and mortality by at least 50% by 2010, compared with 1998. To reduce morbidity and mortality in all endemic countries by at least 20% by 2005, compared with 2000.

(2)

Dengue (I) To reduce incidence rates of dengue fever and dengue haemorrhagic fever by at least 20% in all endemic countries (2001-2005 average compared with 19962000). To reduce the case fatality rate of dengue haemorrhagic fever to less than 1% in all endemic countries.

(2)

7

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

Lymphatic fLIariasis To eliminate lymphatic filariasis from the Pacific by 2010 and from the rest of the Region by 2020.

Other parasitic diseases (1) (2) To provide annual treatment to at least 75% of school-age children at risk for soil transmitted helminths by 2010. To consolidate low schistosomiasis endemicity in Cambodia and the Lao People's Democratic Republic, to improve transmission control in China, and to protect atrisk groups in the Philippines. To reduce morbidity due to foodbome trematodes, and to introduce triclabendazole for human use in fascioliasis endemic countries.

(3)

INDICATORS

Malaria (I) (2) Number of endemic countries with annual malaria incidence and malaria-related death rate reduced by 25% in 2004 compared with 1998. Number of countries with malaria incidence and malaria-related death rates reduced by 20% in 2005, compared with 2000.

Dengue (1) (2) Number of countries achieving 20% reduction in average incidence rate over 2001-2005, compared with 1996-2000. Number of countries with dengue haemorrhagic fever case fatality rate below 1%.

Lymphatic fLIariasis (I) (2) Number of Iymphatic-filariasis-endemic countries in the Region achieving elimination of the disease by 2005. Number of countries implementing a national programme for elimination of lymphatic filariasis.

Other parasitic diseases (l) (2) (3) Number of countries that can document 75% coverage with annual anti-helminthic treatment of school-age children at risk. Number of countries implementing a national helminth control programme. Prevalence of schistosomiasis-related liver fibrosis found by ultrasound sample surveys in sentinel villages reduced by at least 50% by 2005, compared with 2000.

8

2. MALARIA, OlliER VECTORBORNE AND PARAsmC DISEASES

(4) (5)

Documented reduction in prevalence of clonorchiasis-related liver abnormalities, found by ultrasound sample surveys in sentinel villages. Number offascioliasis endemic countries with Triclabendazole registered.

Malaria (I) Support management of multidrug-resistant falciparum malaria in multidrugresistant areas with early specific diagnosis and combination therapy to reduce mortality and delay increasing resistance. Work with countries to ensure high coverage, good targeting and timing and correct use of insecticide-treated mosquito nets or other locally appropriate vector control methods to reduce incidence and prevent epidemics. Work with countries to strengthen local financing and to improve malaria control in the context of health sector reform to ensure sustainability and maximize cost effectiveness.

STRATEGIC APPROACHES

(2)

(3)

Dengue (I) (2) (3) (4) Encourage mobilization of other sectors and the community to control dengue by reducing breeding sites. Support countries and areas to produce and implement epidemic preparedness and response programmes. Promote the strengthening of surveillance, including public health laboratory networks. Work towards improved case management by circulating improved treatment guidelines.

Lymphatic filariasis (1) (2) Ensure that the elimination programme in the Pacific, which started in 1999, is carried through to its goal. Raise funds for and support the implementation of elimination programmes in Cambodia, the Lao People's Democratic Republic, Malaysia, the Philippines and VietNam.

9

PROPOSED PROGRAMME BUDGET2004-2005: PART 2

Other parasitic diseases (I)

For soil-transmitted helminthiasis, support national programmes through periodic mass distribution of antihelminthic drugs in schools as part of health-promoting schools activities; and work with countries and areas to review and finalize national plans for helminths. For schistosomiasis, support epidemiological surveillance in endemic areas through routine reporting by the general health services using appropriate parasitological and morbidity indicators. For foodbome trematodes and zoonotic infections, carry out epidemiological assessments and evaluate their public-health importance.

(2)

(3)

2. Malaria, other vectorborne and parasitic diseases: proposed resources by source of funds Regular budget Organizational level Other sources Increase (Decrease) USS %

2002-2003 USS

2004-2005 US$

2002-2003 USS

2004-2005 USS

Country or area Regional and intercountry Total

2252200 980000 1306000 326000 (9.29) (9.29)

3232200

1306 000

326000

4000000

10

3. STOPTBANDLEPROSY£UMlNA710N

3. STOP TB AND LEPROSY ELIMINATION (Global areas of work: Communicable disease prevention, eradication and control; Tuberculosis)

Tuberculosis One in three people with tuberculosis (TB) lives in the Western Pacific Region. About 1000 people in the Region die of TB every day. It is estimated that there were about 2 million new cases in the Region in 2000 and, of these, about 860 000 were smear positive. However, the number of reported cases is much lower. In 2000, 804 532 cases (all types) were reported, of which 384 755 were smear-positive. In addition, the TB burden is not declining even in industrialized countries, due to such factors as rapid urbanization, ageing and migration. The percentage of newly detected patients enrolled in directly observed treatment, shortcourse (DOTS) in the Region increased from 69% of all new cases in 1999 to 74% in 2000. However, a quarter of TB patients are still not enrolled in DOTS. To provide DOTS services to all patients it will be crucial to secure free drug supplies and strengthen national capacity in countries with a high burden ofTB. A major goal for the WHO Stop TB special project is to reduce the prevalence and deaths due to TB by 50% in 10 years, from 1999 levels, thereby contributing to poverty reduction. In order to reach this goal, it will be necessary to provide DOTS to all TB patients in the Region by 2005. If this is to be achieved, it is critically important that countries with a high TB burden are able to secure a regular supply of TB drugs with the support of Stop TB partners. The Global Fund to Fight AIDS, TB and Malaria is one possible way of filling the gap between resources needed and resources available. TB is the most common opportunistic infection associated with HIV and increasing rates of co-infection are a growing challenge. So too is the emergence of multidrug resistance. Twelve countries and areas reported data on HlV and TB in 2000. Surveys conducted between 1995 and 2001 have revealed resistance to any drug among newly diagnosed TB cases in 12 countries in the Region, with a population adjusted mean of 19.4%. Resistance in countries of the Region ranged from 4.8% to 32.9%, indicating extensive transmission of drug-resistant tuberculosis.

ISSUES AND CHALLENGES

Leprosy The global goal of elimination of leprosy as a public health problem (prevalence of less than 1 case per 10000 population) was accomplished at the regional level by 1991. By the end of 2000, the goal was achieved at the national level by 35 of the 37 countries and areas in the Region. The total number of registered cases decreased by 95% between 1988 and 2000. To deal with the new cases that are expected to occur in the community for many years after e1imination, a post-elimination surveillance system based on a protocol developed at the Regional Office has been implemented on a pilot basis in selected provinces of Cambodia. It has been extended to some provinces in the Lao People's Democratic Republic and Viet Nam. The Leprosy Elimination Monitoring exercise in Viet Nam validated existing data and indicated that there has been a significant decline in new case detection and prevalence following elimination.

11

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

It will be essential to maintain resource mobilization, technical expertise, motivation of

health workers and public awareness. Identification and elimination of highly endemic pockets at the subnational level, and complete integration of leprosy control measures into general health services, will also be needed.

REGIONAL GOAL

Tuberculosis To reduce the prevalence and deaths due to TB by 50% by 2010, from 1999 levels.

Leprosy To eliminate leprosy as a public health problem in all countries and areas of the Region and to develop a post-elimination surveillance system.

WHO REGIONAL OBJECTIVE(S)

Tuberculosis (I) (2) (3) To strengthen TB control programmes so that at least 70% of estimated smearpositive pulmonary cases are detected. To ensure that 100% of newly detected cases are enrolled in DOTS programmes and that drug supplies are secure. To achieve a treatment success rate for smear-positive cases of at least 85%.

Leprosy (I) Reduce leprosy prevalence further by identifying and targeting all clusters of leprosy and introducing post-elimination surveillance systems in selected countries.

INDICATORS

Tuberculosis (I) (2) (3) Enrolment rate of detected TB cases in DOTS programmes. Regional case detection and cure rates. Number of countries securing regular supplies of drugs.

Leprosy (I) (2) Number of countries that reach a prevalence rate of less than 1 case per 10 000 population. Number of countries that introduce post-elimination surveillance systems.

12

3. STOP TB AND LEPROSY EUMINATION

Tuberculosis (I) (2)

STRATEGIC APPROACHES

Provide technical support to expand DOTS and to maintain the quality of its implementation. Support free access to tuberculosis treatment and quality assurance of drug supplies. Implement innovative approaches and develop new policies and strategies to address emerging challenges such as TBIHIV co-infection and multidrug-resistant TB. Strengthen advocacy and social mobilization to ensure adequate national [mancial resources are devoted to tuberculosis control. Support the strengthening of national tuberculosis control programmes, the improvement of tuberculosis surveillance and the promotion of tuberculosis control.

(3)

(4) (5)

Leprosy (I)

In countries that have achieved elimination, introduce and develop sustainable post-elimination surveillance systems at national and subnational levels to ensure detection and treatment ofthe few cases that may occur. Strengthen management capacity at national and subnational levels in countries and areas that have not reached the goal of elimination. Support governments in implementing leprosy elimination campaigns in highly endemic areas, and special action projects for difficult to reach areas.

(2) (3)

3. Stop T8 and leprosy elimination: proposed resources by source of funds Regular budget Organizational level 2002-2003 US$

Other sources Increase (Decrease) US$

2004-2005 US$

2002-2003 % US$

2004-2005 US$

Country or area Regional and intercountry

1 072600 1107000 2179600 1 061 000 1061000 (46000) (46 000) (4.16) (2.11) 4200 000

Total

13

PROPOSED PROGRAMME BUDGET2004-2005: PART 2

4. SEXUALLY TRANSMITTED INFECTIONS, INCLUDING mY/AIDS (Global area of work: HIV /A1DS)

ISSUES AND CHALLENGES

In the Western Pacific Region, an estimated 1.2 million people were living with HIV/AIDS at the end of 2001. The majority of infected individuals were men, although the ratio of women to men in reported cases is steadily increasing (from 1:6 before 1997 to 1:4.7 in 2001). It is estimated that about 40 000 people died of AIDS in 2000 and that this will rise to about 130000 annually by 2005. Currently, there are increasing HIV epidemics in several countries, particularly in China, Malaysia, Papua New Guinea and Viet Nam. In Cambodia, HIV transmission has started to decrease. Although most countries in the Region have an estimated HIV prevalence rate of less than 1% among the 15-49 year old population, data from 2000 showed high STI prevalence among high-risk groups (e.g. 80% of sex workers in Kunming, Yunnan, China have at least one STI) and even among low-risk groups (one third of women attending antenatal clinics in Samoa and Vanuatu had at least one STI), and demonstrated the significant potential for an increasing HIV epidemic. High STI prevalence may also indicate the presence of high-risk sexual behaviour. A major challenge to efforts to reduce STI is the need for further condom promotion and for proper diagnosis and treatment of STI. Marked increases in HIV infection have been seen among sex workers and injecting drug users (lDUs) in countries such as China, Malaysia and Viet Nam. A major factor driving these increases is the low level of consistent condom use in sex work and a high frequency of sharing of injecting equipment (100% in some areas in China). WHO will continue to promote the 100% condom use strategy in establishment-based sex work in the Region, in particular to scale-up the intervention in priority countries. For IDUs, areas that need further focus include mobilization of resources for country implementation, and advocacy for government commitment in supporting harm reduction. As the epidemic grows, the number of AIDS cases increases. This means more efforts will have to be directed at AIDS care, particularly in Cambodia, and in selected areas of China, Malaysia, Papua New Guinea and Viet Nam. Expansion of HIV/AIDS care should be accompanied by expansion of Voluntary Counselling and Testing (VCT). The major challenges for HIV/AIDS care are to improve access to antiretroviral (ARV) treatment and to develop comprehensive HIVIAIDS care. These are prerequisites for effective implementation of ARV and for preventing emergence of ARV resistance, and transmission of HIV resistant strains. The Global Fund for AIDS, Tuberculosis and Malaria offers major opportwllties but submitting proposals to the Global Fund and implementing and monitoring projects are also major challenges for Member States and WHO.

REGIONAL GOAL

To have halted the spread of HIVIA IDS by 2015.

14

4. SEXUALLY TRANSMI1TED INFECTIONS,

INCLUDING HIV/AIDS

(1)

To stabilize or reduce STIIHIV prevalence and incidence among both high-risk groups (including sex workers) and the general sexually active population in priority countries and areas. To improve access to high-quality care and treatment.

WHO REGIONAL OBJECTIVE(S)

(2)

(1) (2)

Prevalence rates ofST! and HIV. Number of people living with AIDS accessing care and treatment in priority countries.

INDICATORS

(1)

Collaborate with the Joint United Nations Programme on AIDS (UNAIDS), the WHO South-East Asia Regional Office, and other global and regional partners to identify needs, plan, coordinate and monitor the response to the HlV epidemic in the Region and at country level. Support Member States to strengthen STI and HIV/AIDS epidemiological surveillance (including second generation surveillance). Support the development and implementation of national policies, strategies and action plans for the prevention and care of ST!, including availability and use of condoms and other cost-effective interventions for high-risk individuals. Support the development and implementation of national policies, strategies and action plans for comprehensive HIV/AIDS care, access to AIDS drugs and reducing stigmatization and discrimination of people living with HIV/AIDS. Support the adaptation of new technologies to the operational and fmancial reality of health care systems in developing countries.

STRATEGIC APPROACHES

(2) (3)

(4)

(5)

4. Sexually transmitted infections, including HNlAJDS: proposed resources by source of funds Regular budget Organizalionallevel OIlIer 1OUn:8S Increase (Decrease) US$

2002·2003 US$

2004-2005 US$

2002-2003 % US$

2004-2005 US$

Counby or Olea Regional aid intertXllf1try Total

622000 645 000 1267000

666000 666 000

21000 21000

3.26 1.66 7000000

15

PROPOSED PROGRAMME BUDGET2004-2005: PART2

S. COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE (Global areas of work: Communicable disease surveillance, Communicable disease prevention, eradication and control)

ISSUES AND CHALLENGES

Outbreaks of corrununicable diseases threatening global and national health security continue to occur throughout the Region. Although the majority of these outbreaks are caused by known pathogens, some of them have been caused by newly emerging pathogens such as the Nipah and avian influenza viruses. The increasing resistance of micro-organisms to antimicrobial drugs is causing a serious public health problem. There are also growing concerns about accidental or deliberate release of infectious agents. Most countries and areas in the Region are experiencing rapid social and environmental changes. Globalization, increasing urbanization and poverty, environmental changes, and ageing populations can all contribute to the emergence of new diseases and the resurgence of old diseases. The risk of cross-border transmission of diseases is higher than ever since huge numbers of goods and people cross borders every day. With the development of new telecorrununication technologies, information on diseases, and particularly on outbreaks, can be disseminated all over the world very quickly. On the other hand, dissemination of inaccurate and unverified information can result in panic, a negative impact on tourism and other industries, and inappropriate responses, which may include travel and trade restrictions. Ensuring that the opportunities inherent in new corrununications technologies are maximized and not abused is a major challenge for corrununicable disease response. Many corrununicable disease outbreaks are caused by known pathogens for which control measures are well established. Such control measures are not fully implemented in many countries because of competing priorities and lack of resources. Some outbreaks are caused by previously unknown pathogens or pathogens that are not recognized. At present, there is insufficient national capacity and a lack of regional mechanisms to detect and respond to such unexpected events. Building such mechanisms, by strengthening national and regional capacities in areas such as epidemiology and laboratory support is another major challenge. There is an urgent need to reinforce mechanisms to detect, verify and respond rapidly and effectively to unexpected outbreaks and epidemics at local, national and regional levels. National plans of action for epidemic alert have to be developed, implemented and evaluated and responses have to be integrated into national corrununicable disease surveillance systems. Preparedness is critical to improving global health security. National surveillance and response systems should provide continuous surveillance of priority diseases, and provide information to enable responses to outbreak. To be sustainable, such systems should be integrated into national corrununicable disease surveillance systems, within the health information system.

REGIONAL GOAL

To work towards global health security and foster action to reduce the impact of corrununicable diseases on health and on the social and economic well-being of the people of the Region.

16

5. COMMUNICABLE DISEASE SUR VElLLANCE AND RESPONSE

To improve national and regional capacities rapidly to detect, identify and respond to threats to national and global health security arising from epidemic-prone and emerging infectious diseases of known and unknown etiology.

WHO REGIONAL OBJECTIVE(S)

Timeliness of detection and response to epidemics and emerging diseases of national and international concern.

INDICATOR

(I) (2) (3)

Strengthen national and regional surveillance and containment strategies for known epidemic diseases. Strengthen mechanisms to detect, verify and respond rapidly and effectively to unexpected outbreaks and epidemics at both national and regional levels. Improve national capacities for surveillance and outbreak response by strengthening field epidemiology and laboratory capabilities.

STRATEGIC APPROACHES

5. Conmmicable disease sUNeiliance and response: proposed resources by source of funds Regular budget Other sources Increase (Decrease)

OrpIizatIonailevei

2002·2003

2004-2005

2002·2003 %

2004-2005

US$ Cou1try or aea

US$

US$

US$

US$

1615400 846000 2461400 869 000 869000 23000 23000 2.72 0.93 1020000

Regional end intercountry Total

17

PROPOSEDPROGRAMMEBUDGET2004-2005: PART2

6. HEALTHY SETTINGS AND ENVIRONMENT (Global areas of work: Health and environment; Food safety; Health promotion; Injuries and disabilities)

ISSUES AND CHALLENGES

The Western Pacific Region has experienced tremendous socioeconomic changes over the last 30-50 years, although their magnitude and pace vary from country to country. Most countries have experienced rapid urbanization and industrialization and overall improvements in standards of living, largely brought about by technological advances. However, such urbanization and industrialization, coupled with the globalization of economies, trade and information and communications that has taken place in the past decade have all resulted in drastic changes to the physical and social environments in which people live, work and learn. These environmental changes, if not properly managed, adversely affect the health and safety of various population groups. The urban population in the Region was only 17% of the total population in 1950, but will exceed the 50% mark around 2015. This rapid urban growth has led to the overloading of urban infrastructure and services (e.g. housing, water and energy supply, sewage and solid waste management, road transport systems), causing sanitation and pollution problems as well as accidents. The modernization of agriculture and the development of mining and manufacturing industries have introduced new chemical and physical health hazards to both workers and general populations. Rapid development has also created a social environment that has resulted in an increase in lifestyle-related and psychosocial health problems, such as obesity, hypertension, excessive alcohol drinking, tobacco smoking, and drug abuse. In many areas, political turmoil has resulted in the escalation of conflict and violence. Economic, social and political changes in many parts of the Region have led to health inequities that are more pronounced among groups that are vulnerable and disadvantaged because of gender, age, ethnicity or economic status. The concept of healthy settings calls for an intersectoral approach to identifying priority health problems in a given local setting and for integrated sustainable responses to address these problems. In the Region, the healthy settings approach has been promoted and applied to cities, islands, Villages/communities, schools, workplaces, marketplaces, hospitals and tourism The approach addresses not only the physical environment of the setting, but also the social determinants of health by generating activities that enable individuals to adopt healthy lifestyles and make healthy choices throughout the different stages of the life cycle. Particular attention is paid to older persons and other vulnerable groups. The main challenges are rigid government and administrative structures which inhibit intersectoral policy-making in some countries; the low priority given to health promotion almost everywhere in the Region; high levels of injuries and low levels of reporting; weak legislation to protect the natural and human environment; and poor surveillance systems to monitor and report threats to health. Underlying all of these is the speed with which changes affecting health are taking place, and the need to ensure that responses to these changes are developed and implemented more quickly than in the past.

REGIONAL GOAL

(1)

To promote and protect the health and safety of people in specific settings and improve lifestyles throughout all stages of the life cycle, especially among older persons and vulnerable groups, and to enable individuals and communities to address the broad social determinants of health. To achieve safe, sustainable and health-enhancing human environments, protected from biological, chemical and physical hazards, and secure from the effects of global and local environmental threats.

(2)

18

6. HEALTHYSETrlNGSANDENVlRONMENT

(I)

To promote the healthy settings approach, healthy lifestyles, and health and well-being throughout the life cycle, especially among older persons and other vulnerable groups. To strengthen national capacity to assess, prevent and manage injury and violence. To incorporate health dimensions into regional and national development agendas, and strengthen national capabilities to assess, monitor and manage microbial, chemical and physical health nsks resulting from local and global environmental changes. To create an environment that enables the health sector, in cooperation with other sectors and partners, to assess, communicate information about and manage foodbome risks effectively.

WHO REGIONAL OBJECTlVE(S)

(2) (3)

(4)

(1) (2)

Number of countries that have developed and implemented injury and violence prevention policies and plans. Number of countries that have effectively taken account of health and environment aspects in national development policies and international agreements. Number of countries that have established and strengthened capacities to assess, monitor and manage microbial, chemical and physical health risks resulting from local and global environmental changes. Number of countries publishing foodborne disease and food hazard data. Number of countries initiating risk reduction strategies for foodborne diseases and hazards.

INDICATORS

(3)

(4) (5)

(1)

Collaborate with Member States and regional partner agencies to strengthen the further expansion and monitoring of Healthy Cities and Healthy Islands initiatives by establishing regional and national mechanisms. Support Member States in further developing healthy settings initiatives in schools, workplaces, villages, hospitals and health facilities, etc. through model projects, dissemination of "good practices", and development and dissemination of technical guidelines and information materials. Work with Member States to strengthen and advocate health promotion and to integrate health promotion into technical areas.

STRATEGIC APPROACHES

(2)

(3)

19

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

(4) (5)

Support Member States to prepare and implement national plans and programmes for injury and violence prevention. Collaborate with Member States to develop capacity to undertake appropriate health impact or risk assessment for priority chemical and physical environmental hazards, including climate change, and to strengthen health impact assessment in environmental impact assessment systems. Enable Member States to apply WHO air quality and drinking water quality guidelines adjusted to their own situations, and to ensure effective monitoring systems are in place. Support Member States to use WHO environmental health criteria and other relevant documents on chemical safety; translate documents into local languages; establish or strengthen information centres; and develop relevant legislation and national standards on occupational health and safety. Support Member States to apply technical guidelines on waste management and pollution control produced by WHO and other international partner agencies, as modified to the needs of the individual countries and areas. Support Member States to implement the global and regional strategies for food safety and to strengthen national food safety programmes.

(6)

(7)

(8)

(9)

6. Healthy settings and environment: proposed resources by source of funds Regular budget Other sources

Organizationalleve!

2002·2003

2004-2005

Increase (Decrease)

2002·2003 '10

2004-2005

US$ Country or !rea

US$

US$

US$

US$

4369750 3615000 7984 750 3078000 3078000 (537000) (537000) (14.85) (6.73)

Regional ald inleicoo1try Total

1350000

20

7.

CHILD AND ADOLE5CEt.rr HEALm AND DEVELOPMEt.rr

7. CHILD AND ADOLESCENT HEALTH AND DEVELOPMENT (Global areas of work: Child and Adolescent Health, Nutrition)

Improving the health, growth and development of the 0--19 years age group encompasses a broad range of issues. As health gains at each stage of the life cycle have the potential to affect health at the next stage, major risks in childhood, school age and adolescence need focused, integrated and interlinked interventions. Members of all age groups need safe and supportive environments in which to develop to their full potential. As many as I million children under the age of five die each year in low- and middleincome countries and areas in the Region. Preventable communicable diseases (acute respiratory infections, diarrhoea, malaria, measles and dengue haemmorhagic fever) account for half of the deaths, with malnutrition as a major associated causal factor. These conditions are also responsible for most of the childhood morbidity in the Region and place a major burden on health services, families and communities. Declining exclusive breast-feeding rates in the first six months of life, together with inappropriate complementary feeding practices and micronutrient malnutrition, mean that action is needed to improve infant and young child feeding practices in the Region. Iron and folate deficiencies are the main contributors to anaemia and affect about 40% of pregnant women and young children. Iodine deficiency is the greatest single preventable cause of brain damage and mental retardation and affects an estimated 8% of people in the Region. Vitamin A deficiency is the main single preventable cause of childhood blindness, significantly increasing morbidity and mortality, and is still a public health problem in at least 9 countries. Adolescents are at high risk of morbidity and mortality from early pregnancy, sexually transmitted infections (including HIV), mental health problems, injury, suicide and violence. The use of alcohol and tobacco as well as inappropriate nutrition can also result in noncommunicable diseases such as cardiovascular diseases, cancers, and diabetes in later life. These health risks can all be prevented. The main challenges for the biennium are: scaling up the Integrated Management of Childhood Illness strategy as the main approach to improve child health; for nutrition, developing and implementing integrated action plans on infant and young child feeding, micronutrient deficiencies, and obesity.

ISSUES AND CHALLENGES

(I)

To reduce by two-thirds the rate of infant and child mortality by the year 2015 compared with 1990. To prevent, reduce and, ultimately, eliminate malnutrition in all its forms; to reduce other diet-related illnesses; and to promote well-being through healthy diets and lifestyles.

REGIONAL GOALS

(2)

(1)

To enable countries to pursue evidence-based strategies in order to reduce health risks, morbidity and mortality along the life course, and promote the health and development of children and adolescents, and create mechanisms to measure impact of those strategies. To improve the effectiveness of Member States in identitying, preventing, monitoring and reducing malnutrition and diet-related health problems, and in promoting healthy diet and lifestyles.

WHO REGIONAL OBJECTIVE(S)

(2)

21

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

INDICATORS

(1)

Number of countries with improved capacity, implementing interventions and applying measurement tools in child and adolescent health and development. Number and proportion of targeted countries with national plans of action on nutrition and integrated programmes on infant and young child feeding, micronutrient deficiencies and obesity developed and implemented.

(2)

STRATEGIC APPROACHES

(1)

Promote all aspects of the Integrated Management of Childhood Illness as the main strategy for improving the survival, healthy growth and development of children, by addressing the major life-threatening conditions of childhood in an integrated manner and strengthening the links between the health services and family and community. Promote optimal infant and young child feeding practices by supporting countries in developing integrated national plans and strategies, with the participation of all relevant sectors and programmes. Support will include increased emphasis on the use of existing programmes and tools. Renewed emphasis will be placed on improving complementary feeding practices as well as on promoting healthy diets and lifestyles in children, adolescents and adults. Promote adolescent health and development by supporting countries and areas in raising awareness, building technical capacity, developing appropriate policies with adolescents' participation and making health services better suited to their needs. Strengthen coordination with other international agencies, bilateral agencies and nongovernmental organizations through meetings, infortnation exchange and infortnal discussions.

(2)

(3)

(4)

7. Child and adolescent health and development: proposed resources by BOUTte of funds Regular budget Organizational level

Other sources Increase (Decrease) USS %

2002·2003 US$

2004-2005 US$

2002·2003 US$

2004-2005 US$

Country or na Regional !rid intertOll1lry Total

1458000 993000 2451000

828000 828000

( 165 (00) (165000)

(16.62) (6.73) 2500000

22

8. REPRoDuCTIVE HEAL m

8. REPRODUCTIVE HEALTH (Global areas of work: Research and programme development in reproductive health, Making pregnancy safer, Women's health

Of all the human development indicators, the greatest disparity between developed and developing countries is in the lifetime risk of maternal death. In the Western Pacific Region, the highest risk for maternal death in pregnancy or childbirth is I in 23 women in the Lao People's Democratic Republic; the lowest is I in 54 347 women in Hong Kong (China). The disparity is due to high maternal mortality ratios and fertility rates in some less developed countries. There is now a growing understanding that a large proportion of complications related to childbirth, particularly those occurring around the time of birth, cannot be prevented or predicted. Thus, the presence of skilled attendants is crucial at every delivery if complications are to be managed and referred appropriately. Unfortunately, over 90% of deliveries still take place at home and, in some traditional settings, women often deliver alone, as in Cambodia and the Lao People's Democratic Republic. When complications occur, it may be too late to take the woman to the hospital and health workers may not have the capacity to manage complications. Globally, each year, approximately 80 million out of 210 million pregnancies are unwanted. Millions of women experience unwanted pregnancies and seek to terminate them Unsafe abortion is the major cause of maternal death in most developing countries. Non-use of contraceptives is a factor in the majority of unwanted pregnancies. Globally, about 55% of couples use family planning methods; however, the contraceptive use rate in Cambodia, the Lao People's Democratic Republic, Papua New Guinea and the Philippines is much lower than this. Unprotected premarital sex and teenage pregnancy are also related to maternal mortality. In countries with high maternal mortality, such as Cambodia, the Lao People's Democratic Republic and Papua New Guinea, the incidence of teenage pregnancy is 40-50 per 1000 women aged 15-19 years. Many studies indicate that the risk of dying from childbirth at that age is twice as high as that for women in their twenties. Unprotected premarital sex among teenagers also increases the risks of unwanted pregnancy and therefore of unsafe abortion. It may also lead to transmission of sexually transmitted infections and HlY/ AIDS. The causes of maternal death are the same for women everywhere but women in the world's least developed areas are particularly vulnerable because many girls and women lack adequate nutrition, appropriate reproductive and maternal health care, basic education, safe environments, participation in decision-making affecting their welfare, freedom from discrimination, and protection from violence and abuse. The challenges include how to keep trained health workers in the remote and poor areas and make reproductive health services available and accessible; how to accelerate the implementation of appropriate interventions on maternal mortality reduction and to improve the quality of care; how to engage other sectors beyond the health sector to achieve our common goals in maternal and newborn health and thereby contribute to the alleviation of poverty.

ISSUES AND CHALLENGES

REGIONAL GOAL To reduce, by 2015, the maternal mortality ratio by 75% of its 1990 level, and to contribute to the reduction of infant mortality by reducing the number of neonatal deaths.

23

PROPOSEDPROGRAMMEBUDGET2004-2005: PART2

WHO REGIONAL OBJECTIVE(S)

(I)

To reduce maternal mortality, particularly in the priority countries of Cambodia, the Lao People's Democratic Republic, Mongolia, Papua New Guinea, the Philippines and Viet Nam. To support government efforts to reduce unwanted pregnancies, increase contraceptive use rates, and provide accessible, equitable, gender-sensitive and high-quality reproductive health services. To support countries and areas to improve the health and nutritional status of women of all ages, especially pregnant and nursing women.

(2)

(3)

INDICATORS

(I)

National maternal mortality ratio and the major causes of maternal deaths in the priority countries. National neonatal mortality rate in selected countries.

(2)

REGIONAL STRATEGIES

(I)

Provide technical support to priority countries through training of midwives and obstetricians in managing complications of pregnancy and childbirth at community and referral levels, and through strengthening the referral system. Provide technical support and information to priority countries on promoting costeffective contraceptive methods, family planning counselling, and user-friendly adolescent reproductive health services. Provide technical support to governments to strengthen their capacity to use and interpret existing information on reproductive health for decision-making, supervision and monitoring. Work with countries to empower women, with knowledge and self-confidence through training and provision of information, to enable them to control their own fertility and seek health care when needed. Support countries to mobilize the family, community and society to meet vulnerable populations' special needs for reproductive health services, especially those of adolescents and pregnant women.

(2)

(3)

(4)

(5)

8. Reproductive health: proposed resources by source of funds Regular budget Organizational level

Other sources Inaease (Dectease) US$

2002-2003 US$

2004-2005 US$

2002-2003 % USS

2004-2005 USS

Country or area Regional a1d intertOO1lry

569500 793000 1362500 738 000 738000 ( 55000) (55 000) (6.94)

Total

(4.04)

2000000

24

9. NONCOMMUNICABLE DISEASES ANDMENTAL flEAL 7H

9. NONCOMMUNICABLE DISEASES AND MENTAL HEALTH (Global areas of work: non~ommunicable

Surveillan~e, prevention and management of diseases; Mental health and substance abuse)

Eight out of ten deaths in the Region are estimated to be caused by the main noncommunicable diseases (NeD) - cardiovascular diseases, cancer, diabetes, and related diseases, and mental diseases and injury. This makes the NeD epidemic in this Region the third largest among WHO regions, after the Americas and Europe. Hypertension and obesity continue to spread in the Region. The risk factors of most NeD are tobacco use, unhealthy diets, and physical inactivity. The key determinants of risk of NCD lie outside the reach of the health sector. For example, transport issues (such as overuse of private cars) influence physical activity, exposure to pollution, and risk of injury and stress. Other examples can be found in the trade, education, labour and agriculture sectors. These will increase as countries increasingly come under the influence of international trade, urbanization, and industrialization. Health services in the Region are not able to cope with the increasing nwnbers of cases of NCD. Health care workers lack training in NeD management and are often unable to deal effectively with patients. Patients thus often have to endure insufficient or expensive supplies of drugs and non-standard care. Mental and neurological disorders constitute a significant burden of this total disease burden. Suicide alone is estimated to be responsible for 1100 deaths a day in the Western Pacific Region. It is estimated that I million people attempt suicide in this Region annually. The burden of mental and neurological disorder affects mostly the socially disadvantaged communities and is both a cause and a consequence of poverty. There is evidence that mental disorders are likely to increase in the years to come, and that new conditions will emerge, related to behavioural disorders of youth, the mental health consequences of HIV/AIDS, and the consequences of the increasing abuse of psychotropic substances and alcohol. Social changes that affect risks of contracting mental illness include globalization, urbanization, changing social support structures cause by migration, unemployment, conflict, and disasters. Mental health care is still not accessible for the majority of people in the Region. Community mental health services exist, but they are not widespread and staff with experience and skills to treat mental illness are unable to meet demands. The main challenges for the Region are to: (1) establish national NeD plans and intersectoral coordinating mechanisms in most countries; (2) strengthen surveillance mechanisms for NCD and their determinants in most countries; (3) strengthen a network of demonstration projects in NeD prevention and control; (4) support the scaling up of demonstration NeD projects into national programmes; (5) support the development of mental health promotion programmes through intersectoral collaboration;

ISSUES AND CHALLENGES

2S

PROPOSEDPROGlUMME BUDGET1OO4-100': PART2

(6) support the development of mental health services through legislation update, consumer associations, and the incorporation of mental health care into general health care.

REGIONAL GOALS

(1) (2)

To reduce the burden of premature mortality, morbidity and disability related to noncommunicable diseases. To reduce the burden associated with mental and neurological disorders and substance abuse, and to promote good mental health

WHO REGIONAL OBJECTIVE(S)

(1)

To assess the burden of NCO, their risk factors, and their complications. To create an environment in which Member States and the international community are better equipped technically and institutionally to reduce people's exposure to the major determinants and risks associated with NCO. To promote standards of health care for people with NCO. To ensure that governments and their partners in the international community place mental health and substance abuse on the national health and development agenda in order to formulate and implement cost-effective responses to mental disorders and substance abuse. To contribute to the quality ofhfe in the Region through the promotion of mental health.

(2)

(3) (4)

(5)

INDICATORS

(1)

Number of countries adopting standardized NCO surveillance activities. Existence of regional and national coordinating mechanisms for exchange of experience and effective intersectoral action. Number of countries implementing evidence-based, management guidelines for diabetes and hypertension. appropriate, clinical

(2)

(3) (4) (5)

Number of countries that have strengthened mental health services through legislation reviews, workforce development, and shifts to community based care. Number of countries carrying out intersectoral activities to promote mental health.

STRATEGIC APPROACHES

(I)

Work with countries to strengthen national integrated NCO programmes and plans, addressing lifestyle and environmental change, and strengthening NCO health services. Support regional networking and exchange of experiences through demonstration projects. Work with countries to develop standardized NCO surveillance activities, especially for cardiovascular diseases, diabetes, cancer, and their risk factors and complications. Collaborate with countries to support the implementation of appropriate clinical management guidelines on hypertension and diabetes in all countries of the Region. Work with countries to develop intersectoral approaches to mental health promotion and the prevention and treatment of mental disorders.

(2) (3)

(4)

(5)

26

9. NONCOMMUNICABLE DISEASES AND MENTAL HEALTH

(6)

Support the shift from institutional care to community based mental health services, with an emphasis on the integration of treatment for mental disorders into general health services and the development of a more informed understanding of mental health in the wider community.

9. NonconmJRicable diseases and mental health: proposed resources by source of funds Regular budget OrglMlizalionailevel

Other lOUrcee

2002·2003

2Q04.2OO5

Increase (Decrease)

2002·2003 0/0

2004-2005

US$ Crultry IX" nil 2191750 1604000

US$

US$

US$

US$

Regionalll1d interc:ourby Total

1498000

( 106 000)

(6.61) (2.79)

3795750

1498000

(106 000)

800000

27

PROPOSED PROGRAMME BUDGET 2004-2005: PAR T2

10. TOBACCO FREE INITIATIVE (Global area of work: Tobacco)

ISSUES AND CHALLENGES

Tobacco remains a major preventable cause of premature death and disability in the Western Pacific. Although increasingly recognized as a leading risk factor for poor health and early mortality, current tobacco control strategies have yet to make an impact on health statistics. The prolonged lead time between beginning tobacco use and onset of disease, the large number of persons already addicted to tobacco, the complex nature of tobacco control and the pervasive transnational influence of the tobacco industry on health policy and legislation mean that, despite extensive tobacco control efforts in many countries, their effect on indices of tobacco use prevalence, disease incidence and attributable mortality is in many cases not yet significant. This is particularly evident within the Western Pacific, which has the greatest number of smokers, the highest rate of male smoking prevalence and the fastest increase in tobacco use uptake by women and young people. As a result, one in four tobacco-related deaths occurs in the Region, and the burden of tobacco-related noncommunicable diseases is fonnidable, and rising. Member States are now engaged in a process of negotiating the Framework Convention for Tobacco Control (FCTC). The FCTC is the first global treaty for tobacco control, and the first to be prepared for adoption by the World Health Assembly under Article 19 of the WHO Constitution. It will probably be presented for adoption in 2003, negotiation of related protocols will occur sometime towards the end of 2003, and ratification during 2004-2005. The FCTC will establish the foundation for a concerted international response to the increasing use of tobacco. WHO will continue to support Member States to achieve reductions in tobacco use prevalence. Expansion of clinical cessation services will produce the earliest impact on disease prevalence and mortality rates. Expanding the regional surveillance system and database will be critical for tracking progress, Integrating tobacco control into existing health programmes will help to ensure that the majority of those at risk, whether active or passive smokers, are effectively reached, The main challenges for the Region are to: (1) maximize support from Member States for the FCTC; (2) establish and enhance national capacity for tobacco control through the implementation of national plans of action that use comprehensive tobacco control strategies, including policy, legislation, regulation, clinical services, health promotion, education and advocacy in all Member States; (3) integrate and reinforce tobacco control within other public health programmes; and (4) incrementally expand the regional surveillance system and database to enable timely assessment of progress.

REGIONAL GOAL

To reduce substantially the prevalence of tobacco use, the harm caused by the use of tobacco products, and exposure to tobacco smoke.

28

10. TOBACCOFREElNl71AT1VE

To ensure that governments, international agencies and other partners are equipped effectively to implement national and transnational approaches to tobacco control.

WHO REGIONAL OBJECTIVE(S)

(1)

Number of countries that ratify the FeTe. Number of countries with effective tobacco control plans and policies that take account of the provisions of the FCTe.

INDICATORS

(2)

(1) (2)

Work with countries to provide technical support for the ratification and implementation of the FeTe. Support countries to develop and implement national plans of action for tobacco control that use effective and comprehensive tobacco control strategies in the areas of policy, legislation and regulation, clinical services, health promotion, media and advocacy, and education. Seek out potential partners in the international community to reinforce funding for tobacco control resources for the Region. Encourage and support Member States to identify and explore areas within public health programmes where tobacco control measures could be integrated. Support countries to adopt and contribute to the regional surveillance system and database. Enable countries to deter the onset of tobacco use, especially among women and adolescents.

STRATEGIC APPROACHES

(3) (4) (5) (6)

10. Tobacco free initiative: proposed resources by source of funds Regular budget Organizational level

Otheraourees

2002·2003 US$

2004-2005 US$

Increase (Decrease) % US$

2002-2003 US$

2004-2005 USS

Counbycrarea Regional and intercountry

479000 250000 528000 278000

111.20 38.13 900000

Total

729 000

528 000

278000

29

PROPOSED PROGRAMME BUDGET 2004-2005: PART2

11. HEALTH SYSTEMS DEVELOPMENT AND FlNAt"lCING (Global areas of work: Sustainable development; Organization of health services)

ISSUES AND CHALLENGES

Many major issues face health systems today, and these affect the effectiveness and outcomes of programmes and services being delivered. Funding is often very limited and, in a few countries, much more is contributed by direct out-of-pocket payments by patients at the time of care and by donors than by governments or through prepaid contributions. Resources are often inappropriately directed to tertiary-level interventions rather than to the basic services needed most by communities, and clinical interventions are often inappropriate, unnecessary, or of questionable quality. In many cases, severe resource limitations have resulted in services that are inaccessible and unsafe for communities, particularly the poor. In addition, health services are struggling to operate effectively in decentralized systems, with fragmentation within the public sector and between the public and private parts of the health system, contributed to by less than optimal government stewardship for health. In addition, public health services, which are the backbone of promoting and protecting the overall health of communities, are often weak, and will not cope with expected future trends in demography, epidemiology, migration, urbanization, and privatization. Policymakers are also struggling with issues related to globalization, and its potential impacts both on their community's health and on their health systems. There are, therefore, several key challenges for many countries and areas in the Region. These are fundamental and affect the performance of the whole sector: health financing arrangements need to become more stable and equitable, and the financial burden on individual households caused by out-of-pocket payments reduced; policy-makers need improved information to enable more transparent decision-making and resource allocation particularly in relation to health expenditure, and the costs, quality and effectiveness of services. Governments need to improve their overall stewardship for health and secure a more central role in the development agenda for health. Particular efforts must be made to strengthen public health, and to improve coordination across sectors, within different levels of the health system and with civil society. It is important that governments recognize and take an active role in ensuring the overall effective and safe functioning of the whole health system, including an appropriate role for the private sector. At an operational level, aspects such as good management, planning, effective delivery of essential public health functions and primary health care remain a constant challenge.

REGIONAL GOALS

(I)

To achieve sustainable health systems that promote and protect health, reduce excess mortality, morbidity and disability, and respond to people's essential needs and legitimate demands in a way that is equitable, safe, appropriate, effective, efficient, coordinated and fmancially fair. To maximize the contribution that better health makes to poverty reduction and economic development - and thus to the achievement of the millennium development goal of reducing the proportion of people living in absolute poverty by 2015.

(2)

30

11. Hf.ALTHSYSTEMSDEVELOPMENTANDHNANCING

(I)

To improve the capacity of Member States to deliver high-quality health services affordably, efficiently and equitably to all their populations, especially those most vulnerable, by developing and enhancing systems for planning and delivery of health services, and to gather evidence and design tools that support informed and participatory framing and implementation of policy. To ensure that health has a central role in international and national poverty reduction and development policies and practices (including their economic, social, environmental and trade components).

WHO REGIONAL OBJECTIVE(S)

(2)

(I)

Availability of frameworks and tools to help policy-makers and health professionals strengthen and monitor the quality and performance of health services, particularly for the poor. Availability of tools to help policy-makers and health professionals integrate concerns related to poverty, gender and marginalized ethnic populations into national health policy, programmes and interventions, and to monitor and evaluate the effects of policies, programmes and interventions from these perspectives. Number of countries adapting and using these tools in their own settings.

INDICATORS

(2)

(3)

(I)

Provide Member States with technical advice to support the development of their health systems and to strengthen country capacity in policy development, health legislation, frnancing and social health insurance, national health accounts, planning, resource allocation, management, resource/donor coordination, essential public healt.'l functions, primary health care, hospitals, quality and accreditation systems, effective organization of the health sector, programmes to improve access and reduce barriers to access for those in poverty, developing pro-poor health policies and programmes, effective use of the private health sector, human rights, and globalization issues. Develop regional guidelines and policy advice in key legislative and system areas, in order to facilitate exchange of information and best practices, and provide frameworks and tools for countries to consider and adapt to local circumstances. Work closely with partner agencies at regional and country levels, as partners to governments, to ensure the development of equitable, efficient, effective and coordinated health systems, and to ensure that appropriate health aspects are included in development plans and programmes.

STRATEGIC APPROACHES

(2)

(3)

~1uVt

Qherscuces

OgirilaicnaileJel

zuz-m mt-m l.5S l.5S

In::reaae (l8:reaae)

m·m 0/0

mt-m l.5S

l.5S

l.5S

O:utyaaea R:I;jaB aD irteau1ry

101314(( 19:DOX 12al1 «X

1Ul20lJ 1632!XXJ

(3180lJ) (3180lJ)

(16.31) (263) 1!OOIXX

Tdal

31

PROPOSEDPROGRAMMEBUDGET2004-2005: PART]

12. HEALTH TECHNOLOGY AND PHARMACEUTICALS (Global areas of work: Essential medicine: access, quality and rational use; Blood safety and clinical technology)

ISSUES AND CHALLENGES

Regular access to high-quality essential medicines, reliable laboratory services and safe and efficient blood service is fundamental to the performance of the health care system. Despite the availability of many effective new drugs, many people in developing countries in the Region still do not have regular access to high-quality essential medicines. This jeopardizes efforts to reduce morbidity and mortality, including combating priority diseases such as tuberculosis, malaria, HIV/AIDS and childhood illnesses. Among the challenges facing efforts to improve access to essential drugs are weak regulatory infrastructures and enforcement mechanisms, inefficient pharmaceutical supply distribution and systems, high prices of pharmaceutical products and shortages of resources for funding, irrational drug use practices, increasing production, sale and distribution of counterfeit and substandard pharmaceutical products. Reliable and efficient laboratory services support key public health programmes such as disease surveillance and control of environmental health. They are essential for highquality curative services and for promoting rational use of medicines. Efforts to combat communicable diseases, to ensure food safety and blood services require timely and high quality support from laboratory services. The main challenge is the weak medical laboratory service infrastructure in some countries in the Region. This leads to an uncoordinated service that wastes limited resources. In many countries, there is lack of management and technical capacity and the quality of test results is frequently poor. Limited access to safe blood and blood products leads to significant mortality. Blood and blood products are often used irrationally, wasting limited resources and putting patients at risk unnecessarily. In some countries in the Region, blood supplies are dependent on family replacement or paid donors. Basic laboratory techniques, such as donor and patient identification and recording, labelling and cross matching of samples and blood units, are not always conducted properly. In some countries, systematic screening of blood units is not carried out at all levels. Traditional medicine is popular in many countries and is being increasingly used in the Region. The increasing awareness and acceptance of traditional medicine by the general public and health policy-makers, coupled with its growing economic importance, will require a more rigorous process of validation and standardization in future. More systematic efforts are still needed to integrate traditional medicines into the existing health care system.

REGIONAL GOALS

(1)

To ensure equitable access to affordable essential medicines on a sustainable basis and to assure the quality, efficacy, safety and appropriate use of medicines by both providers and consumers. To ensure that blood and blood products, laboratory services, diagnostic support and clinical technology are safe, equitably accessible, used appropriately and effectively, and are affordable, particularly in developing countries. To ensure the safety and effective use of traditional medicine, and its integration into the general health service system, where appropriate.

(2)

(3)

32

12. HEALTHTECHNOLOGYANDPHARMACEU11CALS

(1)

To work with countries to: formulate, implement and monitor national drug policies; increase equitable access to essential medicines, particularly for priority diseases; ensure the quality, safety and efficacy of medicines through effective drug regulation; and improve rational use of medicines by health professionals and consumers. To improve access of the population to safe blood, blood products and health care technologies; and to promote quality health care services that are supported by good laboratory services and safe and cost-effective technologies. To improve the fonnulation, updating and implementation of national policies on traditional medicines, to establish appropriate standards for traditional medicines, to promote better understanding of appropriate practices by providers and consumers, and to integrate traditional medicine into existing health care systems.

WHO REGIONAL OBJECTIVE(S)

(2)

(3)

(I)

Nwnber of countries with a national drug policy document covering access, quality and rational drug use, updated within the last five years, and with an implementation plan. Number of countries with national essential drugs lists, updated within the last five years, a!ld being used in the public procurement system. Number of countries with operating drug regulatory registration systems. Number of priority countries with appropriate policies and plans for provision of safe and appropriate clinical use of blood and blood products. Proportion of population in priority countries that has access to blood supply from national coordinated blood transfusion services. Number of priority countries with appropriate laboratory and diagnostic services to support public health care services, particularly for controlling priority diseases. Nwnber of countries with a national policy on traditional medicine.

INDICATORS

(2) (3) (4) (5) (6)

(7)

(I)

Exchange evidence-based information and to share knowledge-based experience on national drug policies, and to strengthen national capacities for policy development and implementation. Provide technical support to Member States to fonnulate, implement, revise and evaluate national drug policies. Advocate policies and plans for blood safety, clinical technologies and laboratory services, and to promote quality assessment schemes using WHO training materials. Work with countries to fonnulate, update and implement national policies on traditional medicine.

STRATEGIC APPROACHES

(2) (3)

(4)

33

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

12. Health technology and pharmaceuticals: proposed resources by source of funds Regular budget other sources Increase (Decrease) US$ %

Organizational level

2002·2003 US$

2004-2005 US$

2002·2003 US$

2004-2005 US$

Country or area Regional and intercountry Total

0 1015000 1015000 1073000 1073000 58000 58000 5.71 5.71 0

34

13. HUMAN RESOURCES FOR HEALm

13. HUMAN RESOURCES FOR HEALTH (Global area of work: Organization of Health Services)

A balanced health workforce and its appropriate use and management are critical for health sector effectiveness and improved quality in healthcare. However, in many countries, there are ongoing health workforce imbalances, including an inappropriate focus on some professional or specialty groups, gender imbalance, poor geographical distribution of the workforce, intakes for educational training institutions that are not linked with ongoing service needs, and a lack of skilled staff within the public sector compared with the private sector. Health workforce imbalances are affected by political and socioeconomic factors, global market forces and weak human resource planning and management capacity. The migration of skilled health professionals within and from countries in the Region exacerbates these workforce imbalances and represents a costly loss for the health sector. A study of the migration of Pacific island doctors and nurses has documented low remuneration, lack of continuing education opportunities, poor working environments, inflexible working hours and personal and social expectations, such as the need to have better educational opportunities for their children as the main reasons for migration. The level and quality of the education of health professionals varies across the Region. There is room for improvement in aligning the curriculum and training to meet national health needs and priorities. Teaching methods and approaches could also be improved in some countries. In medical and nursing education, teachers may lack clinical experience or may have failed to stay abreast of changes in clinical practice. To address these issues, curricula reviews and reforms, teacher training, tools and guidelines for ensuring quality and standards of health professional education and training are required, including networking and collaboration between institutions, health services and other partners. In view of technological advances, the emergence of new diseases and new discoveries in medicine and science, there is a need to provide continuing education for health workers, including those in rural and remote areas. There are a number of challenges facing countries. Applied research is needed for evidence-based human resource policies and strategies to be put in place. National capacity for human resource planning and management mast be strengthened through training and use of appropriate methods and tools. Mechanisms for an integrated and multisectoral approach must be established. Policies to improve retention of skilled professionals must be developed and implemented, particularly in the Pacific. Mobilizing and sustaining political and institutional commitments are essential if the quality of the education of health professionals is to be improved.

ISSUES AND CHALLENGES

To improve health sector effectiveness and quality care through strengthening human resources planning and management capacity and the quality of the education and training of the health workforce and standards of practice.

REGIONAL GOAL

(I)

To strengthen the capacity of Member States in health workforce planning and management. To raise the quality of practice by health professionals through improved quality and standards of education and training, and increased competence and understanding of quality improvement and methods for improving standards of practice and care.

WHO REGIONAL OBJECTIVE(S)

(2)

35

PROPOSEDPROGlUMMEBUDGET 2004-2005: PART2

INDICATORS

(I)

Number of countries using updated databases, methods and tools for improving the planning, distribution, quality and performance of the health workforce. Availability of regional frameworks and guidelines for quality assurance in health professional education at undergraduate and postgraduate levels and continuing education.

(2)

STRATEGIC APPROACHES

(I)

Work with countries to build effective capacity in health workforce analysis and research, and use conceptual frameworks to defme and determine imbalances. Develop tools and guidelines for workforce planning and management and to improve quality and standards of health professional education and training and standards of practice. Support countries to develop strategies to retain skilled health professionals. Establish mechanisms and networks for collaboration among institutions, health services and other partners to ensure appropriate training and enhanced capacity building of health professionals.

(2)

(3) (4)

13. Human resources for health: proposed resources by source of funds Regular budget Other sources Increase (Decrease)

Organizlllionallevel

2002·2003

2004-2005

2002·2003 '10

2004-2005

US$ Co\myoraea Regional ;Ild intElltOllll1y

US$

US$

US$

US$

5785400 1974000 7759400

1970000 1970000

(4 (00) ( 4000)

(0.20) (0.05) 500000

Total

36

14. HEALm lNFORMA nON AND EVIDENCE FOR POLICY

14. HEALTH INFORMATION AND EVIDENCE FOR POLICY (Global areas of work: Evidence for health policy; Research policy and promotion)

In order to meet the changing health needs of the population promptly, policy- and decision-makers in the health sector need useful and practical tools, instruments and methods to support a wide range of functions. These include health needs assessment, planning intervention strategies, monitoring health performance and resource management. Development of new tools and updating and improvement of existing tools need to reflect the reality of the situations in Member States. The overall challenge is to develop a responsive information support system that can meet the needs of policy- and decision-makers by providing information for strategic planning, policy fonnulation, operational management, and stewardship of the health system The health system needs to gather information from the public and private health system and information on external contextual factors, especially those that are relevant to the health care of poor and underserved. Member States still face a number of important challenges as they strengthen their health information systems. These include: how to develop an information system plan that facilitates the establishment of health databases that can be shared; how to integrate information into the health management process, particularly in strategic planning and operational management; how to standardize classification of diseases and events to facilitate comparability of national databases; how to enhance management capacity; how to use information technology and promote better dissemination of health information; and how to strengthen research capacity to collect ad hoc and other policy-relevant information through surveys and studies.

ISSUES AND CHALLENGES

To improve the capacity of health systems for evidence-based policy and decisionmaking, management and monitoring through the development of appropriate information systems and stronger capacity for policy development, situation analysis and research.

REGIONAL GOAL

(I)

To strengthen the performance of health systems by generating more valid and reliable information and evidence for the use of the needs of policy- and decisionmakers, managers and health professionals. To strengthen the capacity to use information in. management decision-making through training and to support research and analytIcal skills. To improve the overall functioning of health information systems.

WHO REGIONAL OBJECTIVE(S)

(2)

(3)

(1)

(2) (3) (4)

Availability and adaptation of practical tools, instruments and methods to supp~~ countries to study, analyse, present and monitor health SItuatIOns and hea system perfonnance. Number of countries that have improved and refined the evidence base for effective policy- and decision-making. Number of countries fonnulating, updating and applying health policies and programmes using the evidence-based policy- and declslon-makmg process. . t'IOns m . health . networks 0 f'Instltu Establishment of intercountry or mcountry information and evidence for policy.

INDICATORS

37

PROPOSED PROGRAMME BUDGET 2004-2005: PART2

STRATEGIC APPROACHES

(1)

Promote a sector-wide approach to health situation analysis for evidence-based policy. Support countries to draw up strategic plans for health information systems and to develop health indicators. Provide methods, practical tools and best practices to enhance health information systems through networking. Promote the use of the International Statistical Classification of Diseases and Related Health Problems (ICD-IO) to standardize classification of diseases and strengthen the public health system. Support training in information management, data analysis, health statistics, disease classification and coding, computer system administration and research methodology. Promote dissemination of outcomes of research results for policy and health services. Strengthen working relationships in national health research councils in Member States for better coordination in health research.

(2) (3) (4)

(5)

(6) (7)

14. Health information and evidence for policy: proposed resources by source of funds Regular budget Organizational level Other SOUI"C8II

2002·2003

2004-2005

Increase (Decrease)

2002·2003 %

2004-2005

US$ Country a aea Regional a1d intertrudry

US$

US$

US$

US$

555000 1099000 1133000 34000 3.09

Total

1654000

1133000

34000

2.06

500 000

38

15. EMERGENCYANDHUMANfTARIANACTlON

15. EMERGENCY AND HUMANITARIAN ACTION (Global areas of work: Emergency preparedness and response)

An emergency is defined as a state in which normal procedures are suspended and extraordinary measures are taken in order to avert a disaster, an occurrence disrupting the normal conditions of existence and causing a level of suffering that exceeds the capacity of adjustment of the affected community. People's health, health facilities and services are always affected by emergency situations and disasters.

ISSUES AND CHALLENGES

The Western Pacific Region is the WHO Region most frequently affected by natural hazards causing disasters andlor leading to emergency situations. Of the 623 major natural disasters in the world from January 1990 to December 1999, 148 or (23.8%) occurred in the Western Pacific. During the 1990s, the number of people killed in the Region due to all types of natural disasters was 63 823 (8.1 % of the global total), the number injured was 746 539 (46.8% of the global total), the number homeless was 56.5 million (69.2% of the global total) and the number affected was 1.22 billion (65.2% of the global total). Almost every year since 1980, the Region has been hit by at least two devastating disasters that immediately claimed at least 500 lives. The Region has recently become exposed to more technological hazards than previously. Since 1995, the annual death toll in the Region from disasters such as major transport accidents, explosions, fifes and chemical spills has been between 1100 and 1500, and has been steadily increasing. There are four main challenges facing efforts to strengthen emergency preparedness and response in the Region: (1) the number of vulnerable and insufficiently prepared communities has increased, which in tum aggravates the impact of hazards on people's health and health systems; (2) in many countries there is weak institutional capacity for emergency management; (3) there is a lack of proactive collaboration among partner agencies, which hinders collective efforts in emergency management; and (4) the shortage of systematic and reliable public health information on emergencies, which makes it difficult to measure their impact, develop sound policies or monitor activities properly.

To reduce suffering and immediate and long-term avoidable mortality, morbidity and disability related to emergencies and to contribute to development.

REGIONAL GOAL

To ensure Member States and the international community are better equipped to prevent disasters and to mitigate their health consequences wough appropriate coordination mechanisms and emergency response.

WHO REGIONAL OBJECTIVE(S)

Number of countries with national disaster reduction policies and plans that address preparedness and relief, taking into account long-term development perspectives.

INDICATOR

39

PROPOSED PROGRAMME BUDG£T2004-2005: PART]

STRATEGIC APPROACHES

(1) (2) (3) (4) (5)

Support Member States to build community-based risk reduction initiatives. Work with Member States to strengthen national capacity for emergency management. Promote a proactive consultation process with partner agencies. Enhance a regional information system for emergency management. Intensify WHO's institutional capacity for emergency response.

15. Emergency and humanitarian action: proposed resources by source of funds Regular budget Organizational level Other aoun:ell

2002·2003

2004-2005

Increase (Decrease)

2002·2003 %

2004-2005

US$ Cru1try IX II1la Regional cnj intertOlJllry

USS

USS

USS

USS

57500 97000 154500

108 000 108 000

11000 11000

11.34 7.12

Total

5000000

40

16. INFORMA nON 7!CHNOLOGY

16. INFORMATION TECHNOLOGY (Global areas of work: Health information management and dissemination, Informatics and infrastructure services)

The complex and diverse environment of WHO provides a challenge to information and communications technology (lcr) staff in overcoming physical and organizational boundaries to work together to share knowledge, experience, systems and infrastructure. Diversity in rates of adoption of leT due to variations in local infrastructure, capacity and costs, fInancial constraints and inequities in investment mean that ensuring all WHO staff have access to the information and services they need is also a challenge. In order to provide cost·effective Icr solutions for improved collaboration and

ISSUES AND CHALLENGES

coordination, data sharing across all WHO locations and efficient administrative support for programme implementation, it is critical that regional and global integrated information systems are developed. Platforms, systems, tools, services, policies and best practices need to be standardized. Security within and between networks and systems must improve. Although progress has been made, replacement of the WHO Administration and Finance Information system remains the most signifIcant leT challenge facing the Organization. The main leT challenges for the WHO in the Western PacifIc Region are to: (1) strengthen access of WHO staff at all locations to reliable health, statistical, technical and administrative information; (2) improve overall information management and document management practice; (3) synchronize regional leT development work with global leT initiatives; (4) develop and maintain appropriate skill-sets among WHO staff and their counterparts; (5) keep abreast of technological developments in the marketplace; and (6) capitalize on emerging leT infrastructure, which may not be funded or managed by WHO. WHO will also examine management of production, workflow, clearance, storage and electronic publication and dissemination of WHO documents and information products. A re-evaluation of web publishing and re-orientation of information architecture according to the needs of identifIed target audiences both inside and outside the Organization will be necessary.

Strengthen the performance of the WHO Regional Office and country offices through provision of a well-managed leT environment responsive to the needs of WHO technical and administrative programmes and management, Member States and target audiences.

REGIONAL GOAL

To provide a well managed leT environment responsive to the needs of all WHO constituents.

WHO REGIONAL OBJECTlVE(S)

41

PROPOSED PROGRAMME BUDGET 2004-2005: PART2

INDICATORS

(1) (2)

New systems implemented, existing systems improved. Accessibility of systems in WHO offices in the Region, and extent to which Regional Office and country office systems are synchronized.

STRATEGIC APPROACHES

(1) (2)

Share best practice and experience of leT platforms, systems, tools and services among WHO offices, country counterparts and partner agencies. Work with other regional offices and WHO Headquarters to standardize ICT platforms, systems, tools, services, policies and best practices and to improve interfaces between systems and common data models. Work with partners to improve both WHO connectivity and the cost effectiveness of existing and emerging information and communications technology infrastructure. Systematically develop capacity of WHO staff in general and WHO leT staff in particular to improve use of information and communications technologies. Take an active part in global WHO leT initiatives and projects. Integrate the health, statistical and technical databases maintained in the Region.

(3)

(4) (5) (6)

16. Information technology: proposed resources by source of funds Regular budget

Other sourteS

Organizalionallevel

2002·2003 US$

2004-2005 US$

Increase (Decrease) US$ 0/0

2002·2003 US$

2Q04.2OO5 US$

Country or area Regional !I1d intercourtry

a 1622 000 1622 000 1187000 1187000 ( 435000) ( 435000) (26.82) (26.82) 0

Total

42

17. EXTERNAL COOPERA770NANDPARTNERSHlPS

17. EXTERNAL COOPERATION AND PARTNERSmpS (Global area of work: Resource mobilization, and external cooperation and partnerships)

The essential role played by health in promoting social and economic development, particularly poverty alleviation, human rights and social equity, has been increasingly recognized by the international community in recent years. This has led to a growing nwnber of multilateral and bilateral agencies and private sector organizations becoming more interested in the health sector and becoming involved financially and technically. This offers a good opportunity to channel more badly needed resources to health development and combating major diseases. At the same time, it poses challenges to WHO with regard to coordination and cooperation, the potential duplication of activities and the need to improve efficiency and effectiveness of investments in health. WHO has strengthened its traditional ties and developed a range of new partnerships in recent years. It has played a leading role in several major coordination activities within the UN system and been actively involved in the Common Country AssessmentiUnited Nations Development Assistance (CCAfUNDAF) exercises in the Region since 1997. In response to the increasing recognition of the important role played by civil society organizations in shaping and implementing health policy at both regional and national levels, WHO has launched a civil society initiative to reach out to a broader range of civil society actors. The Regional Office has prepared a position paper which provides a framework for further work with civil society organizations. The WHO regular budget has declined in real terms since the early 1990s. Coupled with this overall decline, the allocation to the Western Pacific Region has been reduced for a number of years in both real and nominal terms. This trend will continue for the 2004-2005 biennium. However, demands for technical support from Member States have continuously increased, as a result of changing health needs. In recent years, extrabudgetary contributions from various donor partners have been essential in order for WHO to fulfil its mandate to carry out technical cooperation with developing countries. However, there is a danger that the level of extrabudgetary resources may decrease in near future, since a large proportion of the extrabudgtary funds contributed to the Region has been traditionally earmarked for polio eradication and leprosy elimination. The challenges for WHO are: (1) to continue to build and foster partnerships and strategic alliances within the UN system, multilateral and bilateral agencies, civil society organizations and other partners through improved communication, coordination and collaboration; (2) to enhance effective collaboration and alliances with all traditional donor partners and seek new donor partners through better advocacy, dialogue and information exchange.

ISSUES AND CHALLENGES

To ensure health goals are incorporated in overall development policies in the Region and that resources for health are increased.

REGIONAL GOAL

To strengthen, sustain and expand partnerships and collaboration with UN agencies, intergovernmental and governmental bodies, civil society organizations and private sector organizations, to advance the goals and objectives of the Organization and to secure the Organization's resource base in the Region.

WHO REGIONAL OBJECTIVE(S)

43

PROPOSED PROGRAMME BUDGET 2004-2005: PARTl

INDICATOR

Number of functioning partnerships established with UN agencies, private sector organizations and civil society.

STRATEGIC APPROACHES

(I)

Reinforce partnerships, coordination and cooperation with external partners on priority health programmes through improved dialogue, exchange of information and representation at meetings. Strengthen advocacy for WHO's priority programmes targeted at donor partners and to strengthen links with both traditional and new donor partners. To facilitate and coordinate resource mobilization efforts by regional and country offices, as well as to improve planning, monitoring and evaluation of activities funded from extrabudgetary sources. Provide technical support to Member States in developing and submitting proposals to potential donors. To support Member States to plan, coordinate and implement projects funded by increasing numbers of donor partners.

(2)

(3)

17. External cooperation and partnerships: proposed resources by source of funds

Regular budget Organizational level 2002·2003 2004-2005 Increase (Decrease)

Othertources 2002·2003 %

2004-2005

US$ CoIIlIry or !rea

US$

US$

US$

US$

8656000 1176000 1146 000 (30 (00)

Regional inl intertOll1lry

(2.55)

2000000

Total

9832000

1146 000

(30 000)

(0.31)

2000000

44

18. PUBUC INFORMATION

18. PUBLIC INFORMATION (Global areas of work: Resource mobilization, and external cooperation and partnerships, Health information management and dissemination)

Rapid dissemination of information to countries and other partners is essential for formulating policy, taking advantage of new scientific developments, and advocating for health. However, speed is not the only requirement, it is equally important that information supplied by WHO should be accurate, reliable and relevant. Communication strategies have to be planned carefully. Publications and printed materials play a vital role in the effective dissemination of information. Authoritative literature on public health can be of great help to policymakers, managers and health workers. The changing communications envirorunent presents many new opportunities. In the last decade, the way we communicate and deal with information has been revolutionized through the Internet. The media playa crucial role in forming opinion on matters of public health significance and in dispelling myths and misconceptions that are obstacles to health. It is therefore essential that WHO deepens its relationships with media practitioners, that it understands their needs in terms of newsworthy events and deadlines, and that it supplies information to them in a useable form. There are several challenges to the dissemination of accurate and useful health information in the Region. One is the large number of languages spoken in the Region; health workers in developing countries are often deprived of the opportunity of accessing health information because it is in a language they are not proficient in. Another major challenge to the electronic dissemination of information is the scarcity of computers and reliable Internet access in some countries, particularly developing countries in remote locations, such as the Pacific. Even the distribution of printed materials may be problematic in certain contexts.

ISSUES AND CHALLENGES

To enable sound decisions to be made in both health policy and practice by disseminating public health information, to raise awareness of the importance of health and to help shape opinion.

REGIONAL GOAL

To facilitate access of governments and other partners, including the media, to reliable up-to-date health information that serves as a guide for establishing health policy and practice.

WHO REGIONAL OBJECTIVE(S)

(I)

Number of high-quality press releases, fact sheets, opinion-editorials (op-eds), issues of the regional newsletter WHO in action and other information materials distributed. Increase in the number of requests for information materials, interviews and queries on health-related mailers.

INDICATORS

(2)

45

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

STRATEGIC APPROACHES

(1) (2) (3) (4) (5)

Enhance distribution, marketing and promotion of advocacy and news materials (including a user-friendly website). Conduct well-targeted media and advocacy campaigns, and evaluate their impact. Enhance marketing and promotion of WHO publications. Improve partnerships with the media through regular contacts, press conferences, briefmgs and workshops. Strengthen the capacity and skills of the staff in the Regional Office and country offices to respond to media queries and to prepare and distribute information on WHO programmes.

18. Public information: proposed resources by source c:A funds Regular budget Organizational level

Other sources Increase (Decrease) 2002·2003 2Q()4..2005

2002·2003

20()4..2oo5

USS COIrtry or ilea

USS 0

USS

%

USS

USS

Regionalllld intertountry Total

1855000 1855000

1944 000 1944000

89000 89000

4.80

4.80

0

46

19. PROGRAMME PLANNING, MONlTORfNGAND EVALUA170N

19. PROGRAMME PLANNING, MONITORING AND EVALUATION (Global areas of work: Programme planning, monitoring and evaluation, WHO's presence in countries)

The move towards results-based management, including improved processes for strategic planning, progrannne budgeting, operational planning, monitoring and reporting, and programme evaluation, has been essential in making operational the General Programme of Work 2002-2005 and WHO in the Western Pacific Region: a framework for action. One of the main challenges will be to continue to develop an integrated system for these processes. Ibis will require drafting and updating of procedures and guidelines as well as training of staff at all levels. The Regional Infonnation System (RIS) relating to programme management will continue to be modified in consultation with users, to serve the needs of results-based management processes. In its country work WHO is also taking a more strategic approach. The WHO country cooperation strategy is a strategic framework for collaboration in the mediwn term New global initiatives and developments in health, poverty and development as well as particular issues facing each country call for new sets of skills for WHO country staff.

ISSUES AND CHALLENGES

The challenges for WHO will be: (1) to ensure that improved systems and processes are integrated into the day-to-day operation of the Organization's programmes at all levels and to align the Organization's administrative practices and procedures to support a results-based management framework; and (2) to continue to strengthen country work and ensure a strong country perspective in the allocation of technical and fmancial resources across the Organization.

To apply best practice in all aspects of programme planning, monitoring and evaluation, in support of WHO's leadership role in international health.

REGIONAL GOAL

To establish fully functional mechanisms for results-based management and to apply the logical approach in programme management and evaluation in line with WHO's corporate strategy.

WHO REGIONAL OBJECTIVE(S)

Number and quality of WHO progranunes developed according to the guidelines and principles of result-based management using the logical approach.

INDICATORS

(1)

Refme guidelines for the managerial process and review administrative procedures with a view to further streamlining. Carry out country cooperation strategy exercises to further improve and focus WHO's work at country level.

STRATEGIC APPROACHES

(2) (3) (4)

Support and train technical units and country offices in the implementation of the managerial process and administrative aspects of programme delivery. Improve progranune management aspects of the RIS to support the results-based management system.

47

PROPOSED PROGRAltIME BUDG£1" 2004-2005: PART 2

19. Programme planning. monitoring and evaluation: proposed resources by source of funds Regular budget Organlzatlonlllevtl 2002·2003 US$ Country or area Regional and intercountry

Other sources Increase (Decrease) US$ %

20Q4.2005 US$

2002·2003 US$

2004-2005 USS

248 000 248 000

414000 414000

166 000 166000

66.94 66.94

Total

48

20. BUDGET AND FINANCE

20. BUDGET AND FINANCE (Global area of work: Budget and financial management)

The fInancial framework of WHO as set out in the Financial Regulations and Financial Rules has been revised. The challenge now is to continue to implement these consistently and efficiently, with sound internal controls, in the Regional Office and country offices. Flexibility is required, balanced with a need for consistency, in order to reflect the differing circumstances and needs in the countries of the Region. The use of fmancial information to support the health activities of the Organization is essential to ensure effective management by technical programmes. Financial information is one way by which success in achieving objectives can be evaluated by Member States, others donors and beneficiaries of the output of the Organization.

ISSUES AND CHALLENGES

To apply best practices in all aspects of accounting and fmancial management at all organizational levels in the Region and in support of WHO's global leadership role in international health.

REGIONAL GOAL

To follow best practices in fmancial management with integrity and transparency and to provide effective and efficient fmancial administrative support to country offices, including financial reporting on all sources of funds at all levels both internally and externally.

WHO REGIONAL OBJECTIVE(S)

(1)

Acceptance by Governing Bodies and donors of the financial implementation reports. Budget implementation and monitoring that enables Member States and other donors to judge fmancial performance.

INDICATORS

(2)

(I)

Implement a seamless and efficient budgetary and fmancial process, with a sound accountability framework for all sources of funds and at all levels of the Organization. Balance the different requirements of: Member States and other donors at all levels of the Organization.

STRATEGIC APPROACHES

(2)

49

PROPOSED PROGRAMME BUDGET2004-2005: PART2

20. Budget and finance: proposed resources b'J source of funds Regular budget OrgaIiDIionaIlevei OIlIer IOUI'C8I I~e

2002-2003

2CJ04.2005

(Decrease)

2002·2003 %

2CJ04.2005

US$ Co.I1Iry or area Regional and intercoooby

US$

US$

US$

US$

1409000 1409000

1155000 1155 000

(254 000)

(18.03) (18.03) 350000

Total

(254000)

50

21. PERSONNEL

21. PERSONNEL (Global area of work: Human resources development)

The challenges for human resources in meeting the needs of the Organization are: to provide the tools that will enable programme managers to identifY their staifmg requirements and to plan accordingly, as well as to recruit highly qualified staff; to support the continuous improvement of job performance through well targeted staff development; to ensure that human resources functions are positioned to provide effective, relevant and fair policies, processes and advice; to support and encourage a working environment where excellence and irmovation are valued and recognized; to include all stakeholders in the development and delivery of these initiatives; and to ensure the security and safety of staff in the Western Pacific Region. Persormel administration systems are being strengthened and the design and development oflT systems is being improved. Continuing attention will need to be paid to refining and strengthening WHO's core management processes. An integrated approach within a framework of key competencies will be adopted for achieving excellence in recruitment, performance management, staff development and management and leadership improvement processes. To maintain WHO's position as an attractive employer, forward-looking human resources policies and staff development programmes, rotation and mobility opportmutJes, organization tools and processes will need continuous development and renewal. Competitive employment conditions should also be promoted in line with the UN common system to ensure excellence in core and support functions, and enable recruitment and retention of highly qualified staff. Promotion of gender parity and equitable geographical representation will require a sharper focus on diversity management. Active participation in the UN security management system will ensure policy input appropriate to WHO's mission.

ISSUES AND CHALLENGES

To apply sustainable persormel policies and practices in a working environment consistent with WHO's leadership role in international health.

REGIONAL GOAL

To provide effective and efficient human resources services in a timely marmer.

WHO REGIONAL OBJECTIVE(S) INDICATOR

Operational excellence in the delivery of high-quality human resources services at the Regional Office and at country offices.

51

PROPOSED PROGRAMME BUDGET 2004-2005: PART 2

STRATEGIC APPROACH

Deliver human resources services to meet current and future organizational goals, through continuous improvement of people-management capabilities, processes and systems.

21. Personnel: proposed resources by source of funds Regular budget Organizalionallevel Other soun:es Incruse (Decrease) US$ %

2002-2003 US$

2004-2005 US$

2002-2003 US$

2004-2005 US$

Cru1try or a-ea

Regional and intercountry Total

686000 686000

782 ()()() 782000

96000

13.99 13.99 350000

96000

52

22. GENERAL ADMINISTRA 170N

22. GENERAL ADMINISTRATION (Global area of work: Informatics and infrastructure services)

WHO's ability to deliver its health progranunes throughout the Region depends in part on the services it provides in infrastructure and communication equipment. Infrastructure services include the production, printing and distribution of publications for technical, administrative and conference documents; procurement of drugs and medical supplies; provision of travel information and policy; servicing of conferences and meetings; and general building management and maintenance. WHO staff are at times required to work in areas which pose high personal security risk, and minimum telecommunications standards need to be implemented and continually reviewed to assist such staff in their work.

ISSUES AND CHALLENGES

To apply best practice in all aspects of general management at all organizational levels, in support of WHO's leadership role in international health.

REGIONAL GOAL

To ensure access to timely and effective infrastrucwe and logistical support in order to facilitate the implementation of technical programmes at all organizational levels.

WHO REGIONAL OBJECTIVE(S)

Appropriate, cost-effective and reliable infrastructure and logistical support services in place at all organizational levels.

INDICATOR

Provide effective infrastructure and logistical support, including accommodation, office supplies and concessions; building management; conference coordination and planning; documents production; records; mail and security; customs liaison and removals; procurement; and travel policy and information.

STRATEGIC APPROACH

22. General adninistration: proposed resources by source of funds

Regular budget Organizational level

Other sources

2002·2003

2004-2005

Increase (Decrease)

2002·2003 '10

2004-2005

US$ Counby or !rea RegionaIIIld inlerrotrrtry Total

US$

US$

US$

US$

4397000 4397000

4689000 4689000

292000 292000

6.64 6.64 1000000

53

PROPOSEDPROGRAMMEBUDGET2004-2005: PART2

23. SUPPLY (Global area of work: Informatics and infrastructure services)

ISSUES AND CHALLENGES

Goods and services, including reimbursable procurement made on behalf of Member States within the Region, have to be procured and delivered in an efficient and cost effective manner. Web-based purchasing, including pre-negotiated supplier agreements, needs to be established at regional and country levels.

REGIONAL GOAL

To apply best practice in all aspects of purchasing to ensure goods are purchased at competitive prices, that they are of appropriate quality and that they are delivered in a timely manner.

WHO REGIONAL OBJECTIVE(S)

To ensure technical programmes are provided with effective procurement and logistical support at all levels within the Region.

INDICATOR Quality of services provided at regional and country level.

STRATEGIC APPROACHES

(I) (2) (3)

Capture purchasing data in electronic purchasing systems at regional and country levels and to encourage use of that data to improve ordering practices. Maintain regular contact with WHO Headquarters, other regional supply units and local and regional suppliers in order to update sources of supplies and equipment. Improve the existing monitoring system to ensure full documentation of receipt of goods.

23. Supply: proposed resources by source of funds Regular budget Other sources

OrgIIlizaiionailevei

2002·2003

2IXJ4.2005

Increase (Decrease)

2002·2003 %

2004-2005

US$ CaI1Iry or crea Regional or inten:ountly Total 640000

US$

US$

US$

US$

597000

(43 (00)

(6.72)

640 000

597000

(43 000)

(6.72)

100000

54

24. REGIONAL DIRECTOR'S OFFICE AND DEVELOPMENT PROGRAMME

24. REGIONAL DIRECTOR'S OFFICE AND DEVELOPMENT PROGRAMME (Global area of work: Director-General's and Regional Directors' Office and Development Programme)

A key challenge for senior management in the bienniwn is to ensure the effective and creative implementation of the corporate strategy as laid down in the General Programme of Work and regional policies as contained in WHO in the Western Pacific Region: a framework for action, drawing on the complementary strengths of headquarters, regional and country offices. This will mean increased stewardship of the technical agenda and upgrading of management processes in ways that are consistent with the corporate strategy and the Framework for action, improved programme consistency and effectiveness, and enhanced corporate learning.

ISSUES AND CHALLENGES

The Regional Director's development programme will continue to provide contingency funds to meet needs in priority areas which could not be met otherwise or to respond to emergency situations. In addition, it will also provide seed money to launch and develop priority collaborative activities and innovative programmes.

To advance global health and contribute to the millenniwn development goals.

REGIONAL GOAL

To direct and inspire the regional office and country offices so as to maximize their contribution to achieving significant health gains in the populations of Member States, aligned to the principles and functions set out in the Constitution and the policies laid down in the General Programme of Work and the Framework for action.

WHO REGIONAL OBJECTIVE(S)

Extent of delivery of all focuses as set out in the regional programme budget, as reflected in the end ofbienniwn performance evaluation.

INDICATOR

(I) (2) (3)

Advocate WHO's policies on health in the Region. Formulate WHO regional policies, in collaboration with Member States, to improve health based on country and regional needs and global policy. Upgrade management processes and promote a corporate culture that encourages strategic thinking, creative networking and innovation among staff.

STRATEGIC APPROACHES

55

PROPOS£[)PROGRAMME BUDGET2004-2005: PART2

24. Regional Direc:tor'. Office and development progranvne: proposed IeSOUrteI by source of fundi Regular budget OrganIzalioIlllIIMll 2002·2003 2OQ4.2OO5 In~.

Olh....oulC8I (Decraase)

2002·2003

2004-2005

US$ CoIJltry or area RegionaIIIld interccultry Total 2085000 2085000

US$

US$

%

US$

US$

1918000 1918000

( 167 000) (167000)

(8.01) (8.01)

0

56

25. REGIONAL COMMlTlEE

25. REGIONAL COMMITTEE (Global area of work: Governing bodies)

The fonnal contribution of Member States to the work of WHO takes place through a series of governing bodies at global and regional levels. At the regional level, the main mechanism for Member States to contribute to WHO's work and to make policy is the Regional Committee. As the formulation of appropriate public health policy becomes more challenging and more critical, sessions of the Regional Committee must be provided in the most efficient and effective way with both the input and the setting required for informed decisionmaking. Careful and deliberate selection of the most pertinent issues, and greater participation and transparency, are essential in order to sharpen the focus of debate. In framing agendas and prioritizing topics for consideration, dialogue between regional and global level governing bodies must be maintained to bring about consensus on technical and policy matters. New technologies facilitate the dissemination of documentation, making it possible to issue documentation for Regional Committee sessions rapidly on the Internet; yet timely distribution of printed material is still needed in order to ensure availability of documentation everywhere.

IS8UESAND CHALLENGES

To ensure establishment of sound policy on international public health and development that responds to the needs of Member States.

REGIONAL GOAL

To provide support to the Regional Committee in the form of efficient preparation and conduct of its sessions, including timely dissemination of easily accessible, readable and high-quality documentation, and of post-session records and resolutions for policymaking.

WHO REGIONAL OBJECTIVE (8)

Timely preparation of documentation and efficient conduct of the Regional Committee.

INDICATOR

(1)

Expand and improve communication channels between Member States, the Regional Committee and the WHO secretariat. Provide concise documentation by more effectively using technology, including electronic drafting techniques.

STRATEGIC APPROACHES

(2)

57

PROPOSEDPROGRAMMEBUDG£T2004-2005: PART2

25. Regional Committee: proposed resources by source of funds Regular budget Orglnizationallevel Other IOUrc" Increase (Decrease) US$

2002·2003 US$

2004-2005 US$

2002·2003 % US$

2004-2005 US$

Regional and intercountry Total

465000

465000

0

0.00 0.00 0

465000

465000

0

58

ApPENDICES

Appendices

Appendix 1.

Conversion table, Western Pacific regional focuses to global areas of work, 2004-2005, regular budget (regional and intercountry allocations)

Appendix 2.

Conversion table, global areas of work to Western Pacific regional focuses, 2004-2005 regular budget (regional and intercountry allocations)

59

ApPENDICES

Appendix 1. Conversion table, Western Pacific regional focuses to global areas of work, 2004-2005, regular budget (regional and intercountry allocations) Focus EPI MVP Expanded programme on immunization Malaria, other vectorborne and parasitic diseases IVO CPC Areas of Work Immunization and vaccine development Communicable disease prevention. eradication and control Malaria Communicable disease prevention, eradication and control Tuberculosis HIV/AlOS Communicable disease surveillance Communicable disease prevention. eradication and control Research and product development for communicable diseases Health and environment Food safety Heallh promotion Injuries and disabilities Child and adolescent health Nutrition Research and programme development in reproductive health Making pregnancy safer Women's health Surveillance, prevention and management of noncommunicable diseases Mental health and substance abuse Tobacco Organization of health services Sustainable development Essential medicines: access, quality and rational use Blood safety and clinical technology Organization of health services Total by Focus (USS)

946000 135000 1171000 1 306000 64000 997000 1 061 000 666000 869000 0 869000

MAL STB Stop TB and leprosy elimination CPC TUB HSI CSR Sexually transmitted infections, including HIVlAIOS Communicable disease surveillance and response HIV CSR CPC

Integrated with all aspects of communicable disease control activities HSE Heallhy settings and environment

CRO PHE FOS HPR OPR

0 2149 000 367000 432000 130000 3078000 544 000 264 000 828000

CHO

Child and adolescent heallh and development

CAH NUT RHR MPS WMH

RPH

Reproductive heallh Integrated with reproductive heallh

52000 646 000 40000 738000 937000 561000 1498000 528000 1632000 0 1 632000 838000 235000 1073000 1970000

NCO

Noncommunicable diseases and mental heallh

NCO MNH

TFI HRF

Tobacco free initiative Health systems development and financing

TaB OSO HSO

HTP

Health technology and pharmaceuticals

EOM BCT

HRH

Human resources for health

OSO

Those in bold leiters are priority areas.

61

PROPOSEDPROGI!AMME BUDG£T2004-2005L PART2

Appendix 1. Conversion table, Western Pacific regional focuses to global areas of work, 2004·2005, regular budget (regional and intercountry allocations (cont'd) Focus HIN Health infonnation and evidence for policy GPE RPC EHA ITG Emergency and humanitarian action Infonnation technology EHA IMD liS REC IMD REC Areas of Work Evidence for health policy Research policy and promotion Emergency preparedness and response Health infonnation management and dissemination Informatics and infrastructure services Resource mobilization. and external cooperation and partnerships Health infonnation management and dissemination Resource mobilization, and external cooperation and partnerships Programme planning, monitoring and evaluation WHO's presence in countries Human resources development Budget and financial management Health infonnation management and dissemination Infonnatics and infrastructure services Infonnatics and infrastructure services Governing bodies Director-General, Regional Directors and independent functions Total by Focus (US$) 878000

255000 1133000 108000 44000 1143000 1187000

ECP PIO

External cooperation and partnerships Public infonnation

1146 000 1310000 634 000 1944000

PME

Programme planning, monitoring and evaluation

PME SCC HRS FNS IMD liS

265000 149000 414000 782000 1155000 286000 4403000 4689000 597000 465000 1918000

PER BFI GAD

Personnel Budget and finance General administration

SUP

Supply Regional Committee Regional Director's Office and Development Programme Total Regional and Intercountry

liS GBS DGO

GOV RODP

31731000

Those in bold letters are priority areas.

62

ApPENDICES

Appendix 2. Conversion table, global areas of work to Western Pacific regional focuses, 2004-2005 regular budget (regional and intercountry allocations) Areas of Work Total by area of work (USS) Focus Allocation to focuses (USS)

CSR CPC

Communicable disease surveillance Communicable disease prevention, eradication and control

869000

CSR MVP STB CSR

Communicable disease surveillance and response Malaria, other vectorborne and parasitic diseases Stop TB and leprosy elimination Communicable disease surveillance and response Integrated with all aspects of communicable disease control activities

869000 135000 64000 0

199000 CRD Research and product development for communicable diseases Malaria Tuberculosis Surveillance, prevention and management of noncommunicable diseases Tobacco Health promotion Injuries and disabilities Mental health and substance abuse Child and adolescent health Research and programme development in reproductive health Making pregnancy safer Women's health HIV/AIDS Sustainable development Nutrition Health and environment Food safety Emergency preparedness and response

0 1171 000 997000 937000 MVP STB NCD

0 1171 000 997000 937000

MAL TUB

Malaria, other vectorborne and parasitic diseases Stop T8 and leprosy elimination Noncommunicable diseases and mental health Tobacco free initiative Healthy settings and environment Noncommunicable diseases and mental health Child and adolescent health and development Reproductive health

NCO TOB HPR DPR

528000 432000 130000 561000 544000 52000

TFI HSE NCD CHD RPH

528000 432000 130000 561000 544000 52000 646 000 40000

MNH CAH RHR

MPS WMH HIV HSD NUT PHE FOS EHA

646000 40000 666000 0 284000 2149000 367000 108000 EHA Emergency and humanitarian action HSI HRF CHD HSE Sexually transmitted infections, including HIV/AIDS Integrated with health systems development and financing Child and adolescent health and development Healthy settings and environment

666000 0 264 000 2149000 367000 108000

Those in bold letters are priority areas.

63

PROPOSEDPROGRAMMEBUDGET2004-2005L PART2

Appendix 2. Conversion table, global areas of work to Western Pacific regional focuses, 2004-2005 regular budget (regional and intercountry allocations) (cont'd) Areas of Work Total by area of work (US$) Focul Allocation to focuses (US$)

EDM IYD

Essential medicines: access, quality and rational use Immunization and vaccine development Blood safety and clinical technology Evidence for health policy Health information management and dissemination

838000 946000 235000

HTP EPI HTP HIN ITG PIO GAD

Health technology and pharmaceuticals Expanded programme on immunization Health technology and pharmaceuticals Health information and evidence for policy Information technology Public information General administration Health information and evidence for policy Health systems development and financing Human resources for health Regional Committee Extemal cooperation and partnerships Public information Programme development and operations Office of the Director, Programme Management

838 000 946000 235000

BCT GPE IMD

878000

878000 44000 1310000 286000 255000 1632000 1970000 465000 376000 634 000 264 000 506 000

1 640000 RPC OSD Research policy and promotion Organization of heaHh services

255000

HIN HRF HRH

3602000 GBS REC Governing bodies Resource mobilization, and extemal cooperation and partnerships

465000

GOY ECP PIO ECP

1780000 PME HRS FNS liS Programme planning. monitoring and evaluation Human resources development Budget and financial management Informatics and infrastructure services

265000 782000 1155000

PME PER BFI ITG GAD SUP

Programme planning, monitoring and evaluation Personnel Budget and finance Information technology General administration Supply Regional Director's Office and Development Programme Programme planning, monitoring and evaluation

265000 782000 1155000 1143000 4403000 597000

6143000 DGO SCC Director-General, Regional Directors and independent functions WHO's presence in countries Total Regional and Intercountry

1918000 149000 31731000

RDDP PME

1918000 149000 31731000

Those in bold letters are priority areas.

64

WPR/RC53/4 page 1

ANNEX 3

INDICATIVE COUNTRY PLANNING FIGURES

The Western Pacific Region has experienced a significant decline in its regional allocation as a result of resolution WHA51.31. The application of the model recommended by

resolution WHA51.31 has meant that the overall allocation to the Western Pacific has decreased from US$ 80 279 000 in 1998-1999 to US$ 71 305000 in 2004-2005, a reduction of about US$ 9 million.

.-

The proportion of the regional allocation grant for country activities has remained fairly constant. In 1998-1999, it was 55.4% and for 2004-2005 it is 55.5%. Despite efforts to minimize the effect of the reduction in the regional allocation on countries, the allocation for country activities has been progressively reduced from US$ 44 506 000 in 1998-1999 to US$ 39 574 000 in 2004-2005, a reduction ofUS$ 4 932000, and this has inevitably resulted in a reduction in the allocations for many individual countries. In addition, as indicated in the proposed programme budget 2004-2005, Part I (p.8), the

estimated resources allocated to "WHO's presence in countries" have been substantially increased in order to strengthen WHO's country offices and to enhance their operational capacities. This has been achieved largely by reallocating 10% of the funds for country activities to "WHO's presence in countries", that is for WHO staff and offices, as requested by the Director-General. In accordance

-

with this increased emphasis, the costs of some essential country staff (such those associated with country liaison officers and their support staff) have been shifted from country allocations to "WHO's presence in countries" in order to reflect this priority more accurately. Therefore, although in

countries affected by this 10% shift it would appear that there has been a significant decrease in the allocation, in fact overall support has been maintained at levels similar to or greater than that in the previous biennium, as the costs of a professional staff member (and in the case of country liaison officers support staff as well) have been transferred to "WHO's presence in countries". For the determination of indicative planning figures, the Regional Committee for the Western Pacific at its fiftieth session requested the Regional Director to use the following guiding principles when deciding the country allocations in the budget for 2002-2003 and beyond:'

I

Resolution WPRJRC50.RI.

WPRlRC53/4

page 2 Annex 3

60% of the country planning figure should be detennined in accordance with the model recommended by resolution WHA51.31, with allocation of the remaining 40% to be detennined by the Regional Director, in the course of preparing the proposed budget, taking into account the following considerations: (1) the difference between the allocation for 2000-2001 and the new allocation should be adjusted over three bienniums; (2)

an adjustment should be made to ensure that least developed countries should not receive a lower allocation in 2002-2003 than they did in 2000-2001;

-

(3)

the possibility of a minimum allocation should be considered for countries and areas which would have received zero allocation if the model recommended by resolution WHA51.31 were applied;

(4)

the specific health needs of individual countries should be taken into account.

In accordance with the considerations to be used in determining the allocation of the remaining 40%, least developed countries (LDCs) were allocated amounts that were not lower than the allocations they received in 2002-2003, although, as already noted, the costs of country liaison officers and administrative support staff are now included in "WHO's presence in countries". Countries that would have received a zero allocation according to the model were given minimum allocations of US$ 45000, a 10% reduction except in cases where the 2000-2001 allocations were lower than US$ 50 000. In such cases, the lower allocations were also subject to a 10% reduction. The principle that any reduction or increase should be made over three bienniums was applied to the remaining countries. Consideration was then given to selected health statistics for each country, such as infant and child mortality rate, maternal mortality ratio, life expectancy, availability of skilled health workers, and the burden of communicable and noncommunicable diseases. allocated to those countries in greatest need. The following table provides the outcome of this process. Additional funds were then

WPRlRC53/4

I

page 3

Annex3 '

Indicative country planning figures, Western Pacific Region 2004-2005 American Samoa Australia Brunei Darussalam Cambodia* China*

125000 0 45000 1 600000 5900000 400000 980000 45000 45000 45000 35000 370000 1450000 45000 850000 260000 480000 1885000 96000 45000 36000 97000 45000 115000 2250000 1 550000 45000 1022000 45000 1 263000 95000 780000 115000 960000 3950000 27069000

Cook Islands Fiji French Polynesia Guam

-.

Hong Kong, China Japan Kiribati* Lao People's Democratic Republic* Macao, China Malaysia Marshall Islands Micronesia, Federated States of Mongolia* Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau Papua New Guinea Philippines Republic of Korea Samoa* Singapore Solomon ISlands· TOkelau 1----,

-

Tonga* Tuvalu Vanuatu*

Viet Nam* Subtotal

WHO's presence in countries TOTAL

12505000 39574000

* Additional professional staff support is included under "WHO's presence in countries",

WPRlRC53/4 pagel ANNEX 3

INDICATIVE COUNTRY PLANNING FIGURES

The Western Pacific Region has experienced a significant decline in its regional allocation as a result of resolution WHA51.31. The application of the model recommended by

resolution WHA51.31 has meant that the overall allocation to the Western Pacific has decreased from US$ 80 279 000 in 1998-1999 to US$ 71 305000 in 2004-2005, a reduction of about US$ 9 million.

-

The proportion of the regional allocation grant for country activities has remained fairly constant. In 1998-1999, it was 55.4% and for 2004-2005 it is 55.5%. Despite efforts to minimize the effect of the reduction in the regional allocation on countries, the allocation for country activities has been progressively reduced from US$ 44 506 000 in 1998-1999 to US$ 39 574 000 in 2004-2005, a reduction of US$ 4 932 000, and this has inevitably resulted in a reduction in the allocations for many individual countries. In addition, as indicated in the proposed programme budget 2004-2005, Part 1 (p.8), the estimated resources allocated to "WHO's presence in countries" have been substantially increased in order to strengthen WHO's country offices and to enhance their operational capacities. This has been achieved largely by reallocating 10% of the funds for country activities to "WHO's presence in countries", that is for WHO staff and offices, as requested by the Director-General. In accordance

-

with this increased emphasis, the costs of some essential country staff (such those associated with country liaison officers and their support staff) have been shifted from country allocations to "WHO's presence in countries" in order to reflect this priority more accurately. Therefore, although in

countries affected by this 10% shift it would appear that there has been a significant decrease in the allocation, in fact overall support has been maintained at levels similar to or greater than that in the previous biennium, as the costs of a professional staff member (and in the case of country liaison officers support staff as well) have been transferred to "WHO's presence in countries". For the detennination of indicative planning figures, the Regional Committee for the Western Pacific at its fiftieth session requested the Regional Director to use the following guiding principles when deciding the country allocations in the budget for 2002-2003 and beyond: I

, Resolution WPRlRC50.RI.

WPRlRCS3/4

page 2 Annex 3

60% of the country planning figure should be detennined in accordance with the model recommended by resolution WHA5 1.31, with allocation of the remaining 40% to be detennined by the Regional Director, in the course of preparing the proposed budget, taking into account the following considerations: (1) the difference between the allocation for 2000-2001 and the new allocation should be adjusted over three bienniums; (2)

an adjustment should be made to ensure that least developed countries should not receive a lower allocation in 2002-2003 than they did in 2000-2001;

-

(3)

the possibility of a minimum allocation should be considered for countries and areas which would have received zero allocation if the model recommended by resolution WHAS1.31 were applied;

(4)

the specific health needs of individual countries should be taken into account.

In accordance with the considerations to be used in determining the allocation of the remaining 40%, least developed countries (LDCs) were allocated amounts that were not lower than the allocations they received in 2002-2003, although, as already noted, the costs of country liaison officers and administrative support staff are now included in "WHO's presence in countries". Countries that would have received a zero allocation according to the model were given minimum allocations of US$ 45000, a 10% reduction except in cases where the 2000-2001 allocations were lower than US$ 50 000. In such cases, the lower allocations were also subject to a 10% reduction. The principle that any reduction or increase should be made over three bienniums was applied to the remaining countries. Consideration was then given to selected health statistics for each country, such as infant and child mortality rate, maternal mortality ratio, life expectancy, availability of skilled health workers, and the burden of communicable and noncommunicable diseases. allocated to those countries in greatest need. The following table provides the outcome of this process. Additional funds were then

-

WPR/RC53/4 page 3

Annex3 '

Indicative country planning figures, Western Pacific Region 2004-2005 American Samoa Australia Brunei Darussalam Cambodia* China* Cook Islands Fiji French Polynesia

125000 0 45000 1 600000 5900000 400 000 980000 45000 45000 45000 35000 370 000 1450 000 45000 850 000 260 000 480 000 1 885 000 96 000 45000 36000 97 000 45000 115 000 2250 000 1 550 000 45000 1022 000 45000 1263 000 95000 780 000 115000 960 000 3950 000

-

Guam Hong Kong, China Japan Kiribati* Lao People's Democratic Republic* Macao, China Malaysia Marshall Islands Micronesia, Federated States of Mongolia* Nauru New Caledonia New Zealand Niue Northern Mariana Islands Palau

-

Papua New Guinea Philippines Republic of Korea Samoa* Singapore Solomon Islands· Tokelau Tonga* Tuvalu Vanuatu* Viet Nam*

Subtotal WHO's presence in countries TOTAL

21069000 12505 000

39514000

* Additional professional staff support is included under "WHO's presence in countries",