________________________________________________ High-Level Preparatory (HLP) Meeting for the Regional Committee WHO/SEARO, New Delhi, 29 June – 2 July 2009 Agenda item 2.3 SEA/HLP-Meet/2.3 22 June 2009 COLLABORATION WITHIN THE UN SYSTEM AND WITH OTHER INTERNATIONAL AGENCIES AND PARTNERSHIPS The recognition of health as a key element for sustainable development and global security has resulted in a substantial increase in global resources for health in recent years; these stood at US$ 16.7 billion in 2006. At the same time, the diversity and number of health actors have also increased significantly. With this proliferation of actors in health, WHO, particularly at country level must coordinate its work, through effective partnerships, not only with government authorities and other UN Agencies, but also with donors, NGOs and the private sector, in order to ensure alignment of health strategies and goals and other development objectives. This paper provides an overview of WHO’s collaboration within the United Nations System and with other international agencies and partnerships over the last year. It reflects the Organization’s efforts in collaborating with a diverse and complementary array of partners to improve the effectiveness of the global health community in accelerating the achievement of the internationally-agreed development goals, including the Millennium Development Goals, with particular emphasis on those focusing on improving global health. The views and recommendations of the High-level Preparatory (HLP) Meeting on this agenda item will be submitted to the Sixty-second Session of the Regional Committee for its consideration.
SEA/HLP-Meet/2.3 Global partnerships 1. Global health has become a multi-stakeholder process. Alongside WHO, a complex array of actors play an increasingly significant role in global health governance, each accountable to a different constituency and with different mandates, guiding principles, expertise, resources, governance structures and authority. 2. A number of partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the Global Alliance for Vaccines and Immunization (GAVI) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), have entered the scene with large amounts of grant money and are playing an increasingly prominent role in the global health architecture. Since its creation in 2002, the Global Fund has become the main source of finance for programmes to fight AIDS, tuberculosis and malaria, with approved funding of US$ 11.4 billion for more than 550 programmes in 136 countries. The Fund provides one quarter of all international financing for AIDS globally, two thirds for tuberculosis and three quarters for malaria 1 . Global Health Partnerships have mobilized important new resources for health and brought political and technical focus to priority diseases or interventions. 3. A multiplicity of non-State actors play a substantial, often predominant role in both the financing and delivery of health-care services: corporate sector (e.g. pharmaceutical companies); nongovernmental organizations; (e.g. Rotary and Medicines sans Frontiers); and philanthropic foundations (e.g. Rockefeller and the Bill and Melinda Gates Foundations which has committed more than US$ 3.6 billion to organizations working in global health). The role of individual entrepreneurs (e.g. Bono), cannot be underestimated. In 2006 alone, American private philanthropy amounted to US$ 34.8 billion. 4. As a result of the increasing number of health initiatives, recipient countries have been overwhelmed among other things by inefficient aid: duplication, fragmentation, multiple reporting requirements, high transactions costs and fierce competition for scarce health staff, etc. 5. Focused Global Health Partnerships (GHPs) have an important role in aligning and coordinating efforts at country as well as at global level. The International Health Partnership and Related Initiatives (IHP+) and its compacts represent a commitment by world leaders, donors, agencies – and the countries receiving aid – to work together in a more effective way to provide support to a country’s costed and validated national health plan. The IHP is supported by donor governments and agencies representing half of the world’s aid spending on health, totalling US$ 14 billion. 6. Nepal is one of twelve developing countries participating in the International Health Partnership and Related Initiatives (IHP+). In February 2009, Nepal became the first Asian country to sign an International Health Partnership National “Compact” with emphasis on aid effectiveness; national 1. http://www.theglobalfund.org/en/about/ SEA/HLP-Meet/2.3 Page 2 ownership and leadership; equity and focus on vulnerable groups, thereby bringing the concept of IHP to a higher level. 7. WHO was actively involved in co-facilitating the International Health Partnership process in Nepal with the World Bank and United Nations Children’s Fund (UNICEF), providing assistance in ensuring greater coherence, harmonization and alignment among multiple stakeholders. 8. The Regional Office is also actively engaged in a number of GHPs such as GAVI, GFATM, the Stop TB Partnership; The Partnership for Maternal, Newborn and Child Health and the Roll Back Malaria Partnership, and provides through its technical units and country offices, technical assistance and support to Member States to help maximize the benefits and minimize the challenges to the countries of engagement with global health partnerships. 9. Other partnerships in which WHO is an active participant include the IFRC 2 , with which the Regional Office enjoys a privileged relationship, particularly in the areas of disaster management; emergency preparedness and response; blood safety; and health information. In February 2009 the Regional Director and the Secretary-General of the IFRC met to review the collaboration between the two organizations, and discuss ways to continue to strengthen the existing partnership and increase the scope of collaboration to other areas such as community rehabilitation, mental health and road safety. 10. In order to help streamline its engagement with such a multiplicity of partners, WHO recently drafted a policy guideline for relations with partnerships, which will be submitted to the Sixty-third World Health Assembly. The policy provides a framework for guiding WHO’s assessment of, and decisions concerning potential engagement in health partnerships, as well as specific parameters to be applied by the Organization in hosting formal partnerships. Comments 11. Some of the Global Health Partnerships are often not aligned with government priorities, and can often undermine and potentially even distort country’s public health priorities. 12. Global Health Partnerships are usually not present at country level and therefore rely on other agencies, such as WHO, to provide technical assistance. The increased demand for WHO to scale up the provision of technical support to countries in response to increasing partnership financing, is not being matched by predictable core resources from GHPs or donors to support the additional workload and costs incurred by WHO. 13. Lessons learnt from new and innovative partnerships such as the IHP+, will be important to guide Member States’ efforts to coordinate external health development assistance. 14. The policy guideline on Partnerships which will be submitted to the Sixty Third World Health Assembly will impact on Region’s work in this area. The Region may consider developing its own guidelines for engaging in regional partnerships. 3. International Federation of Red Cross and Red Crescent Societies. SEA/HLP-Meet/2.3 Page 3 Coordination and Collaboration within the United Nations system 15. With health issues forming part of the agenda of many UN organs and entities, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Economic and Social Council (ECOSOC), the World Bank, the United Nations Children’s Fund (UNICEF), the United Nations Environment Programme (UNEP), the United Nations High Commissioner for Refugees (UNHCR), and the United Nations High Commission for Human Rights, the UN system continues to be a privileged partner for WHO. 16. WHO’s collaboration within the United Nations system and with other intergovernmental organizations takes place at three distinct levels; intergovernmental, interagency and country. WHO’s interaction with the United Nations systems and in particular its involvement in United Nations reform efforts has a twofold orientation: the promotion of health as a contributor to national development processes; and the increased coherence and effectiveness of the United Nations system’s contribution to national development processes 3 . 17. WHO’s interaction with the United Nations system and in particular its involvement in United Nations reform efforts are in line with the World Health Assembly resolution WHA58.25, which requests the Director-General to ensure Organization-wide adherence to the international harmonization and alignment agenda as reflected, inter alia, in the Rome Declaration on Harmonization (2003) and the Paris Declaration on aid effectiveness: ownership, harmonization, alignment, results and mutual accountability (2005), and to take account of the United Nations triennial comprehensive policy review of operational activities for development of the United Nations system 4 . Global coordination and collaboration 18. WHO is increasingly pursuing opportunities for collective action to enhance collaboration and efficiency within the United Nations system. WHO actively participates in the planning process for UN joint action and reform, as well as in the Chief Executive’s Board (CEB), which addresses United Nations system-wide policy, programming, management and operational issues, and its subsidiary bodies. The CEB has recently reformed to bring the United Nations Development Group under its purview as a third pillar focusing on country-level operations, along with the other two pillars: the High-level Committee on Programmes (HLCP) and on High-level Committee on Management (HLCM). 19. The WHO Regional Offices for South-East Asia and the Western Pacific Regions held a high- level meeting with UNICEF and UNFPA to strengthen collaboration in health sector at country level and ensure coordination between the UN agencies in Asia Pacific region, in supporting countries to achieve the health related MDGs as well as joint approaches to advocate and support aid- effectiveness mechanisms. 4. WHA 62/40, Provisional agenda item 20: Collaboration within the United Nations System and with other intergovernmental organizations, May 2009. 5. Ibid SEA/HLP-Meet/2.3 Page 4 Regional coordination and collaboration 20. At the regional level, WHO is actively engaged in strengthening opportunities for improved synergies and alignment among UN agencies with regional mandates in Asia and the Pacific through the UN Regional Coordination Mechanism (UNRCM-AP) convened by the Executive-Secretary of UNESCAP 5 , as well the UN Regional Directors Team, (RDT) convened by the UNDG. WHO also co- chairs the health thematic working groups with UNFPA and participates in the other working groups. 21. Through its membership in the RDT, WHO participated in May 2009, in the first Consultations with the Resident Coordinators/UN Country Teams of 2009 UNDAF countries, to dialogue on process and substantive UNDAF issues. This included Indonesia and Myanmar from the SEA Region. 22. Through its participation in the UNDG, WHO has also participated in achieving greater coordination between the work of the Regional Commissions and the Regional Director Teams. Agreement has been reached that the Regional Commissions will assume a lead role in regional policy issues, and linkages to global policy issues, while the UNDG’s Regional Director Teams will lead in country operational issues and on issues around the Resident Coordinator System. Country- level coordination and collaborative efforts 23. The current directions and guidance for WHO on UN reform at country level are based on the following principles: (details available in the information documents) • Focus on improved health outcomes; • Accountability to Member States; • Based on national needs and priorities; • Focus on aid effectiveness as reflected in the Rome and Paris Declarations; • Partnerships for support to countries; • Contributing to global commitments; and • Ensuring coherence. 24. WHO is a committed partner in the United Nations system’s "Delivering as One” pilot initiatives, which are under way in eight countries. 6 A decision has been made not to launch another set of pilots, but rather to mainstream the lessons learned from the eight pilots in the context of the new UNDAFs. The Governments of Spain (US$ 200 million) and the United Kingdom (GBP 40 million pounds) have contributed additional funds in this regard, 7 as well as providing increased core funding to some organizations. From the SEA Region, Bhutan is expected to come forward of the Expanded ‘Delivering as One’ Funding Window. Although there are no countries in the SEA Region among the pilots, lessons learnt from the eight exercises will be important to achieve flexible, 6. United Nations Economic and Social Commission for Asia and Pacific 7. Albania, Cape Verde, Mozambique, Pakistan, Rwanda, United Republic of Tanzania, Uruguay and Viet Nam. 8. “The Expanded ‘Delivering as One’ Funding Window” SEA/HLP-Meet/2.3 Page 5 inclusive and effective UN team coordination mechanisms, and enhance coordination of development assistance to countries. 25. In line with the Paris Declaration on Aid Effectiveness, WHO's work in and with countries is aligned with national development strategies and plans through the Country Cooperation Strategy (CCS), and harmonized with the UN system in the context of the United Nations Development Assistance Framework (UNDAF). Since its onset, WHO has been a continuous supporter of the UNDAF as the programming framework for effective and efficient coordination of operational activities for development of the UN system at country level. 26. Recently, WHO has been actively involved in the elaboration of The “New UNDAF”, which draws its direction from UN General Assembly resolution 62/208 and the lessons learnt from the eight pilots. Over 90 countries are expected to go through the “New UNDAF” process from 2009 to 2011, including all countries in the SEA Region, with the exception of the Democratic People’s Republic of Korea where a similar process known as “UN Strategic Framework” has been set up. 27. WHO country offices in Indonesia, Maldives and Myanmar will participate in the UNDAF during 2009, ensuring the health section is aligned with priorities in the National Health Sector Plan. 28. WHO has been an active participant in the work undertaken by the UN Development Group (UNDG) to improve the effectiveness and efficiency of UN operations across the system, and to help clarify roles and responsibilities between UN system actors. Achievements in this area include the endorsement by the Chief Executive Board (CEB) in October 2008, of “The Management and Accountability System of the UN Development and the Resident Coordinator (RC) System, including the functional firewall for the RC System”, chaired by the UN Secretary-General and attended by all heads of UN funds/programmess/agencies. The UNDG has subsequently developed and approved a detailed implementation plan. 29. The agreed long-term vision expressed in “The Management and Accountability System of the UN Development and the RC System, including the functional firewall for the RC System”, is that the Resident Coordinator (RC) has an equal relationship with, and responsibility to, all UNCT member agencies”, “is empowered by clear recognition by each agency of his/her role in strategically positioning the UN in each country”, and is “supported, as required, with access to agencies’ technical resources as agreed with the agencies’ representatives, balancing available resources with tasks to be performed”. << 30. In this context, the UNDG has agreed that, different countries being at different stages of the “Delivering as One” initiative, it would not be possible to have one specific model in place for all countries. The need to maintain flexibility and commitment to the country-driven approach has therefore been acknowledged. 31. The Framework further clarifies the issue of a “firewall”, which provides the distinctive internal arrangements that are essential to ensure clarity between UNDP’s role as a programmatic and operational development partner, and UNDP’s functions performed on behalf of, and in support of, the UNCTs . SEA/HLP-Meet/2.3 Page 6 32. Other important accomplishments which WHO has been involved in, include the approval by the UNDG of three key policy papers : (i) Job Description for Resident Coordinators: (ii) Guidance Note on Working Relations between the Resident Coordinator and UN Country Teams (UNCTs ) and (iii) Dispute Resolution Mechanism for UNCTs. 33. Other efforts to improve coordination of joint United Nations activities, include the creation of Multi-donor Trust Funds which may be used by donors to channel and pool resources to support national development priorities and facilitate the work of United Nations country teams. WHO participates in activities of several of these Funds, some of which are increasingly being used to fill the funding gaps in joint country team programmes as defined. Comments 34. The division of labour between UN system agencies at country level needs to be better defined, with special emphasis on ways in which the UN system can collectively provide support to sectoral needs at country level, taking into consideration the respective mandates, roles, competencies and business models of all the UN funds, programmes and specialized agencies. 35. While the value of the UNDAF for the collective UN system is undisputed, there are limitations of the UNDAF and the “One UN” in leveraging action in the health sector. The concept of “comparative advantage” implicit in the UNDAF, has the potential to undermine the contribution which individual agencies such as WHO, bring to development cooperation. WHO will continue to strive to enrich the health dimension of the UNDAF through the CCS, which provides a platform for the development community at country level to discuss cooperation for health, as well as the role of the UN agencies and the particular contribution of WHO. 36. Given the substantial implications of the UN reform agenda for health at the global, regional and country levels, it is essential for Member States to lead and be fully engaged in this ongoing process. Health authorities need to increasingly collaborate with Foreign Affairs officials to enhance their understanding of the implications of UN reforms on health development activities at the country level. 37. Efforts by WHO and the United Nations system as a whole to exert effective and impartial leadership, and improve their effectiveness on global development priorities must be supported by coherent and predictable financing by donor governments. 38. The upcoming ECOSOC Ministerial Review and High-Level Panel in July presents an important opportunity for the international community to focus on health issues and pledge to maintain current health funding during the global financial crisis. Collaboration with regional intergovernmental organizations 39. Intergovernmental Organizations are important partners in health development, although in most cases, their primary objectives are linked to economic, security and/or common political interests. SEA/HLP-Meet/2.3 Page 7 40. WHO has to become increasingly active in advancing the global health agenda in such fora as the G8 and the G20. 41. Initiated in the 1980s, the Regional Office’s collaboration with ASEAN 8 , was reviewed in July 2008, and a new Memorandum of Understanding (MoU) was negotiated which provides a framework for implementation of a shared workplan. The MoU, which focuses on joint activities in areas such as prevention and control of communicable and noncommunicable diseases; health systems strengthening; food safety; climate change; emergency preparedness and response; and traditional medicine, was endorsed by the Ninth ASEAN Health Ministers’ meeting in Manila, Philippines, in October 2008. 42. Collaboration between the Regional Office and the South Asian Association for Regional Cooperation (SAARC) was formalized through an MoU in 2000, and is functional in the areas of HIV/AIDS, TB, malaria and the Tobacco Free Initiative. Conclusion 43. Over the past decade, health has gained increasing recognition as a key component for sustainable development and global security, with a prominent role assigned to the health sector, through various mechanisms including the G8 and G20 agenda, International Health Regulations, the MDGs financing, the UN reform, the Paris declaration, and the Accra plan of Action. 44. Within this global context, it is essential for WHO, as the largest Intergovernmental Organization with an exclusive international health mandate, to strengthen its role as the leading and coordinating authority on international health, both within the UN system as well as beyond. WHO must increasingly engage in effective and innovative health partnerships and networks, in order to support countries in the achievement of the Millennium Development Goals. 45. National governments must continue to play a lead role in coordinating external assistance for health, and assuring alignment with national health development goals and strategies. Action by the High-level Preparatory Meeting (HLP) 46. The HLP is invited to note the report and provide its comments, guidance and recommendation. 8 Association of Southeast Asian Nations SEA/HLP-Meet/2.3 Page 8 Annex Key documents used in preparing the Working Paper (1) Yach, Derek and Hashemian, Farnoosh Global Health Functions In The 21st Century. (2) Summary of Conclusions United Nations System Chief Executives Board for Coordination Meeting, April 2009. (3) Summary of Conclusions of the UNDG Advisory Group Meeting – Principles, October 2008. (4) SEAR/RDMWR-59/6 WP on Agenda Item 3.5 UN Reform: Progress and update, 59th Meeting of the Regional Director with the WHO Representatives, November 2007. (5) SEAR/RDMWR-59/6.1 INF doc on Agenda Item 3.5 UN Reform: Progress and update, 59th Meeting of the Regional Director with the WHO Representatives, November 2007. (6) WHA62/40, Provisional agenda item 20: Collaboration within the United Nations System and with other intergovernmental organizations, May 2009. (7) SEA/ACM/Meet.1, Provisional agenda item 2.6: UN Reform Process and Health Partnerships: Progress and Developments.