W O R L D H E A L T H ORGANISATION MONMACE ORGANIZATION DE LA SANTL
MEETING OF WHO REPRESENTATIVES AND PROGRAMME COORDINATORS
Alexandria, 5 - 9 June 1983 1 June 1983
MANAGERIAL FRAMEWORK FOR OPTIMAL USE OF
WHO'S RESOURCES IN DIRECT SWPORT OF MEMBER STATES
Dr. Rafxque A. Khan WHO Programme Coordinator and Specla1 Representative
Khartoum - Sudan
1.1. This presentation concerns the ways and a w ~ n of hat b.8t t o U s 8
the resources of WHO through a reorg .n imt im of n u r u g m n t fot di rec t WpOott t o
the Hanber Stater . In the provisional PtogrurC, a s ~LrculatCd, khts itma read8
a8 follows :-
Menagerial framework for optimml use of UtlO tewurcer i n d i r w t 8upport of Member States - Countries' experience ~ n d apectattonn
With regard t o the word "optimal", I did my bent to look it up i n a
dictio-ry and found that the Shorter Oxford Errgliph Diutionrry , Edition 1971,
p8ge 1974, reveals that there i r no ouch w r d ; the m a t o r t verd being ''optimL8tW,
meaning "who holds o r believes i n the met#phyriorl grimclpk of spCiaia, or, QQ#
disposed, under a l l c i r c u n u t ~ ~ c e s t o bow fsr tk wt". %hare@, the word
"optimiems' i s defined that "the a c w l wrlsd L the b e t of p r r t b k wrld., ot
t o any view which suppose8 tbt goad w e u l t i m t C 1 j prwatl mr qvil tn Sha
universe". The word "sptinunn" is nhovn bt ir q w l i f i a d w u, 411111 wwd Md
is defined ae a degree or amount of heat , l igh t , food, om s tu re etc,. , mOSf
favourable for growth and reproduction etc. .". The CBl\cire C&fmd P i c t l o n * ~
8180 docs not $ h a the word, but the Webstcr equates i t re M rdv,rb of "qtimm''.
I would, therefore, l i k e t o indulge myself ~ n d extraat thq beet fop the wotdr
from a l l three, i.e. "optimism", "optinbrt" and "apt&md1, to give to the
word "optimal" its fu l l e s t raeanlng.
1.2 The other operative atatme of ehr ~ p u a t a t h L *'oounf,ci~*'
experfence8 and cfpcctatione ". X t m a d ba w(rwry for r ~ p tn p i n e out
that the propored ifanitwork hm yet to be imnbrcorl end ckrc#cw, mCSh.r
the O r g m i r ~ t i o n *or t h t rolntriw ?uvc any axperjaw, ep &r, of Lh. ch.ag.r
tha t a re proposed t o be made.
1.3 The previow presentations have dealt in an exhaustive manner with
the Global, Regional and National Strategies for HFA 2000; the Monitoring
Implementation and Evrluation of the effectivenesq of those strategies; the
Implementation of 1982/83 Progranae Budget and preparation for a review of the
next b i e ~ i u m budget and a proposed budget for 1986/87 , including the program review missions. All the speakers have, in one way or another, also touched upon
the new rutnagemant procedure$ in general terms and particularly those relevant
to their presentation.
2. S W R Y OF EVOLUTION
2.1 Here I st pause and m k e a general, summary of the background,
even at the risk OF repetition, of the rapid developments which have brought us
to this stage. Every new philosophy. dogma, creed or faith, from the t i n it
is conceived , takes ages to propagate and find acceptance. T can recall no
other example in history where a revolutionary idea hqs spread like wild
fire to the four corners of the mr?h;n;l has been universally acclaimed as the
only way in which all the people on this plapet could achieve acceptable
'standards of health for and by themselves by the year 2000. When I say this,
T am not exagerating , because it should be remembered that at the global level,
the UHA adopted in 1977 the goal of Health for All by the Year 2000, and declared
at Alma Ata in 1978, that Primary Health Care will be the key to the attainncnt of
that goal. In 1979, the Organization and Member Stater launched the IUationr!,
Regional and Global Strategies of Health for All 2000; and in the same year,
the UN General Assembly passed Resolution no. 34/58 confirming that health is
an integral part of developuent. Even the most vehenmnt critics and cynics will
readily concede that this, indeed, ts 8 great @chiavement in the bhort space
of five years.
. . , . . . . . . . .3
2.2 Fur ther important s t epa were taken qnd, a t v a r i w a deve lopmntr l
s tages , periodica1l.y seven qamandmeots b v e been iasued, urging the
f a i t h f u l to :-
1. Formulate your Health S t r a t e g i e s fo r t h e year 2090 (1979)
2. Follow Global S t r a t e g i e s j o i n t l y agreed upon I l9Sl )
3. Develop i nd i ca to r s f o r monitoring prograss (1981)
4. Observe guiding p r inc ip l e s f o r managerial procesr f o r National Health D e u e l o m n t (1981)
5. Evaluate your Health Pr~gr rnmes (1981)
6 . Es tab l i sh PLan ,o$ At t ion fo r implernntingl € F A 2000 Global S t re tegy (1982)
7 Adhere t o t he Seventh Censrel Probrenme o f Work
With t h e new concepts and s t r a t e g i e s fo r achisving the Health f a r A l l o b j e c t i v ~ r
through Primary Health Care Rogramnc, cher t heve t o be many rep8rcuraionm and
vas t changes. A l l these have been dipcurqed and c s l l e a t i v e l y agreed upon by
t he Me&er S t a t e s , demna t r a t i ng once again t he dedicpt ion and c o a p i t w n t to
t he new philosophy, o r , should I say, t he new f a i t h i n hea l t h for al l . I cannot
quote any o the r ins tance when the whole o f mankind, through its duly appointed
Representat ive, has embraced a new creed without any d i ssen t . A l l the &be?
S t a t e r , b i g o r small , developed or dwelap ing , super-povers o r not, a l igned
o r non-aligned, have comnitted themselves to the achievement o f KFh 2000
objec t ives i n the s i x t een and halE years t h a t remain, before t he pount-down
reaches zero
2.3 With the magnitude of changes t h a t a r e contemplated, a thorough
revamping of t h e management aspec ts of t h e p r o g r a m had t o be brought i n t o force.
A l l these foreseeable cnanges a r e described i n g r ea t d e t a i l i n t he doqun+nt
~ ~ 0 / 8 3 . 1 which has a l ready been c i rcu la ted . ThLs very erhfaustive doc-nt
cen be considered a s an ampl i f ica t ion and major rqv is ion o f earlier doeuarnt
no. 5 e n t i t l e d "Managerial Process f o r National H w l t h IPevel~prnPnt Guiding
Pr inciples" , i ssued i n 1981. But t he Director-Gener8l 's document , j p ~ t r e f e r r ed
to , goes much fu r the r and seeks t o e s t a b l i s h comprehmrive gu ide l iner m d
procedures f o r i n t e r n a l use o f WHO s t a f f a t @ I 1 l eve l s . ......... 4
Page 4
The Director-General, In pursuance of d l r ec f ive s glven t o hlm by t he Executive
Board and the World Health Assembly, s t a t ed about a fo r tn igh t ago, during the 36th
Assembly i n Geneva, t lmt IIC had t o maintain, a t a l l co s t s , the momentum of ~mple-
mentation. For t h i s purpose, the present phase of monltorlng w i l l be completed
t h l s year and w i l l be reviewed In 1984 by the Assembly, together with comments
of the Executive Board.
3. GUIDING PRIKCIPLES
However, Dr Mahler a l s s s t a t e d t hd t ne could not wait f o r formal monitoring
before ht: took fu r fhe r s t eps t o make the most of tJHO's resources a t the country
leve l . Therefore, he ny\nounced a framework oi a new wnclger ia l process t o support
the count r les In t h e i r e f f o r t s . Thrs new managerial framework has one purpose - t o he lp the count r les put I n to practrce t h e i r s t r a t e g i e s for HFA 2000 by brlnging
the welght of WHO'S tctsl l resources - p o l i t i c ~ l , moral, trclinrcal and f l nanc l a l - t o bear on t h e ma~nstream of n s t l ona l l ~ e a l t h developmerL a c t i v l t l e s The new
management pr(~cedures have f i ve bas], pr inc ip les :-
Princi&-~lo2 -1 -- -- The iovernments must assume r e spons ib i l i t y for the
a p p l r c ~ t ~ o n of c o l l e c t ~ v e l y agreed p01Lc1, and fo r the best use of
WlIO rescrutces.
Pr L nclpI~l-&--Z -- Resources c ~ f ' & O $hould be used only for a c t l v i t l e s
t ha t a r e cons l s teq t with defrnud natzonnl p o l i c ~ e s and wllh ln te rna t rona l
p o l ~ c l e s agreed c o l l e c t r v e l ~ In the Uorld Health Assemblres.
E r ~ c _ i ~ t & No. -3 Use of WHO resourcer t o ensure the proper p l ann~ng and
management of heal th i n f r a s t ruc tu re , so that r t de l i ve r s programmes and
appl ies eechnolog~* tha t a r e approprlare t o the circrmstances, thus making the
most a l the Organization's capacrty rn a supportive and participatory ro l e .
P r ~ n c r p l e - No -- 4 Atsolute r e l ~ a n c e should be placed on pollcy and
progratlme reviews wh~ch should be undertaken ?o in t l y with WHO by the Plember
S t a t e s Lo ensure t h a t maximum use 1% bei*;g made of what has t o o f f e r and
for ge t t i ng maximum WHO support
.. 5
Principle-@& -- There will have to be much greeter accountability
for the manner in which use is m d e of WHO resources. This muld be
necessary not only ta meet national and intemati-1 standards of accounta-
bility, but also to retain the confidence of external donors and partners.
4. THE NEW MNAGEEENT SYSTEM
As mentioned earlier, the Director-General has enunciated the principles
of the new system of supporting the countries. It is, hwever, necessary to
go into further details and describe the various measures that will be taken
at the country, the regional and HQ levels, as well a8 to define aare precirely
the Governments and WHO responsibilities. The various levels of interaction
are dealt, with, in terms of changes, in the folloving paragraphs : - 4.1 @venmvnt and WHO responsibilities
The main issue at country level is how to ensure that the Governments
carry out individually what they have agreed collectivelg in the World Health
Assembly. The Governments must realize that lJHO assistance can only be
effective if used to support the priority health activities and not seen as a
marginal addition to the national health ~udget. This mans that WAO re8ources
ehrmld be used for activities that are consistent both with the defined national
and international health policy coIlectively accepted and adopted. These
policies should be translated, with WHO help, into national strategies, with
built-in mechanism for strengthening the planning and development of health
infrastructure and management processes.
4.2 UH-0 reCmquFzer
One of the priority areas which needs rtrengthaning, with WHO
resources if necessary, would be the monitoring and evaluation aspectr, which
are so essential to good management. Ilouever, the Governments must assuma
the responsibility for the work of WHO and its Regular Budget resource8 for
the projects and may the entire national health programs. within the
health system, that conform to agreed WHO policies . In all these activities
.......... 6
which are entirely national, WHO can only be seen as the upp porting partner,
because its limited assistance can only be available in the most critical
areas to develop Lteir iofrastructure gnd implement their technrcal programmes
4 3 Oq Fhe part of WHO, it must 8ssucpe the new role, not only vis-a-vis
the Governments, but also when it is designated as an executing agency by one
of the funding institutions A t all times, i t muvt be made clear to all concer-
ned that all actlvfties are part of the Ccvernment's polic~es for whrch the
Government elone is responsible, but in w h ~ c h WHO has a technical supportive
role. The existing projects for which WHO rs currently the executing agency
will havq to be reviqued and refornulqted ta conform tp the new concepts,
4.4 The importance of jolnt WHO/Goverment: reviews mvst be emphasized
as these will ~ n d ~ c a t e the handicaps, drwbadks and def~ciencres and wlll
assist the aqtl~orities to take corrective decisions with regard to the future
utilization of rqsourceg. These reviews should be undertaken by a broad range
of senzor officla1s who can take derisions and should be drawn from all sectors
concerned, Invariably, the WRC shot~ld be ftrlly involved rn the reviews and
could call pn the Reglo~lal Offrce to prqvide technical support as and when
required The reviews would also give Further drrection to the programs and
define ways of making even better use of WHO ressurces, lo support natlonal
efforts and to initiate or strengthen their programme planning and development.
The Seventh General P r o g r a m of Work will be usqd as a check-list to determine
where and when the rnvolvernent of WHO Is needed in the four principal areas,
namely, Direction, Coordination and Management, Fieal~h System Infrastructure,
Healtli Sclence and Technology and Prograqne Support.
The Joint polrqies and progranqne review shovld lead to a continuous exercise
of programme budgeting coverrnp Ctre current jolnt activities, the activities
and costs for the next year, and,outline of the broad programme of actlon and
allocation of lentativs resottrces for the next biennium 1986187 The best way of
achieving tbls ib to cunrtltute b t~igh level f,ovr~n1nentb4HO Coord~nation
page 7
Cornittee. This comnittee should have the task of dealing with the practical
issues of program implementation, monitoring, evaluation and reprograming
including any further involvement by WHO , if the Government so desires.
The con~position and mechanism of the working of such cornittee8 would vary from
one country to the other, but it would be useful to share such experiences
through well-organized meeting. The monitoring and evaluation aspects
should not only satisfy that WHO assistance has been efficiently delivered, but
also that it has been effectively used by the Governments together with other
external resoumesthat n ~ y be available in support of these programnes.
4.5 Whatever fimncer are earmarked and from whichever source they
would have to be accounted for. This accountability of regources should
meet bot only the national requirements but also the international standards
of accountability defined collectively by WHO Member States. This will
entail strengthening of accounting procedures and timely provision of
financial infomationto the governing bodies, as well as to the external partners
contributing to the national programmes. Only thus can the confidence of the
funding authorities be maintaw for the future.
4 6 To smmarlze, therefore, that in order to achieve the desired
objectives it must be restated that the Gwernments must assume responsibility
for coordinating broad Issues and actions related to HFA 2000 and that WHO
will work closely with Governments to help them realize their objectives and
will make available resources to help strengthen the Gwernments in this
coordinating work. A logical consequence of the changing relationship will
be a rwiew of the existing basic agreements within the terms of which
WHO currently operates. Such rev~sions will be considered by interdisciplinary
groups after they have reviewed the experiences of the new system which will
be tested in a few selected countries. Tn the intervening period, memoranda of
understanding will be drafted reflecting the new type of relationship evolving
between WHO and the Member St ates.
5. ROLE OF WHO REPRESENTATIVES AND COORDINATORS
5 . 1 As this is the most cr~trcal and perhaps the closest working
relationship between the Organirat~on and the Member State, the Director-
General has given very specifrc and detailed instructions with regard to the
future role of WRCs located in the countries The future functrons ~1.11 be
In four areas bs below , under w h ~ c h the Representatives will be requrred to :-
( a ) Frov~de the Governments w ~ t h lniormation and explanation concerning
the potlclea of the governing bodies of the Organization More specific
guidance must be nffered concerning the reg~onal and global strategies for
HFA 2000 and the parameters of the the Seventh General Programme of
Work They must ensure that these policies are taken full* into account
(b) Support the Covernments in the plann~ng and better management of nat~onal
health programmes
(c) Collaborqte with the Governments In identifving more profitable areas of
the national health programme in which WHO could have mean~ngful partlcr-
pation and well deF~ned funct~ons such as In the planning and management
of jo~nt activities
(d) Help the Governments to identtfv and coordinate available and potentlal
external resources In support of the national health programne
5 2 To enable the Representat~ves to iunctlon effecttvely, formal
authority will be delegated to them to negotiate with Governments on behalf
of WHO, including negotiations cavering programme formulation, subsequent
modificatrons and implementation The negotiating process will be a contrnuing
and a flexible rnechn~sm for programne budgeting following certain well defined
steps will be set. For instance the WRC, after recelpt of "provisional country
planning figures" from the Regional Director will outl~ne a natlonal program
where WHO involvement would be most effect~ve and beneficial However, the
recomendations wlll nnt be in terms of expend~ture, but tn terms of programne
contr~bution After h ~ s recomendations have been accepted, the WRC wlll draft
. 9
on behalf of the Govermacnt, WHO progranme budget proporals based on the
narrative country statement Further instructions regarding the preparation8
of the budget documents will be refined by the Regional Office and conveyed to
all concerned.
5.3 At a11 time WRCs will ensure that propouls for joint activities
w e t the criteria for determining the organisational level for iapcplrpantation
of programne activities which enact solving problem8 of major public health import-
ance and should resolved from a national identification of priortty ~eeds,
vhich in turn should give rise to the establishment and sustained implementation
of the country health program
5 4 Once the Regional Director has given his approval, the country
health program is not subject to control at any other level or to the health
progranme actfvities The delegation of authority to WRC includes the right and
duty, together with the national health authoritier concerned, to screen
technical proporals made to the Government and to reject proposals, if they are
considered irrelevant All WHO involvement in direct support of the country,for
the sake of financial accountability, in future, will take two forms, i.e.
"direct financial participation" and "provision of international services" to the
programmes -
The mechatdms for such support have been described in detail in one of the
earlier presentations However, these will have to be hrther defined and
incorporated into WHO Manual before these can be implcrrnted by all concerned,
but the baric principles remain that , the procedures would be greatly simplified,
and that, the Governments would acm unt for the "direct f inancial participation''
and W H l l for the elemmt of "international services". Such accountability w 11 not
only have to meet the national, but also the international standaids of accountabi-
lity A system of releasing "working capital in advance" to the Governments will
page 10
also be instituted to provide timelv financial support at the co~~ntry level
5 5 The WRCs will be accountable, at the country level, for the activities
of WHO to the Government and to the Regional Director. The WRC has, thus, been
placed In a situation where it wlll become necessary for him to firmly, but
correctly, refuse certain requests for activities which are not in conformity
with the Organlzat ton's pol ~ c y
5 6 The proposed new system of programme budget~ng and financial
accountabil~ty, although apparently very complicated at this stage, and
difficult to comprehend, ie, in fact, designed to be much simpler than the
existing system This has been fully described by the Director Support
Programne, and will be f.111~ realized as a11 staff me&ers become familiar and
gain experience 7f the new proceduree
6. SUPPORTTNI: ROLES AT H l G I P R LEVELS
6.1 Regional Of irces
6.1.1 Concurrent with the change of role at the country level
correpsondtng changes would be made at the higher echelons of the Organization
with the singe1 purpose of giv~ng the most effective support to the Country
Programs.
6.1.2 At the Regional Offices, maln techn~cal cooperation functions
will be pooled, held in reserve and deployed according to requests from
cor~ntries promptly and eCF~cientlp.
6.1.3 In order to ensure coordlnated support requested from any
level "Country Desks" will be organized with the functions of assisting the
WRC/Gwernments in all aspects of IlFA 2000 activities. A "focal person"
would mastermind theseWdesks" and assemble "multidisciplinary teams" according
to each situat~on.
6.1.4 In essence the "desks" crhould facilitate and expedite
work at the country level by expediously responding to the requests for
support of all kinds including managerial and administrative. ........ 11
page 11
6.1.5 New procedures would r equ i r e not only t he technica l
s t a f f , but a l s o t he Administration and Finance elemente t o v i s i t countr ies .
Only through such v i s i t s w i l l a r e a l understanding develop betveen t he f i e l d
and the Reglonal Office s t a f f which i n t u r n would lead t o r e a l l y e f f e c t i v e
support and col laborat ion.
6.2 Headquarters
6.2.1 The Director-General has given a new d e f i n i t i o n of the
runc t io~is of Headquarters i n t he context of l a t e s t development . These
a r e g loba l st i inulntion through the generat ion, crystallization and promotion of
ideas; worldwide c o o r d ~ n a t i o n on behalf OF the Executive Board and Health
Assembly; collation, ana ly s i s , synthesis and dissemination of v a l i d Jnformation
on he l a th mat te rs , c e n t r a l o rqan i~a t i o r r of g loba l p r o g r a m s and p r w i s i o n of
t he r i g h t kind of i n f o r m t i o n and o the r support t o t he governing bodies and
the global advisory groups, pa r t i cu l a r l y those involved i n mul t i sec tora l and
rmtl t idiscipl icary ac t i on f o r hea l t h and i n t c t e n a t l o n a l t r ans f e r of rcsaurces
fo r hea l th .
6.2.2 A l l Headquarters s t a f f w i l l ca r ry out the abwe f u n c t ~ o n s i n
the s p i r i t of emphasis of support t o the count r ies a t request of the Regional
Offices. They w i l l a l s o dea l wi th in te r - reg iona l and g loba l a c t i v i t i e s
according t o c r i t e r i a defined i n t he Seventh General P r o g r a m of Work. Such
reques t s must be i n i t i a t e d by the Regional Off ices concerned.
6.2.3 Although research pro jec t s w i l l continue t o remain a
separa te cntegory, Headquarters s t a r f cannot ignore t he countr ies ' v ievs
emerging f r ~ m j o i n t policy reviews.
7. IMPLEWNTATTON
Beglnnlng with each and every responsible o f f i c i a l , and involving
appropr ia te groups i n the country and through the j o i n t Government h H 0
coordination mechanism, these new c loae support procedures w i l l be introduced,
......... 12
page 12
tested, improved and perfected. The Regional Offices will develop ways and
means of monitoring the implementation and for keeping Headquarters informed
of the progress inade by the new managerial procedures.
8. S O E REFLECTIONS
8.1 Given the diversity of administrative management procedures Ln
various countries, the variable involved, the rnherent human resistance to
change, the personalities and backgrounds of various partners, the task
of rmplementation will meet many obstacles insrde and outside the Organization.
8.2 In due course, the new procedures, after a period of trial may
prove to be an improvement. Initially, however, all thosc responsible for
worklng these, nationals or WHO staff, must have these fully explained and
thrashed out through short well-organrzed workshops.
8.3 Frnancral control and accounting methods vary from one country to
another. Foreign exchange situations in the most needy countries are desperate
and "working caprtal advances" may easily be diverted and thus, programmes
dc prlveii of dlrect Frnancial support.
8.4 IY ~ : d ,, superhuman for tneq'focal person" or the "country desk" to
resist bcclr~tlrng an additional bottleneck in bureaucratic hierarchy. There
are grave apprehensions that these new bodies rn~ght delay effective
collnharatlon nr make ~rrelevant mterventron.;.
8 5 >lore thought should be grven to the introduction of periodic
TR/TPR type of programme reviews. These would allow for better technical
monitoring and more relevant accounting and financial control.
8.6 Other administrative and financial procedures of the Organization,
in support of countries, should also be revrewed and made more liberal and
less costly to the countries seeklng assrstance through revolving funds and
reimbursable purchases.
............ 13
page 13
8.7 WHO Representatives should be brought at par with other Agency
Heads in the countries, in terms of delegated authority fn administrative , financial and prograunne matters. Country office8 would have to be strengthened
through assignment of addrtional support staSf, administrative and technical.
8.8 To permit WRCs to be fullj in the picture with all developments
in the Organization, they should routinely attend the Regional Cmittees, along
with the national colleagues, and, also other important meetings affecting
progrznw matters at the country level.
8.9 By-passing or short-circuit~ng of the WRCs must be resolutely
discouraged and whenever other cnannels of comunlcation have been resorted to,
under exceptional circumstances, the WRC's [ o m 1 views must be obtained
before finalizing action.
8.10 WLiO is ore of the "big four" utkh~n the IrN system and anything that it
does 1s bound to have rcperculrsLons f lr all the Orgclnizat~ons. Should our
new procedures run counter t o tllc-ir interrsrs, certain amount antagonisc~
and attempts at thwfirtirlg WHO should be ~xpected. It is wondered if
consultations with the major W partners have taken place lnd what was the
trend of react iarle.
9. CONCLUb TON
No system devlsed by the human mrnd can be perfect and must be looked upon
only as another step towards further development and future improvement.
Introspective reviews grve abje~t~vrty to change and an impetus to dynamic
revival and progress . Wlth these refleptions, but without any reservations,
the WHO staff in Svdan, with the willing consent of the highest national
authorities, wlll implemtn the sew management procedures with utmost sincerity. I
have, therefore, been asked to colvey to tllr Regional Director, by the Government,
to consider Sudan as one of the first countries for implenentation d these
magcrinl methods and to give Sudan the guidance and Support it may need.
SLIDE I - PAYAGERIAL FRAPFIU~OPK F ~ ) P O P r I Y L
LlSt OF IYO'S PFYCIUPCFS IF ' !IJb'FC?
SUPPOFT OF MEVRFK STATE? - COl'nTSIFS
EXPEFI EYCF AYD FXPECTAT I C l l C -
S L I D E 2 - PUSPOSF
THE FRAMEWOPK WAS qY€ PUPPOCE I , E , TO YELP THE
COUNTHIES PUT I PITO PPACTI CE TMFI I? STKATF6 I ES FOR
HFA/200r3 BY R P I !!GI VC- TYF VIEIFHT OF IllUn'? TOTPL
RESOURCES - POLIT ICAL, MORAL, T t C H N I C4L AYD FINA"4CIAL -
(0 BEAR ON TUE P"lINSTSE4p OF NATIONAL YFALTH llFVELDP'"'Eb1T
A C T I V I T I E S ,
SLIDE 3 - PRINCIPLES
THE NEW MANAGEVENT PPOCEDURE PAS FIVE BASIC
PRINCIPLES:
N-LL
THE GOVERNMENT WUST ASSUPE RESPOflSIFILITY FOR THE
APPLICATIOM OF COLLECTIVELV AGREED POL1 C I E5 AVD FOR TYE
REST USE OF WHO RESOURCES,
M I L 2
RESOURCES OF WHO SYOULD SE UTED OYLY FOP ACTIV IT IES
THAT ARE CONS ISTENT \!I TY DEFI VED NA1 IOVPL POL1 C I ES A I D
WITH I NTERI'IAT I OIIAL POL I C I ES AGREED COLLECTIVELY I N TY F
WORLD HEALTH ASSEMRLI ES ,
MO, 3
USE OF WYO RESOURCES TO EWSURE THE PROPER PLANFIIrVG
AND MANAGEPEYT OF UEALTH INFRASTYUCTUQE, SO THAT I T
DELIVERS PROGRAPMES AND APPLIES TECFNOLOG I ES THAT ARE
APPROPRIATE TO TUE C I RCUPSTANCES, THUS MAKIYG TYE POST
OF THE OPGANIZATIOY 'S CAPACITY I Y A SUPPORTIVE AYD
PART I C I PATORY ROLE,
NU, 4
ARSOLUTE R F L I A V C F 5HVIILD pF PLACED OIJ P O L I C Y PMD
PROGRAMPE REV I E l l ? WF ICY SPOULD RE UPJDEPTAKFY J n I M T L Y
W I T H klHO BY T Y E MEF1FFR STATES Tf l ENSUSE T N A T F A X I Y I I M
USE I S S E I I J G MADE OF WYAT WYO F A C TO DFFFS bND FOP
G E T T I N G P A X I P U V blYO SUPPORT,
NO, 5
I H E R E \ \ ILL HAVE TO I3E MUCF GREATER A C C O U N T A S I L I T Y
FOR THE PAMNER l b 4 Y H I C Y USF I < PIADF OF WKl PESOURCFS,
T M I S WOULD R E NFCESSARY P!OT O V L v TO I'IEET N A T I O N A L AYD
I NTERNATIONAL STANDARDS OF ACCOUYTARI L I T Y , B U T A L V T o
R E T A I N THE COWFIDEYCE O F FXTERI !AL DONORS AYD PARTYFRY,
S L I D E 4 - ISSUES, PEASIJPES AND RESPOnlSIFl L! TIFY
COUNTRY, RFGI OVAL.. Ha -GLOBAL -
THE D I RECTOR-GEPJERAL HAS EFIUYC I ATED THE PRIVCIPLES
OF TYE YEW SY'5TFM OF SUPPORTIblG TUF COUNTRIFS, I T IS ,
HOYEVER, NECESSARY TO 50 I I T O FURTYFR DFTA ILT AND DFYCPIRE
THE VARIOUS WEI-\,SUSES l Y A T \.'ILL RE TPYEV AT THF CQUFITRY,
IYE PEGIOPIAL AND YO LEVELS, AS \ \ E L L AS r0 D t F I Y E PVRE
PRELISELY THE C.OVERYl1ErJT1S A V D \!YO PE'5POPIS!SI L I T I F S ,
SLIDE 5 - COUNTRY L F V L
A, TFE GOVESNMFNTS PU5 1 PFALILE TFAT WHO KE$OlIRCES C4N
ONLY PF EFFFCTIVF I F USED TO '5UPPOPT TYE PRIORITY
HEALTH ACTIV IT IES AND VOT SEEY AS A PARBINAL ADDIT IN1
TO TFE NATIONAL HFALTH BUDGET I , E , WHO PFSOUPCFS
SHOULD HE USED FOP ACTIVITIEY TVAT PVE COIISISTFrlT
BOTH WITH THF DEFINED YAT IONAL AND I l!TERNATIONAL
HFALTF POL1 C I ES COLLFCT 1 VFLY ACCEPTFD AUD ADOPTED.
B , POLICIES SPOULU RF TRAfilCLATFD, WITY \'YO HtLP, INTO
NATIONAL STRATE61 FS, b'ITF R U I LT- 14-f"'FCYANISf"l FUR
S I RENGTHEN I PIG THF PLANN I NG AbID DEVELOPPENT OF FFALTP
I MFKASTRUCTURE AND MAP!AGFMFPJT PPOCESSFC ,
C , TO STRENGTHEN, PPEFEPASLY, UITY 14YO PESOLIRCES, OF
MONITORING AND EVALUATIOY ASPECTC, W1Ccc APF_ Sn
ESS t N T I AL TO GOOD VAFAGEflEFIT,
D , GOVEPNP?F!lTS rlUST A5SLlVE TFF SESPOYSIRI L I I Y FOP TYE
FORK OF IJHQ AYD THF l!SF OF I T S REGULAR r3UDGET PE'jOUPCFS
FOR NATIOYAL YEALTY PPOGPAVPIFS, I + l ITV IY TtrF YEALTq
SYSTEP?, TYAT CONFORV TO AGREED blHO P O L I C I F S ,
E , WHO MUST ONLY 1SF Sk-EbJ AC P SUPPORI IF16 PAPTFJER OF W F
GOVERYMEYTS - I T S L I F I T E D A S S I S T A W CAY ONLY RE
AVAILABLE I N TYE MOST C Q I T I C A L AREAS TO DEVELOP T H E I S
IrlFRASTRUCTURE AVD IWPLEWEVT T V E I R TFCY 4 I CAL PPOGPAPMES ,
F, WHO'S FIE\4 ROLE, AS 44 EYECI!TING AGENCY, VIS-4-VIC TNF
FUNDING I NSTI TUT 10% PUST UblUEPGn A PAOICPL CHANGE,
THE EXIST IFJG PP@,IFCTS FOP V Y I C F lf i lYO I C CClPPFYTLv TWF
EXECUTIklG AGENCY w l LL UAVE TO PF REVIFWED UnJD RE-
FORMULATED T n CONFOPPI TO THE 4EV COh'CFPTS.
SLIDE 6 - IMPORTANT MEASIJW
A, JO INT WHO/GOVERNNFNT POL1 CY AYD PROCRAMME REV1 FIJS
MUST BE EMPHASIZED AS THESE 141 L L I v D I L A T E THE
HAND I CAPS, DRAWBACKS AND DEF I C I ENC I ES AYD M I L L
ASSIST THE AUTHORITIES TO TAKE CORRECTIVE DECISIONS
WITH REGARD TO TFE FUTURE U T I L I Z A T I O N OF RESOURCES,
B , REVIEW GROUPS SHOULD COMPRISE SFNIOP OFF IC IALS WYU
CAN TAKE DECISIONS AND SHOULD RE D R A W FPOW ALL
SECTORS CONCERNED, WRC SY OULD RE FULLY INVOLVED I N
THE REVIEWS AND MUST CALL ON T I E REGIOYAL OFFICE
TO PROVIDE TECHNICAL SUPPURT AS AWD WHEN RErlUI PED
S L I D t 8 - MECHANISMS
A, A H I GH L E V E L GOVERNMEMT/WHO COOPD I NATIOY COMMITTEE
FOR PROGRAMFE FOPMULATION, IMPLEMEYTATIOY, NONITORI NG,
EVALUATION AND REPROGRAMMING I NCLUDI MG ANY FUPTHER
INVOLVEMENT B Y WHO, I F THE GOVERNMENT SO DESIRES, THE
COMPOSITION AND VFCYANISV OF THE WORKING OF SUCH
COMMITTEES WOULD VARY FRON ONE COUNTRY TO T I E OTYEP,
B . ACCOUNTAR I L I TY O F KESOURCES - N A T I O N A L REQU I PFFEblTS
AND INTERNATIONAL STANDARDS AS D E F I N E D COLLECTIVELY
B Y WHO MEMBER STATES,
C , STRENGTHEN I NG O F ACCOUNT1 NG PROCEDURES AND T I M E L Y
P R O V I S I O N O F F I N A N C I A L INFORMATIOY TO THE GOVERN1 NG
BOD I ES ,
S l I D E 9 - RUI E OF WHO REPRESENTATIVES AND
COORD I NATORS -
A, PROVIDE THE GOVERNMENT Y I T H IYFORM4TION AND
EXPLANATION CONCFRNING TY E P O L I C I E S PF THE
GOVERNING BODIES OF THE ORGAY I Z A T I O N ,
B. SUPPORT THE GOVERWENTS I N THE P L A Y f l I f I G AND
BETTER MANAGEMENT OF NATIONAL HEALTH PROGRAVVES ,
C , COLLABOTIKTE W I Tti TY E GOVERMMENTS I Y I DENT I FY I NG
MORE PROFITABLE AREAS O F THE N A T I O V A L UEALTY
PROGRAMME I N WHICH YYO COULD HAVE MEANINGFUL
P A R T I C I P A T I O N AND WELL DEFINED FUYCTIONS SUCH AS
I N THE PLANNING AND FANAGEMEYT O F J O I N T A C T I V I T I E S 4
D. HELP THE GOVERNMENTS TO I D E N T I K Y AND COORDINATE
AVA I L A B L E AND P O T E N T I A L EXTERNAL RESOURCES I N SUPPORT
OF T H E N A T I O N A L HEALTH PROGRAMME.
S L I D F 1 0 - DELEGATION OF-UTHORITY
A, NEGOTIATE WITH GOVERNMFNTS 04 BEHALF OF WHO, INCLUDING
NEGOTIATIONS COVER1 NG PROGRAMWE FORNULATION, SURSEnUENT
MODIFICATIONS AND I MPLEMENTATIOM ,
B , ESTABLISH A FLEXIBLE MECHANISM FOR J O I Y T PROGRAMME
BUDGET1 NG BASED ON JOINT POL IC IES AND PROGRAMME REVIE16
AND 7 GPV,
C, THE WRC WILL DRAFT ON SEHALF OF THE GOVEPNMEuT, YYO
PROGRAMME BUDGET PROPOSALS RASED ON THE b!ARRATIVE
COUNTRY STATEMENT,
D , WRCs W I L L ENSURE THAT PROPOSALS FOR JOIt4T A C T I V I T I E S
MEET THE CRITERIA FOP DETERMINING THE ORGANIZATIONAL
LEVEL FOR IFPLEM~NTATIO~ I OF PROGR4WF A C T I \ / I T I F S ICY
ENACT SOLVIbJG PRORLEPS OF PAJOR PUSLIC UFHLTH IWPORTANCE
AND SHOULD RESOLVE FROM A YATIONAL IDENTIF ICAT ION,
E , AFTER RD's APPROVqL, THE COUNTRY YEALTY PROGRAMME I S
NOT SUBJECT TO CONTROL AT ANY OTHER LEVEL. WRC FUNCTIO!S
INCLUDE THE RIGHT AND DUTY TO REJECT PSOPOSALS, I F THEY
ARE COIIS IDERED I RRELEVANT,
F. T t i t WRCs W I L L R E ACClJI I~1T4SLEI P T TYE COUNTRY LFVEL,
FOR THE A C T I V I T I F S OF WHO TO THE GOVERYPEYT AND TO TYE
REGIOMAL DIRECTOR, THE VRC HAS, THUS, EFEV PLACED I! P
S I T U A T I O N WHERE I T WILL BECOME NECESSARY FOR H I M TO
F I RWLY, RUT CORRECTLY, REFUSE CERTAIN REPUESTS FOR
A C T I V I T I E S WHICH ARE NOT I N COMFORWITY W I T 4 TNE ORGAnl IZATION'S
P U L I CY,
THESE W l L L B E D I V I D t D i V T O IN0 S N I A D TYPES.
A , D I RECT F I N A N C I A L PART I C 1 P A l I O N I !J VAT IOWAL PPOGPA'"'flES,
T H I S WOULD COMPRISE RESOURCFS M4DF 4 V A I L A s L F TO T P E
GOVERYMEM l S TO SUPPORT THEN I bl A T T A I 4 I b!G DFF I Y ED PEALTH
OBJECTIVES, TARGETS A\lD OUTPUTS. G O V E R W N T S MOULD
ASSUME RESPONS I R I L I T Y FOR BUDGETARY CONTROL AYD ACCOUPITIWG.
B , P R O V I S I O N OF INTERNATIONAL SERVICES: I U C L U D I Y G A L L
UFFSHORE I NVOLVEPEN I SUCH 43 IYTFPNAT IObJAL ST4FF,
S U P P L I E S AYD EOUIPMEVl AYU FELLOWS! I P S t.TC, FOR T H I S VHO
WILL B E ACCOUNTABLE TO TYE GOVERWEYT AS WELL 4s TO I T S
OYN GOVERN I V G ROD I ES ,
C . URCs OW BEHALF OF WHO AND, I N C O L L A S O P A T I O ~ ~ WITH
GOVERNMEhlTS, \J I LL ENTURF CORRECT ACCOUVT I Y G PROCEDURES,
TO RE D E F I N E D AND O R 5 F F V t D FY 4LL COYCERYED.
S L I D E 12 - SUPP R G R -
A, TO M O B I L I Z E THE MOST EFFECTIVE SUPPORT TO THE COUYTPY
PROGRAMMES,
B , TO ENSURE COORDINATED SUPPORT REQUESTED FROM ANY
LEVEL, "COUNTRY DESKS" W J LL B E ORGANIZED WITH THE
FUNCTIONS OF ASS I S T I NG THE GOVERNMENTS THROUGH :
I. SUPPORT THE J O I N T GOVERNMENT/WHO MECHANISMS,
2 , REVIEW PROGRAMME PROPOSALS TO THE REGIONAL DIRECTOR
FROM GOVERNMENTS,
3 , ENSURE THE COORDINATED SUPPORT TO COUNTRIES,
4, COMPREHENSIVE REVIEWS OF THE COUNTRY ' S S ITUAT ION AND
NEEDS,
"5, POLICY ANALYSIS,
6, FORMULATION, IMPLEMENTATION, MONITORING AND EVALUATION
OF STRATEGIES FOR HEALTH FOR ALL.
7, DEVELOPMENT OF THE NATIONAL HEALTH SYSTEM, BRINGING
SCIENCE AND TECHNOLOGY TO BEAR ON HEALTH DEVELOPMENT.
8, COOPERATI'VE PLANNING OF PROGRAMMES I N WHICH WHO I S
INVOLVED AND PROPER USE OF WHO'S RESOURCES TO T H I S END,
SLIDE I3 - REFLECTIONS ON IMPLEMFNTATION
1, THE TASK OF IFPLEMENTATIOY WILL MEET MANY OBSTACLES
INSIDE AND OUTSIDE THE ORGANIZATION,
2 , ALL THOSE RESPONSIBLE FOR WORKING TYESE, YATIONALS OR WHO STAFF, MUST HAVE THESE FULLY EXPLAINED AND THRASHED
OUT THROUGH SHORT WELL-ORGANIZED WORKSHOPS,
3 , FINANCIAL CONTROL AND ACCOUNTING METYODS VARY FROM ONE
COUNTRY TO ANOTHER, "WORKING CAPITAL ADVAKES" MAY
EASILY BE DIVERTED AND THUS, PROGRAMMES DEPRIVED OF DIRECT
FINANCIAL SUPPORT,
4 THE "FOCAL PERSON" OR THE "COUNTRY DESK" MAY BECOME AN
ADD I T 1 ONAL BOTTLENECK I N BUREAUCRAT1 C HIERARCHY, THUS
CAUSING DELAYS I N EFFECTIVE COLLARORATION,
5 , THOUGHT SHOULD SE GIVEN TO THE INTRODUCTION OF PERIOEIC
MTR/TPR TYPE OF PROGRAMME REVIEWS, THESE WOULD ALLOM FOR
BETTER TECHN I CAL MON ITORI 4G AND MORE RELEVANT ACCOUNT I MG
AND FIVANCIAL CONTROL,
6, OTHER ADMINISTRATIVE AND FIYANCIAL PROCEDURES OF THE
ORGANIZATION, I N SUPPORT OF COUNTRIES, SHOULD ALSO BE
REVIEWED AND MADE MORE LISERAL AND LESS COSTLY TO TYE
COUNTRIES SEEKING ASSISTAYCE THROUGH REVOLVING FUNDS AND
RE I MBURSASLE PURCHASES,
SLIDE I4 - EAXTASIA
WE VOW HAVE ONE-AND-A-HALF YEAR'S EXPERIENCE OF
FULLY DECENTRALIZED DECISION-MAKING AND, HITHI!
ACCEPTED PRINCIPLES, OF COMPLETE FREEDOW TO USE "ALL
THAT WHO HAS TO OFFER",
I MUST ADMIT THAT OUR PROGRAMME RUDGETING EXERCISE
I S NOT WITHOUT PROBLEMS, RUT WE ARE LEARNING HOW TO
OVERCOME THESE PROBLEMS, I i E TRY TO SEEK SOLUTIONS THAT
ARE ACCEPTABLE TO OUR NATIONAL ADWINISTPATION AYD TO WHO
AS WELL, WE ARE PROGRESSING WITH CERTAINTY BUT WE NEED
TIME, I T WILL PlOT BF REFORE THE EYD OF I985 THAT bfE CAN
DRAW SOLID CONCLUSIONS WHICY MAY INSPIRF AYD COYTPIEUTE
TO THE EFFORTS OF OTHER MEMBER STATES,
S L I D E I 5 - DR MAHLER
" I H A V E NO I L L U S I O N S ABOUT THE D I F F I C U L T I E S YOU YAVE
TO FACE I N PURSUING YOUR STRATEGIES FOR HEALTH FOR ALL,
WHATEVER THE L E V E L OF S O C I A L AND ECONOMIC DEVELOPMENT
OF YOUR COUNTRY, Q U I T E APART FROM INTERNAL OBSTACLES,
THE WORLD P O L I T I C A L AND ECONOMIC C L I M A T F HANGS OVER US
A L L L I K E AN EVER-PRESENT SWORD OF DAMOCLES, YET YE YAVE
BEEN SINGULARLY SUCCESSFUL U N T I L NOW I N G U I D I N G OUR
ORGANIZATION BETWEEN THE M I N E F I E L D S OF INTERNATIONAL
P O L I T I C A L AND ECONOMIC TURMOIL, I CONSIDER I T E S S E N T I A L
THAT WE CONTINUE TO FOLLOW THAT ROUTE, THE POUTE TO
HEALTH FOR A L L THAT WE HAVE MAPPED OUT TOGETHER I S APPLY
WIDE TO MAKE I T UNNECESSARY TO TRESPASS ON OTHERS'
TERRITORIES. "
- CONCLUSIOH
NO SYSTEM DEVISED BY THE HUMAN MIND CAN RE PERFECT
AND MUST BE LOOKED UPON ONLY AS ANOTHER STEP TOW.4RDS
FURTHER DEVELOPMENT AND FUTURE I MPROVEMEMT, I NTRO-
SPECTIVE REVIEWS GIVE OBJECTIVITY 'TO CHANGE AND AN
IMPETUS TO DYNAMIC REVIVAL AND PROGRESS, WITH THESE
REFLECTIONS, BUT WITHOUT ANY RESERVATIONS, I HAVE REEY
ASKED TO CONVEY TO THE REGIONAL DIRECTOR, RY THE
GOVERNMENT, TO CONSIDER SUDAN AS ONE OF THE FIRST
COUNTRIES FOR IMPLEMENTATIOY OF THESE MANAGERIAL Y E T I ODs
AND TO GIVE SUDAN THE GUIDANCE AND SUPPORT I T MAY NEED,
PROGRAMME IMPLEMENTATION
WHO P a r t i c i p a t i o n i n Nat ional Programmes
Varred I l l u s t r a t r v e Examples
A major, communrty-based n a t i o n a l h e a l t h development p r l o t programme, based on prrmary h e a l t h c a r e . ~ s t i m a t e d t o t a l co s t : US$ 2 500 006 over a f i v e year per iod. WHO w r l l provide d i r e c t f i n a n c i a l p a r t i c r p a t i o n up t o 202, o r US$ 100 000 per yea r f o r f r v e years . Thrs r s a p i l o t scheme t o des ign and t e s t a new PHC approach, r n r t r a l l y r n 30 v r l l a g e s , wrth a t t e n t r o n t o prrmary and f r r s t l e v e l r e f e r r a l and suppor t , and bu r l t - an h o r i z o n t a l r e p l r c a t i o n between v r l l a g e s . The programme w r l l t e s t t h e use o f v r l l a g e a c t r o n comm~t t ee s , community h e a l t h plannrng and management methods, v r l l a g e v o l u n t e e r s and o t h e r h e a l t h workers, revolvrng d rug fund and s e l f - f i nanc rng PHC scheme. I f t he p r l o t ope ra t ron rs s u c c e s s f u l , t h e scheme w r l l be extended natron-wrde, us rng r e a l l o c a t e d n a t r o n a l budget resources . The Mrn i s t r r e s of Heal th and Local Development have submit ted t o t h e J o r n t GovernmentfWHO Coordrnat ing Commrttee a n a t r o n a l programme <roposal s e t t i n g f o r t h t h e o b j e c t i v e s , t a r g e t s , mr l e s tones , a c t i v r t r e s and p lan of work f o r t h e p ~ l o t programme, t oge the r wrth a f ive-year budget f o r es t rmated annua l c o s t s o f s t a f f , suppor t payments, t r a r n r n g , equipment and supp l r e s , p resen ted I n t he normal governmental format. The Commrttee ha s endorsed-the proposal and WHO has i nd i ca t ed i t s commitment f o r up t o 20% o r US$ 100 000 per yea r , and w i l l make an i n i t r a l payment of US$ 50 000. Subsequent r e l e a s e s o f WHO funds w i l l be t i e d t o pe r rod rc programme performance r e p o r t s t o t h e J o i n t Coordinat ing C o r n i t t e e , i nc lud ing e x p e n d ~ t u r e s r epo r t ed a g a i n s t budget , c e r t i f i e d by t he r e spons ib l e n a t r o n a l programme manager and a f i n a n c i a l a u t h o r i t y , and accepted by t h e Coordrnating Committee. On be ing informed of t h i s , t h e WHO r eg rona l o f f r c e w r l l promptly t r a n s f e r funds t o t h e des rgna ted government agency programme account. WHO a u d r t o r s a r e au thor ized t o review r e l e v a n t documentation and n a t ~ o n a l account ing e n t r i e s when necessary. The J o r n t Coordinatrng Committee w r l l make ~ t s own eva lua t i on r e p o r t once each y e a r , and t h i s w i l l be a v a i l a b l e t o t h e M i n i s t r i e s o f Heal th and Local DS!~ I=-t and t o WHO.
A p r o j e c t f o r t h e des rgn and e v a l u a t i o n o f a country-wlde communrcable d i s e a s e c o n t r o l programme. Est imated t o t a l co s t : US$ 200 000 over a two-year perrod. WO w r l l provrde d i r e c t f i n a n c r a l p a r t i c l p a t r o n up t o 50X, o r US$ 50 000 per yea r f b r two y e a r s , r n add r t ron t o p r o v ~ d i n g t echn rca l adv i so ry s e rv rce s . This i s a n a t i o n a l ~ r o j e c t t o a s s e s s a new, country-wrde s t r a t e g y f o r ma la r i a c o n t r o l whrch i s intended t o make op t imal use o f a v a i l a b l e h e a l t h manpower and communrty h e a l t h s e r v r c e s t o c a r r y o u t c e r t a i n def ined func t rons rnc lud ing ep idemrolog ica l s u r v e r l l a n c e , c a se f i n d i n g , chemotherapy t rea tment and r e f e r r a l , under appropriate t echn rca l and managerral supe rv r s ion and q u a l i t y con t ro l . The n a t r o n a l s t r a t e g y rnc ludes manpower t r a i n i n g , p e r r p h e r a l l abo ra to ry and l o g r s t i c suppo r t , and i s complemented by i r r i g a t ron c o n t r o l and/or i n s e c t r c r d e sprayrng o p e r a t r o n s , whenever app rop r i a t e . The p r o j e c t w r l l eva lua t e and re-desrgn a s necessary t h i s country-wide s t r a t e g y f o r r n t e g r a t e d , i n t e r - s e c t o r a l ma la r r a c o n t r o l o p e r a t i o n s , and a s s e s s t h e adequacy of supe rv r s ron and support . The M i n i s t r i e s of Heal th and Agr r cu l t u r e have submrtted t o t h e Joint"GovernmentfWH0 Coord+inating Commrttee a n a t i o n a l programme eva lua t ron projec' t p roposa l , t oge the r wrth a two-year budget f o r t h e es t rmated annual c o s t s o f two na t rona l c o n s u l t a n t s , t r a n s p o r t a t r o n , s u p p l i e s and c e r t a i n l o c a l expenses, p resen ted r n t h e normal governmental p r o j e c t proposal format. The Commrttee has endorsed t h e proposa l , and WH? has agreed t o f rnance d i r e c t l y 50% o f t h e p r o j e c t , i n a d d i t r o n t o provrding c e r t a i n o t h e r ~ n t e r n a t r o n a l s e r v i c e s i n support o f t he se a c t r v a r t r e s . The WHO r e g l o n a l o f f r c e w i l l make q u a r t e r l y payments t o t h e des rgna ted government account rn accordance w i th an e s t a b l r s h e d payment schedule , b u ~ s u b j e c t t o a semr-annual performance and expendr ture r e p o r t , c e r t r f r e d by t he n a t i o n a l p r o j e c t manager and a f r n a n c r a l a u t h o r i t y , berng accepted by t h e J o r n t Coordrnating Committee. The f r n a l programme eva lua t ron r e p o r t produced by t h e p r o j e c t w l l l be submrtted t o t h e Co~nmit tee , and t o t h e Mrn r s t r r e s
n C w a s 1 th b.-.-.....l t..-- - -A ... I I L- --.A- ".."- 7 -I., ..- r - r n
atinnal workshop on the managerial process for national health ebelo merit. Estimated additronal cost requirements: US$ 50 000. MI0
wi 1 orovide direct financial uartici~ation un to 80% or US$ 40 000. +- This is a one-month course inthnded, bn the basis of draft materials supplied by WHO and national'participants, to develop appropriate training
~ ~~ ~
and learning materials for use in strengthening managerial capacities, particularly at district level, for effectrve health programmrng, programme budgeting, implementation, monitoring and evaluation, with necessary infomatron support. The workshop wrll be attended by natronal representatives from Ministries, agencies and services of Health, Education, Planning and Community Development, as well as representatrves from two neighbourrng countries and GMO. The costs of attendance will be bornc by the participants. The >!inistry of Health and WPC have subm~tted q b r ~ e f outline proposal, together with certaln addrtronal cost estimates, which have been accepted by the Joint Covernment/\JIiO coordinating Commrttee. The WHO regional office will make US$ 10 000 immedrately available for initial documentation, translation and interpretation costs and the services of a national expert. A small sum will be drawn from the WPC's imprest account for meeting unforeseen incidental costs of the vorkshop. Upon successful completion of the workshop, signaled by the kTC, the balance of resources will be made available by WHO for the translation into local languages, printing, productron and dissemination of the resulting "packages" of learning materials for use at different levels and rn drfferent areas of the country. A final cost accounting for the a c t ~ v i t y will be submrtted to the Coordinating Committee. The national government has kindly offered also to make the output materials available to the two participating neighbourrng countries and to 1JH0, rn a spirit of TCDC.
A "think-tank" on alternatrve approaches to financing the national health svstem. Estimated addrtional cost: US$ 30 000. WHO wrll pay 100% of . - - - .-
this added cost. The Iiealth Ministry has convinced the ~ i n i s t r ~ o f Planning to take a completely fresh look at the carrying capacity of the national economy, and allocations of natronal and external resources, taking Into account the new strategy for HFA/2000 based on PHC, and alternative approaches to fingncrng the natronal health nystem, including: use of national ahd local budgets, health insurance, fee-for-service, and local self-financing schemes. The Health Ministry has sought the Joint Government/WHO Coordrnating Committee's endorsement of a proposal to establish an inter-disciplinary "think-tank" to "brainstorm" some of these issues. It is proposed to strengthen this endeavour by drawing on a national expert and two highly-recbinmended n a t ~ o n a l unrversity graduates, one in economics and the other in social sciences. Since these could not be foreseen in the Ninrstry budget, W1t0 has agreed to pick up this year's casts, based o n national rcales of remuneration. WHO will advance an initial US$ 10 000 to a designated government payroll account, and will pay the balance in response to officially certified evidence of personnel payments. The preliminary outcomes or conclusions of this "think-tank" approach will b e reported to the Joint Coordinatrng Committee at year end.
A mrcroscope f o r a t r o p r c a l d i s e a s e r e sea rch l aho ra to ry . Cost: US$ 500. WHO w r l l pay f o r i t . Thc exrs t lnp : binocular mlcroscoDe rn use . - - a t t he Del ta Rrver research labora tory was broken r e c e n t l y , t hus holdrng up rmportant n a t i o n a l f i e l d ?esearch work on Schrs tosomlas l s c o n t r o l , and t he l abo ra to ry l a cks budget resources t o buy a new one. Fo r tuna t e ly , t h e WC knew of a second-hand replacement on s a l e a t t he Natronal Unlvers l ty . He t o ld the l abo ra to ry t o go ahead and buy i t and send t h e b l l l t o IJIiO. The \ P C mentroned t h i s f a c t t o t he Coordinating Comrnrttee, and he w r l l rnclude t he exac t sum I n t he accounting t o t he Commrttee f o r the u t r l l z a t l o n of the WHO r e g u l a r budget resources allocation t o t he country f o r t h e c u r r e n t f ~ n a n c l a l perrod.
A t r a r n l n g course on colnmunrty approaches t o c o n t r o l of l ~ y p e r t e n s l o n and s t roke . Estrmated a d d r t l o n a l cos t : US$ 2500. WHO w l l l pay 100% of t h r s added c o s t . Tho a c t u a l a t t endance c o s t s w r l l be pard by t h e p a r t r c r p a t l n g agencres and s e r v r c e s themselves, and accordrngly a r e not presented here . The two-week course f o r " t r a l n l n g of t r a r n e r s " 1s p a r t of a wlder na t rona l programme d e s ~ g n e d t o demonstrate t h e f e a s ~ b l l r t y and benef r t s of "primordial preventron" and t h e "popula t ion npproachV1 t o the prevention and c o n t r o l of c a rd iovascu l a r d i s e a s e s r n t h e n a t l o n a l s e t t l n g . The d c c i s l o n t o Itold the course was a l a s t mlnute one, triggered rn pa r t by t he r e c e n t a v a r l a b r l l t y of new gurde l rnos and ~ n f o r m a t i o n on o t h e r c o u n t r i e s ' exper iences made available through WHO. The ~ n t r o d u c t ~ o n of t he se m a t e r r a l s could provlde needed rmpetus t o t h e n a t l o n a l programme, and a t t he same trme would s e rve t o v a l l d a t e t h e WIiO m a t e r r a l s In d ~ f f e r e n t n a t r o n a l and c u l t u r a l con tex ts . Therefore , t h e J o ~ n t Covernment/l4ltO Coordrnatrng Committee has endorsed t h e rdea , and WHO has agreed t o pay tlre government f o r t h e c o s t of one n a t l o n a l t r a r n r q g course o rgan rze r and suppor t s e c r e t a r y , by t r a n s f e r t o a des igna ted government account , and t o pay f o r t h e c o s t of a l o c a l l y purchased p r o l e c t o r , against r e c e r p t o f a c e r t r f l e d rnvolce o r payment voucher. On c o m p l e t ~ o n , an assessment of t h e t r a r n r n g course r e s u l t s u r l l be submitted t o the Coordrnating Committee.
G E N E R A L D I S C U S S I O N S F O R W E D N E S D A Y ' S
S E S S I O N
8 J u n e 1983
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
1 P R O G R A M M E R E V I E W M I S S I O N S
2 N A T I O N A L A N D I N T E R - C O U N T R Y W O R K S H O P S - M P N H D
3 S U B S I D I E S
4 R O L E OF U N C O O R D I N A T O R
5 N O T E S B Y W P C & S R , 5 U D A N
$ HMD/SFIS N O T E O N E X P E C T E D S U P P O R T F R O M WRPCs
POINTS TO B E DISCUSSED IN EMRO DURING WEDNESDAY'S SESSION
8 June 1 9 8 3
1 P e r l o d r c i t y o f m e e t i n g s w l t h t h e R e g i o n a l D r r e c t o r
and s t a f f
2 Grade and s t a t u s o f WHO l n t e r n a t r o n a l s t a f f
3 . D e s i g n a t r o n f o r nationally r e c r u i t e d l o c a l s t a f f
4 C o o r d i n a t i o n o f work o f N G O s
5 S a l a r y s u b s i d l e s
6 S t r p e n d r a t e s
7 Reimbursable p u r c h a s e s f o r Government - S e r v r c e c h a r g e
Itcrn f o r g e n e r a l d l s c $ ~ s i l o n s - Wednesday, 8 J u n e 1983 -- - - - - - - HMU/SHS N U l b ON t A P E C T E D SUPPORT FROPI WRIJCs
I lie q roup ~ d e n t i f i e d t h e f o l l o w l u g
- l h e ~ i e c e s s l t y f o r WRPCs t o g l v e t h e l r t e c h n ~ c a l comments when conveying
Coverrunent r e q d e s t s t o EMRO, and t o I n d i c a t e how t h r s r e q u e s t f a l l s w r t h l n
t h e c o u n t r v ' s g e n e r a l h e a l t h programme and WHO p o l ~ c i e s
- R e p o r t s from WKPCs on t h e h e a l t h situation and programme i n t h e c o u n t r y
Lt was no ted t h a t t h l s I n f o n n a t l o n c o u l d n o r m a l l y be p a r t of t h e programme
profiles s e n t r e g u l a r l y by t h e WRPCs, w h ~ c h s h o u l d t h e r e f o r e be d e t a l l e d and
~ n f o r m a t i v e
- Assistance and s u p p o r t which WRPCs p r o v l d e t o v l s l t l n g c o n s u l t a n t s and RAs
- WRPCs c o u l d d e v o t e more t lme t o a c t u a l t e c h n l c a l I n p u t I n t h e l r c o u n t r y of
assignment, and be more a c t l v e r n l n i t i a t l n g programmes I t war; no ted t h a t
i n o r l n c i p a l h ~ s p o s l t l o n a s c h l e f t e c h n l c a l a d v l s e r of WHO i n a g i v e n c o u n t r y
was a s t r o n g one
- l he appropriateness of WRPCs contacting, s h o u l d t h e y s o w l s h , HQ I n s t e a d o f
tMR0 f o r t e c h n l c a l a d v l c e I t was no ted t h a t a s i t cou ld n o t be e x p e c t e d
tha : 'JRPCs cou ld p r o v ~ d e ~ n - d e p t h t e c h n l c a l a d v l c e f o r a l l t e c h n i c a l a r e a s ,
t h e m a t t e r of a d d l t ~ o n a l t e c h n l c a l as w e l l a s a d m l n l s t r a t l v e s u p p o r t t o WRPCs
u d ~ t o be discussed a t t h e WRPCs' mee t ing
- R e s n o n s l b l l l t y of WRPCs t o f o l l o w up recommendations made f o l l o w i n g a v ~ s ~ t
h \ WHO/STC o r Adv l se r
- Ihe possibility of more d l r e c t communication between EMRO and WRPCs, 1 . e by
t e l e p h o n e , f o r t h e s a k e of speed and effectiveness It was no ted t h a t t h e
c o s c l b e n e f i t of t h r s p o l n t was one t o be r o n s l d e r e d by t h e Administration
- IJRPCS o f t e n had ~ n f o r m a t l o n on programmes and a c t L v l t l e s n o t a s s l s t e d by WHO
NOTE ON
RrVIEW MISSIONS TO MEMBERS STATES IN CxlR
P t ~ ~ p o s e l o v l r , l t Yember S t a t e s rn CHR and revlew c o l l a b o r a t r v e -- - .-
e f f o r t s ant1 t c c t ~ n l c a l cooperntron between Member c o u n t r r e s and WHO.
2 1.1, To ensu re t h a t t h e count ry of assignment had prepared
a s cn t enen t on po l r cy , s t r a t e g y , and p l an of s c t l o n f o r HFA/2000, and
t o a s s l s t c o u n t r l e s whlch d id no t p r epa re a s ta tement t o i n r t i a t e one
2 1.2 lo d ~ s c u s s wl th c o u n t r l e s and a s s e s s t h e progress achleved
11) implementation of t h e s t r a t e g r e s of HFA/2000, and t o r d e n t l f y any
p o s s l b l e remcdres
2 1 3 To assess t h e needs of t h e country of assrgnment f o r add r t rona l
t e c ' l n l c a l , f l n a n c l a l , and admln r s t r a t l ve suppor t r n r c l a t l o n t o t h e imple-
m e n r a t ~ o n of t he s t r a t e g y of ~ ~ ~ / 2 0 0 0 .
2 2 I'roposed P r o g r a m e and Budget Estrmates 1936/87
7 2 1 To ensure t h a t t h e count ry s t a t emen t s r e l a t e d t o t h e Programme
and Budget Estrniatea r e f l e c t t h e socro-e~onomrc development p o l r c r e s and
d 5 r e c t l o n s In the h e a l t h f r e l d of t h e count ry and i s r n l i n e w i th t h e
o b ~ e c t ~ v e s of the Seventh General Programne of Work.
2 2 2 To revlew t h e d l s t r i b u t r o n of t he Programme-and Budget a l l o c a t r o n s
betkcen t h e d l f f e r e t r t components of programme and p r o j e c t a c t i v i t i e s w l t h i n
the country c e l l l n g s shown on document EM/RC30(82)/3, 1982, a g a i n s t each
programme component for 1984-85.
2 3 WHO I n f o r m a t ~ o n System
2 3 1 To t l rscuss wl th WlIO Programne C o o r d ~ n a t o r s , and Nat iona l WllO
Programme C o o r d ~ n a t o r s , o r n a t i o n a l s upda te of count ry p r o f r l e s and p r o j e c t
p r o f ~ l e s where they e x l s t , and t o l n r t i a t e t h e prep t l ra t lon of new ones ~ f
t h e y d ld not e x l s t