WHO presence in countries, territories and areas: 2019 report

Contact World Health Organization Department of Country Cooperation and Collaboration with the United Nations System Avenue Appia 20 1211 Geneva 27 Switzerland Tel: +41 22 791 21 11 Fax: +41 22 791 31 11 http://www.who.int 2019 Report WHO presence in countries, territories and areas W H O P R E S E N C E IN C O U N T R IE S , T E R R IT O R IE S A N D A R E A S Ι 2019 R E P O R T

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Photos and figures: WHO Design and layout: L’IV Com Sàrl, Switzerland Printed in France Contents FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Methodology for data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Limitations of the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1. WHO WE ARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.1 World Health Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.1.1 Governance and Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.1.2 Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1.3 WHO country offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1.4 WHO country offices covering more than one country, territory or area . . . . . . . . . . . . . . . . . . . . . 10 1.1.5 Countries and areas covered by WHO regional offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.1.6 Suboffices in countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.2 People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.1 WHO country office leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.2 Status of acting HWOs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.3 Gender distribution of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.2.4 Region of origin of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.2.5 Age and retirement of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.2.6 HWOs’ length of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.2.7 WHO workforce in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2.8 WHO country-level staffing situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2.9 Gender distribution of WHO staff at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.2.10 Diversity of WHO staff capacity at the country office level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.3 Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.3.1 Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.3.2 Corporate communication capacity at country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 1.3.3 Information sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1.3.4 Access to breastfeeding facilities in WHO country offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. WHAT WE DO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.1 Contributing to national health policies, strategies and plans to roll out UHC, ensure healthy lives and respond to health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.2 Country Cooperation Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.3 Joint WHO and government monitoring mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.4 Supporting implementation of the Sustainable Development Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 2.5 WHO support in health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6 Supporting health sector coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3. HOW WE DO IT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 3.1 Technical backstopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3.2 Funding WHO’s work at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.1 Availability of financial resources at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.2 Distribution of base funds by programmatic priorities and operations . . . . . . . . . . . . . . . . . . . . . . . 49 3.2.3 Sources of funding for WHO country-level work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 3.2.4 Distribution and spending of planned funds at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 3.2.5 Mobilization of funds for Human Resource support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 iii 4. WHO WE WORK WITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.1 Collaboration with the United Nations system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.1.1 Supporting the United Nations Resident Coordinators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.2 Engaging within the United Nations Country Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.2.1 WHO participation in Joint National/United Nations Steering Committees . . . . . . . . . . . . . . . . . . . . 59 4.2.2 United Nations Development Assistance Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.2.3 WHO participation in the thematic groups of United Nations country teams . . . . . . . . . . . . . . . . . . 61 4.2.4 WHO participation in United Nations common business operations and activities . . . . . . . . . . . . . . 62 4.2.5 WHO participation in joint activities of the United Nations resident coordinator office . . . . . . . . . . . . 63 4.3 UN Multi-Partner Trust Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.4 WHO country-level engagement with global health initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4.1 WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4.2 WHO and Gavi, the Vaccine Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 4.4.3 South-South and triangular cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5. OUR WORK AND ITS RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Expanding universal health coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Addressing health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Promoting better health and well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 ANNEXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annex 1: List of WHO Member States and Associate Member States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annex 2: WHO offices and suboffices in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Annex 3: Number and categories of staff members working in WHO offices in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Annex 4: Global Fund grants of which WHO is a subrecipient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Annex 5: Countries eligible for Gavi new vaccines support in 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Annex 6: Planned costs and available funds for WHO work in countries, territories and areas . . . . . . . . . . . . 111 iv Ι WHO presence in countries, territories and areas Foreword T he ultimate measure of WHO’s success is not the number of reports we publish or the meetings we hold, but the difference we make to the health of the world’s people. That’s why delivering impact in countries is the essence of both WHO’s 13th General Programme of Work (GPW13) and the Sustainable Development Goals (SDGs). The “triple billion” targets of GPW13 are designed to make us focus on delivering results for the people we serve, and value for money for our donors. To support those efforts, WHO is now embarking on a comprehensive transformation, to make sure we empower and enable the entire organization – and especially our country offices – to make a measurable difference at country level. It’s impossible to adequately summarise the extraordinary work that WHO does all over the world every day, but the 2019 country presence report is an excellent snapshot of the Organization’s work in 149 countries, territories and areas across six regions. This year’s report attempts for the first time to provide additional information on the role of WHO country offices in supporting governments and partners to achieve the SDGs and provide support for South-South and triangular cooperation initiatives. It also features several country stories highlighting achievements relating to each of the “triple billion” targets. While we have achieved significant results, we cannot be content. The world remains dangerously off-course for the SDGs, and we have a lot of work to do to support countries to get on track and stay on track. One of the principles of both the SDGs and GPW13 is that they are for all countries, rich and poor. No health system is perfect, and WHO has something to offer every country. Our new policy dialogue process is designed to give us a robust mechanism, based on solid data and projections, for identifying weaknesses in health systems and recommending policy solutions. We are also improving the way we develop “global goods” including norms and standards, to ensure we develop the highest-quality products that address the needs of countries. WHO’s new aligned structure will help to ensure we work more seamlessly across all three levels of the organization to deliver results. But delivering results in countries is not a job for WHO alone. Partnership is key. The Global Action Plan for Healthy Lives and Well-Being for All, which was launched last year and will be presented at the United Nations General Assembly in September 2019, is a vital platform for ensuring enhanced collaboration in the global health community. WHO is pleased to be leading the development of this ground-breaking instrument, in which 12 global health and development agencies have committed to align their operating practices, identify ways to accelerate progress, and develop shared milestones to keep ourselves accountable. The challenge now is to turn good intentions, bold promises and ambitious documents into concrete changes that make a difference. I am optimistic that future editions of this report will highlight even greater results in pursuit of our mission to promote health, keep the world safe and serve the vulnerable. Dr Tedros Adhanom Ghebreyesus Director-General World Health Organization Foreword Ι v Executive summary WHO as an intergovernmental organization has a governance system that comprises the World Health Assembly, the Executive Board and Regional Committees. The WHO Secretariat is headed by the Director-General and comprises country and regional offices, headquarters and associated offices. The six regional offices are headed by regional directors. WHO has one of the largest field presences within the UN system. Working with 194 Member States across six regions and from 149 offices in countries, territories and areas, WHO through its large network of staff, provides support to countries through policy dialogue, technical assistance in strategic areas as well as operational support, depending on the country context. WHO has placed countries squarely at the centre of its work. Through its transformation programme, WHO is stepping up efforts to continue strengthening its country office leadership, ensure a fit-for-purpose staffing structure, and provide optimal tools and processes for enhanced effectiveness and efficiency. In addition, other levels of the Organization have been supporting country offices to strengthen their capacity to achieve greater impact in each country. WHO’s engagement with Member States and partners ensures that a robust technical platform is in place and that the Organization acts as an impartial convenor and coordinator of health in support of national authorities. To highlight WHO’s work in countries as envisioned by the Director-General, the 2019 country presence report provides information on: who we are as WHO, what the Organization does, with whom it works and with what resources. Compared to the 2017 country presence report, this year’s report provides additional information on: the role of the WHO country office in supporting governments and partners in implementing the SDGs; support for South-South and/or triangular cooperation initiatives; WHO`s collaboration with the United Nations system; and selected country stories categorized by the strategic priorities of GPW 13 from countries where WHO teams are contributing in making a difference in systems and in the lives of people. The information contained in this report was obtained through an online country presence survey administered to all 149 Heads of WHO offices (HWOs) in 2018, the WHO Global Management System and other internal and external information systems and sources. As of January 2019, WHO opened a new country office in Greece and eight subnational offices in different countries to strengthen its field presence. The Organization is represented across the six regions by 123 Heads of WHO offices in countries, territories and areas and by 26 acting HWOs, indicating the continuing need to improve succession planning. Gender and geographic diversity is increasing among WHO leadership. In 2017, the Director-General announced a new management team at HQ with 60% women leaders. At country level, a similar growing trend is being observed as the proportion of women HWOs has increased to 39% from the 33% The 2030 Agenda for Sustainable Development views health as vital for the future of our world. With a commitment to achieving Goal 3, which calls on all stakeholders to “ensure healthy lives and promote well-being for all at all ages”, the World Health Organization (WHO), as a specialized agency of the UN system, leads and coordinates global health, and supports countries in reaching all health-related SDG targets. vi Ι WHO presence in countries, territories and areas reported in the 2017 country presence report. In five of the six regions there has been an increase in the proportion of HWOs serving outside their region of origin. The proportion of HWOs serving outside their region of nationality has increased from 18% in 2010 to 28% in 2019 – which falls just short of the 30% target. Over 60% of HWOs in WHO are aged 56 years and above. From 2019 until 2025 an average of nine HWOs are expected to retire each year. With the increasing focus on country impact, the WHO workforce is also increasing, including professional and support staff as well as others recruited on non-staff contracts. As of 31 December 2018, WHO had a total of 3956 staff members working at country level across the six regions. This figure represents a 9% increase on that of the 2015 country presence report. Of the country level workforce, 20% are professional and higher graded staff (1% higher compared to the 2017 report), 30% are national professional officers (a 2% increase compared to the 2017 Report) and 50% are general service staff members (3% less than in the 2017 report), continuing a trend towards a higher proportion of professional staff. Sixty-nine per cent of WHO office premises across the world are made available to the Organization at no cost to it. There are 28 country offices in common UN premises (19%), with 10% of country offices being independently owned or rented by WHO. WHO corporate communication capacity is gradually being enhanced with the proportion of full-time communication staff increasing from 41% to 44% between the 2010 country presence report and the 2019 report. WHO is also increasingly using digital media to extend its outreach to stakeholders as 89% of WHO country offices reported having a country-specific website and 49% reported using the social media platform, Facebook. WHO delivers its technical cooperation based on biennial workplans developed through country cooperation strategies and biennial collaborative agreements (European Region only) – country support plans have been developed for the Programme budget 2020–2021. Currently, there are 83 valid country cooperation strategies and 26 valid biennial collaborative agreements in place, while a further 24 countries, territories and areas are in the process of developing or updating one, in line with the GPW 13 strategic priorities. Joint WHO and government mechanisms are used to enhance implementation, monitoring and reporting on WHO technical cooperation, and are reported to be present by 89% of WHO country offices, an increase from 83% in the 2017 country presence report. WHO country offices are supporting governments and partners in implementing the Sustainable Development Goals by contributing to national SDG coordination platforms, advocacy, resource mobilization, coordinating the setting of national targets and monitoring and evaluation. A high proportion of WHO country offices reported being engaged in providing technical support for the mainstreaming of SDGs into national plans, policies and programmes (89%). Such support is in line with WHO’s engagement strategy to promote health in the 2030 Agenda for Sustainable Development. During the reporting period, WHO was able to successfully respond to public health and humanitarian emergencies and support countries in enhancing their national capacity for preparedness, which is key to mounting effective responses. In 2017–2018, a total of 901 new health emergency events occurring in 162 countries, territories and areas were reported to WHO. All WHO country offices reported having provided at least one form of support to national authorities and partner organizations for emergency preparedness, prevention, detection and response during this period. Following events that occurred over this period such as Hurricane Irma in the Caribbean and Cyclone Donna in the Pacific as well as the Ebola outbreak in the DRC, WHO country offices in the Bahamas, Cuba, Vanuatu, Nigeria and the DRC among others, reported providing multifaceted support for the emergency response and preventing disease outbreaks. Since 2010, all 196 States Parties to the international Health Regulations (IHR 2005) have reported at Executive summary Ι vii least once to the Secretariat using the State Party Annual Reporting (SPAR) questionnaire. Globally, progress has been reported across the 13 core capacities, particularly in respect of surveillance, laboratory and IHR coordination, but the overall average scores suggest that further and sustained efforts are urgently needed in the areas of chemical events, capacities at points of entry and radiation emergencies. Throughout 2016-2018, joint external evaluations of IHR (2005) core capacities were completed in a total of 91 Countries (AFRO–39; AMRO/PAHO–4; EMRO–16; EURO–13; SEARO–8; WPRO–11). To augment WHO country office capacity for effective and responsive technical cooperation, WHO regional offices and HQ have been increasingly providing technical backstopping to its country offices to better support Member States towards the implementation of their national health policies, strategies and plans. With the focus on putting countries at the centre of WHO’s work, the demand for technical support is also growing. A total of 5870 missions were reported between January 2017 and 31 July 2018 to support WHO country offices in all six regions. A total of 68% of these missions were initiated by WHO country offices, which indicates an increasing trend of demand-driven backstopping. Between the 2015 and 2019 country presence reports, a 17% increase was observed in backstopping missions initiated by country offices. Communicable diseases and health systems/universal health coverage were the most frequently mentioned focus areas of such backstopping missions, covering 54% of all missions. In accordance with the vision of the Director General as expressed in GPW 13 regarding the transfer of more resources to countries, resources allocated to countries are also gradually increasing. A total of US$ 2.48 billion was made available for WHO country-level work under the WHO programme budget, representing 79% of the total planned costs for the 2018-2019 biennium, which indicated some gaps between the planned budget and actual funds made available to countries. However, almost 60% of these funds were allocated for polio, outbreak and crisis response and special programmes, leaving 42% (US$ 1.036 billion) for technical cooperation executed through base programmes. As of 31 December 2018, fifty-five per cent of the funds distributed for the 2018–2019 biennium had been spent at country level; it should be noted that this date marks the midpoint of the biennium. The Government of the United States of America, the European Union, Gavi, the Vaccine Alliance, the Government of the United Kingdom (DFID) and the Government of Japan are among the key donors of WHO at country level. As part of the UN Country Team, WHO has been proactively engaged in the UN reform at country level to enhance the effectiveness of UN presence in countries in support of their efforts to achieve the SDGs. With the global plan of action on SDG 3, WHO will be more involved in coordinating health, especially among UN agencies at country level. WHO’s engagement as part of UNCT within the UN Resident Coordinator system includes: participating in initiatives such as joint national/United Nations steering committees; joint thematic/ results groups; the Business Innovations group; development, implementation and evaluation of the United Nations Development Assistance Framework (UNDAF) within the purview of the SDGs. One hundred and twenty-eight (128) WHO country offices reported having participated in the development of UNDAF in their country of assignment. Most of the priorities of the country cooperation strategies are reflected in the UNDAF, which echoes the synergies between these two strategic frameworks and the work of WHO and the UN. However, 24% of WHO offices in the field reported that the UNDAF of their respective countries reflected all the priorities identified in the CCS. Compared to the 2017 country presence report, an increase of 11% percentage points was observed (70% in the 2017 and 81% in 2019) in the WHO offices in the field reporting participating in at least one of the United Nations common business operations and services. WHO country offices are increasingly involved in the health thematic/results group, with an viii Ι WHO presence in countries, territories and areas increase of 11 percentage points compared to the 2017 report, of WHO office staff who chair or co-chair this group, indicating an increasing level of cooperation. Integration and cooperation in the field have become of paramount importance in the SDGs era and WHO continues to lead or co-lead donor coordination mechanisms with governments. WHO country offices reported increasingly playing a leadership role in 70% of the countries, territories and areas in such mechanisms. These coordination platforms provide a hub for dialogue among multilateral, bilateral and nongovernmental agencies. United Nations Multi- Partner Trust Funds, such as One Fund/MDTF and the Sustainable Development Goals Fund are partnerships whereby the United Nations system, national authorities and funding partners establish a joint fund that uses the “pass-through fund management model”. WHO country offices in 24 countries, territories and areas receive financial support from such funds. In 2018, WHO and the Global Fund signed a new strategic framework for collaboration to strengthen the coordination and effectiveness of joint support to countries. WHO country offices in all 113 countries, territories and areas which are eligible for Global Fund grants have been active in at least one significant aspect relating to the grant process. Fifty-two (52) country offices reported acting as subrecipients of Global Fund grants to strengthen national programmes and systems to address HIV, TB, Malaria and relevant areas of work. The level of involvement in providing technical support and capacity building for accessing, implementing and reporting Global Fund grants has generally risen among WHO country offices, particularly the number of countries which are active members of the country coordination mechanism. WHO and Gavi, the Vaccine Alliance, are partners in improving access to new and underused vaccines for children. Between the 2017 and 2019 country presence reports, the number of WHO country offices reporting contributing to accessing and implementing Gavi grants has remained stable at 73 (49%). Engagement in certain elements of the funding process has generally remained the same. However, an almost 50% increase in WHO country offices channelling funding for cash grants was observed. The 2030 Agenda reaffirms the need to enhance South-South and triangular cooperation (SSTC) as well as regional and international cooperation on access to science, technology and innovation for the achievement of the Sustainable Development Goals. Globally, half of the WHO offices in countries, territories and areas in the six regions reported supporting a total of 241 South- South and/or triangular cooperation initiatives. GPW 13 focuses on driving impact in countries – while its implementation started in January 2019, an effort was made to collect country experiences, stories and achievements to highlight WHO’s contribution in terms of protecting and promoting health and serving the vulnerable. Over 200 stories of achievements and progress made by WHO country offices and interagency collaboration with other UN agencies were shared by these offices as part of the data collection exercise for the 2019 country presence report. Among the WHO country success stories collected in 2018, over a third referred to contributions made to the expansion of universal health coverage and the strengthening of health systems at country level, demonstrating the level of the work being carried out, which is key to meeting the triple billion goal of having 1 billion more people benefitting from universal health coverage, 1 billion more people protected from health emergencies and 1 billion more people enjoying better health and well-being under GPW 13. Over 60% of stories of interagency collaboration and partnership were related to promotion of health through the life-course. This reflects the fact that efforts outside the health sector are required to ensure effective implementation of the third billion, which is to improve the health of populations to achieve the goal of 1 billion more people enjoying better health and well-being. Executive summary Ι ix

Introduction Introduction Overview The country presence report is a biennial document produced by the Department of Country Cooperation and Collaboration with the United Nations System. The Report is a joint effort of the Country Support Unit Network – a network of focal points based in all six regional offices – heads of WHO offices in countries, territories and areas (HWOs) and relevant departments at WHO Headquarters. The 2019 country presence report aims to capture a wide range of relevant information to give a snapshot of the work of WHO in the field. It provides information on: 1 Who we are: WHO, people and places – infrastructure, leadership, capabilities and resources at the country level; 2 What we do: WHO at country level through the country cooperation strategy, implementation of the Sustainable Development Goals, and preparation for and response to health emergencies among other areas; 3 How we do it: technical back- stopping provided by the regional, subregional and headquarters levels and financial details including budgeting, funding and expenditure by the country offices; 4 Who we work with: collaboration with United Nations and non-United Nations partner organizations, c o u n t r y - l e v e l c o o r d i n a t i o n , contribution to implementation of global health initiatives and promotion of South-South and triangular cooperation; and 5 Work and results achieved by the WHO country offices: in relation to strategic priorities such as expanding universal health coverage, addressing health emergencies and promoting better health and well-being. In addition to the information provided in the 2017 report, it highlights country presence and performance information through the lens of the Thirteenth General Programme of Work (GPW 13), keeping in mind that 2019 is a year of transition for its implementation. It analyses more in-depth information on WHO country office human resource capacity, WHO’s contribution to the Sustainable Development Goals and WHO’s engagement in South-South and triangular cooperation. Methodology for data collection The information contained in this report was obtained through: • an online presence survey administered to all 149 HWOs in 2018; • WHO’s Global Management System (information on human resources and finance) and the database of the Department of Country Cooperation and United Nations Collaboration on the HWOs; • information obtained from the relevant departments, e.g. WHE and HTM Cluster. The data was collected through a cross- sectional quantitative and qualitative global survey administered to all WHO offices in countries, territories and areas. The survey was also translated into French and Spanish, enabling HWOs to provide the information in their preferred language. The survey was administered to all 149 HWOs in the six regions, with a 100% response rate. 2 Ι WHO presence in countries, territories and areas Limitations of the report The data and draft of this report were shared with the regions and different WHO departments at headquarters for review and validation. While due diligence has been undertaken to ensure the quality and consistency of data, the data collection, analysis and writing process had a few limitations. The respective HWOs self-reported the survey responses with no alternative mechanism to verify the accuracy of reported data. In certain instances, this may have led to minor discrepancies in data analysis or interpretation which could not be fully explained. It is also pertinent to mention that, though the survey instrument was administered with a set of detailed instructions and a glossary of terms, there is a possibility that the survey questions may not have been interpreted consistently or uniformly. To overcome these challenges, regular contacts were maintained with all six regional offices through the Country Support Unit Network, which made it possible to clarify any questions during the submission of the online survey. In instances where no responses were provided to some questions, direct contacts were made, where necessary, with the relevant WHO country offices. Introduction Ι 3

Who we are 1. “Health is a human right. No one should get sick or die just because they are poor, or because they cannot access the services they need.” dr tedros a. ghebreyesus who director-general 1. Who we are 1.1 World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations and acts as the directing and coordinating authority on international health. It was established in 1948 and is headquartered in Geneva, Switzerland. WHO’s Constitution1 entered into force on 7 April 1948 – a date now celebrated around the globe every year as World Health Day. 1 The Constitution of the World Health Organization entered into force on 7 April 1948. Available at http://apps.who.int/gb/bd/PDF/bd48/ basic-documents-48th-edition-en.pdf#page=7 (accessed 7 February 2019). Figure 1. Thirteen General Programme of Work framework 6 Ι WHO presence in countries, territories and areas WHO fulfils its role in public health through a set of six core functions which are grounded in the WHO Constitution and were first articulated in the Eleventh General Programme of Work. They remain relevant today and are reiterated in the Thirteenth General Programme of Work, 2019–2023 (GPW 13). They are: 1 providing leadership on matters critical to health and engaging in partnerships in which joint action is needed; 2 shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3 setting norms and standards and promoting and monitoring their implementation; 4 articulating ethical and evidence-informed policy options; 5 providing technical support, catalysing change and building sustainable institutional capacity; and 6 monitoring the health situation and assessing health trends. GPW 13 sets out WHO’s vision and strategic direction for 2019–2023, outlining how the Organization will proceed with its implementation and providing a framework to measure progress in this effort. GPW 13 is structured around three interconnected strategic priorities to ensure healthy lives and well-being for all at all ages: achieving universal health coverage, addressing health emergencies and promoting healthier populations. These strategic priorities are supported by three strategic shifts which are further supported by five organizational shifts as presented in Figure 1. 1.1.1 Governance and Structure The WHO Secretariat, headed by the Director- General, mainly comprises 149 offices in countries, territories and areas, as well as six regional offices and headquarters (see Fig. 2). It is governed by its 194 Member States and two Associate Member States (Puerto Rico and Tokelau). Annex 1 lists WHO Member States and Associate Member States. The World Health Assembly is WHO’s supreme decision-making body. Its main function is to determine the policies of the Organization. The World Health Assembly appoints the Director- General, supervises the financial policies of the Organization and reviews and approves the proposed programme budget. It similarly considers reports of the Executive Board,2 which it instructs on matters that may require further action, study, investigation or reporting. The Executive Board implements the decisions and policies of the World Health Assembly, advises it and generally facilitates its work. WHO’s Regional Committees meet each year to set policies and approve budgets and programmes of work for each of the six WHO regions. Each session addresses the specific public health needs and challenges of the area represented by the region. 2 The Executive Board comprises of 34 health experts at any time who are nominated by Member States. 1. Who we are Ι 7 3 There are also several subregional and geographically dispersed offices. Figure 2. The three levels of organization in WHO3 WHO Headquarters HQ outpost offices Global Service Centre in Kuala Lumpur, Malaysia, houses the administrative services of the Secretariat WHO office at the United Nations, in New York, represents the interests of WHO at the UN These are located in Addis Ababa, Ethiopia; Bangkok, Thailand; and Brussels, Belgium and managed, respectively, by the WHO Regional Office for Africa, WHO Regional Office for South-East Asia and WHO WHO Regional Offices 149 WHO offices in countries, territories and areas Outpost offices managed by regional offices 2 field offices in territories and areas 147 WHO country offices WHO country offices covering more than one country, territory or area WHO Centre for Health Development in Kobe, Japan, conducts research on the consequences of social, economic and environmental change and their implications for health policies Regional Office for the Europe. Some sub-regional offices related to WHO Region Office for the Eastern Mediterranean are located in Amman, Jordan. Further sub-regional offices in the African Region are located in Harare, Libreville and Ouagadougou. Geneva, Switzerland WHO suboffices in countries Figure 3. Map of WHO’s presence in countries, territories and areas WHO headquarters WHO HQ outpost office WHO regional office (*) includes 1 WHO field office in a territory or area Country, territory or area with a WHO office WHO headquarters WHO HQ outpost office WHO regional office Country, territory or area with a WHO office 8 Ι WHO presence in countries, territories and areas 1.1.2 Regional Offices WHO Member States are grouped into six regions, each having a regional office. 1.1.3 WHO country offices WHO as a specialized agency of the United Nations (UN) system, leads and coordinates global health and supports countries in reaching all health-related SDG targets under the 2030 Agenda for Sustainable Development. With its 149 offices in countries, territories and areas, WHO has one of the largest global footprints. To effectively support Member States, WHO has developed one of the largest in- country networks of offices compared to other UN Agencies. These offices, equipped with infrastructure and human and financial resources, are the foundation of WHO’s support to its Member States; providing a platform for effective cooperation to advance the global health agenda and contribute to national health policies, strategies and plans. Table 1. WHO regional offices, location and Member States covered Region Regional office Location Number of Member States covered African Region Regional Office for Africa Brazzaville, Congo 47 Region of the Americas Regional Office for the Americas Washington DC, USA 35 Eastern Mediterranean Region Regional Office for the Eastern Mediterranean Cairo, Egypt 21 European Region Regional Office for Europe Copenhagen, Denmark 53 South-East Asia Region Regional Office for South-East Asia New Delhi, India 11 Western Pacific Region Regional Office for the Western Pacific Manila, Philippines 27 Total 194 WHO’s newest country office opens in 2018 in Athens, Greece In June 2018, WHO and the Greek Ministry of Health inaugurated the new WHO Country Office in Athens. WHO Director-General, Dr Tedros Adhanom Ghebreyesus, and the WHO Regional Director for Europe, Dr Zsuzsanna Jakab joined the Minister of Health for Greece, Dr Andreas Xanthos for the official opening. Considering past achievements, the new office represents a deepening of bilateral cooperation between WHO and Greece. 1. Who we are Ι 9 1.1.4 WHO country offices covering more than one country, territory or area Some WHO country offices provide support for WHO’s activities in locations outside the boundaries of the countries in which they are located. The following table shows the WHO offices that provide support to more than one country, territory or area. 4 The Director of the Division of Pacific Technical Support/WHO Representative in the South Pacific coordinates WHO’s intercountry programmes in the Pacific with WHO representatives based in Samoa and Solomon Islands and with the WHO country liaison officers in Kiribati, Northern Micronesia, Tonga and Vanuatu. Table 2. WHO country offices covering more than one country, territory or area Region WHO office Additional countries, territories and areas covered African Region Madagascar (based in Antananarivo) Réunion Island (French Overseas Department) Region of the Americas Bahamas (based in Nassau, New Providence) Turks and Caicos Islands PAHO/WHO Office of the Eastern Caribbean Coordination (based in Bridgetown, Barbados) Antigua and Barbuda, Anguilla, British Virgin Islands, Dominica, Montserrat, Grenada, Saint Lucia, Saint Vincent and the Grenadines, Saint Kitts and Nevis and the French departments in the Caribbean (Guadeloupe, Martinique, French Guiana and French Saint Martin) Jamaica (Kingston, Jamaica) Bermuda and Cayman Islands Trinidad and Tobago Aruba, Curaçao and Sint Maarten and the special municipalities of the Kingdom of the Netherlands in the Caribbean (Bonaire, Saba and St Eustatius) Western Pacific Region Malaysia, Brunei Darussalam and Singapore (based in Kuala Lumpur) Brunei Darussalam, Malaysia and Singapore American Samoa, Cook Islands, Niue and Tokelau (based in Apia) Samoa, American Samoa (United States of America), Cook Islands, Niue and Tokelau (New Zealand) Division of Pacific Technical Support/ WHO Representative Office in the South Pacific (Suva, Fiji)4 Fiji, French Polynesia (France), Commonwealth of the Northern Mariana Islands (United States of America), New Caledonia (France), New Zealand, Nauru, Palau, Solomon Islands, Tuvalu, Wallis and Futuna (France) and Pitcairn Islands (United Kingdom) The Director of the Division of Pacific Technical Support/WHO Representative in the South Pacific coordinates WHO's intercountry programmes in the Pacific with WHO representatives based in Samoa and Solomon Islands and the WHO country liaison officers in Kiribati, Northern Micronesia, Tonga and Vanuatu Northern Micronesia (Country Liaison Office based in Palikir, Pohnpei, Federated States of Micronesia) Federated States of Micronesia, Marshall Islands and Palau In the Eastern Mediterranean Region, on account of ongoing emergencies in several Member States, WHO offices in some countries provide logistic and operational support to neighbouring or nearby countries. For example, the WHO Country Office in Afghanistan has a liaison office in Pakistan (Islamabad); the WHO Country Office in Somalia has one liaison office in Kenya (Nairobi); and the WHO Country Office in Yemen has a liaison office in Djibouti (Djibouti) and another in Jordan (Amman). 10 Ι WHO presence in countries, territories and areas 1.1.5 Countries and areas covered by WHO regional offices WHO does not have a physical presence in all 196 of its Member and Associate Member States and areas. In 36 of these, WHO provides technical and normative support from its respective regional offices and headquarters. Table 3. WHO Member and Associate Member States and areas without WHO offices Region Member States, Associate Member States and areas Region of the Americas Canada, United States of America and Puerto Rico (Associate Member State) Eastern Mediterranean Region Bahrain, Kuwait, Qatar and United Arab Emirates European Region Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland and United Kingdom Western Pacific Region Australia, Guam (United States of America), Hong Kong Special Administrative Region (China), Japan, Macao Special Administrative Region (China) and Republic of Korea 1.1.6 Suboffices in countries In some countries, suboffices are established as subsidiaries of a country office to provide support for implementing field activities to a programme or to facilitate effective coverage of WHO activities in geographically large countries as well as in countries facing complex emergencies or countries affected by polio outbreaks. A suboffice is normally located at the subnational level and led by a senior staff member who reports to the Head of WHO Office (HWO). HWOs usually delegate authority to these officers to effectively execute their responsibilities in accordance with the WHO mandate and under the rules and regulations of the Organization. WHO has a total of 147 suboffices, distributed throughout 32 countries. That number includes 81 suboffices in the African Region, 10 in the Region of the Americas, 39 in the Eastern Mediterranean Region, six in the European Region, nine in the South-East Asia Region and two in the Western Pacific Region. Since the 2017 country presence report, nine suboffices have been opened and one closed. Four new suboffices have been opened in the African 1. Who we are Ι 11 Table 4. Number and location of WHO suboffices in countries by WHO region Region Country, territory or area Number of subofffices Location of suboffices African Region Nigeria 37 In each of the 37 States, including the Federal Capital Territory in Abuja Democratic Republic of the Congo 11 Kinshasa, Matadi, Bandundu ville, Kananga, Mbuji Mayi, Lubumbashi, Bukavu, Goma, Kindu, Kinsagani and Mbandaka South Sudan 10 In all the capitals of the 10 States that constitute the country Chad 6 Abeche, Sarh, Moundou, Mongo, Mao and Ndjamena United Republic of Tanzania 5 Zanzibar, Tanga, Dodoma, Mwanza and Iringa Kenya 4 Garissa (serving the North Eastern Province), Embu, Eldoret, Nakuru Central African Republic 3 Bambari, Kagabandoro and Bouar Guinea 2 Nzérékoré and Guéckédou Ethiopia 1 Somali Region Ghana 1 Tamale Uganda 1 Moroto Region of the Americas Barbados 7 Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia, Saint Vincent and the Grenadines, and Anguilla Guatemala 1 San Marcos Mexico 1 Tuxtla Gutiérrez Chiapas Paraguay 1 Boqueron, Filadelfia in El Chaco Paraguayo Eastern Mediterranean Region Afghanistan 8 Jalalabad, Gardez, Herat, Kandahar, Bamyan, Kunduz, Balkh and Badakhshan Sudan 6 El-Fasher, Nyala, Geneina, Kassala, Kadugli and Damazine Iraq 5 Erbil, Dohuk, Sulaimaniyah, Basrah and Baghdad (within the Ministry of Health) Pakistan 4 Lahore, Karachi, Peshawar and Quetta Somalia 4 Nairobi (Liaison Office), Hargeisa (serving Somaliland), Garowe (serving Puntland), and Baidoa (serving southwestern state) Syrian Arab Republic 4 Qamishly, Aleppo, Homs and Latakia Yemen 4 Aden, Al Hodeida, Ibb (serving Ibb and Taiz) and Sadaa Libya 2 Benghazi , Sabah West Bank & Gaza Strip 2 Ramallah, Gaza European Region Ukraine 4 Donetsk, Kramatorsk, Luhansk and Severodonetsk Bosnia and Herzegovina 1 Banja Luka Turkey 1 Gaziantep South-East Asia Region India 7 In all seven regional hubs in the country Indonesia 2 Jakarta Western Pacific Region Philippines 1 Davao City Viet Nam 1 Ho Chi Minh City Region (three in Kenya and one in Ethiopia), one in the Region of the Americas (Paraguay), three in the Eastern Mediterranean Region (two in Libya and one in Somalia) and one in the European Region (Ukraine). In Uganda, one of the two suboffices was closed (Table 4 shows the distribution of these suboffices by WHO region). 12 Ι WHO presence in countries, territories and areas 1.2 People 1.2.1 WHO country office leadership A WHO office in a country, territory or area is usually headed by a Head of WHO Office (HWO). The designations included in this report under the term HWO include: WHO representative (WR); PAHO/WHO representative (PWR); liaison officer, and country liaison officer. While different regions use different titles in some cases, the roles and functions of the position have been standardized across the Organization. Profile of an HWO As the designated representative of the Director-General and under the guidance of the Regional Director, the HWO is the most senior WHO staff member at the country level. She/ he is responsible for leading, managing, implementing and coordinating WHO’s strategic and operational functions in the country of assignment towards the realization of health outcomes in line with national priorities, regional and global commitments, the WHO General Programme of Work and the SDGs. The HWO serves as a credible, trusted, neutral broker, an effective, influential and accountable leader in health at the country level, working across different sectors and at all levels of government, as well as with the UNCT, other partners, non-State actors, civil society and communities. Supported by all levels of the Secretariat, the HWO delivers excellence in her/his various policy, technical, political, diplomatic, managerial and advocacy roles. 5 The desk officers for Bahrain, Kuwait, Qatar and the United Arab Emirates are not considered HWOs. 6 Country Liaison Officers are internationally recruited staff members. An HWO represents the Director-General and the respective Regional Director in the country of assignment and is the responsible officer for all aspects of the collaborative activities of WHO. The generic roles and functions of an HWO (detailed terms of reference that have been revised to reflect the SDGs, GPW 13 and UN reform are available on request) include: • convening, representation, partnership and advocacy; • technical cooperation, policy advice and dialogue; and • administration and management. As of January 2019, WHO was represented across the six regions by 123 appointed and 26 acting HWOs, as represented in Table 5. 1.2.2 Status of acting HWOs Across all regions, between 2015 and 2019 the number of acting HWOs increased from 18 to 26, highlighting the need for timely recruitment of HWOs and better succession planning to ensure uninterrupted presence of a full time HWO in each country office. As shown below, the greatest increase in acting HWOs was observed in the African Region. Table 5. HWOs in countries, territories and areas by WHO region (excluding acting HWOs) Region WHO Representative PAHO/WHO Representative WHO Representative or Head of Country Office Other Comments Total African Region 31 31 Region of the Americas 24 24 Eastern Mediterranean Region5 14 1 “Other” refers to the head of the WHO Office in the West Bank and Gaza Strip 15 European Region 13 16 29 South-East Asia Region 11 11 Western Pacific Region 11 2 “Other” refers to the Country Liaison Officers in Northern Micronesia and Vanuatu6 13 Total 80 24 16 3 123 1. Who we are Ι 13 1.2.3 Gender distribution of HWOs WHO is committed to advancing gender equality in its workforce. However, progress AFR AMR EMR EUR SEAR WPR Figure 4. Number of acting HWOs by WHO region 2015–2019 0 2 4 6 8 10 12 14 16 2015 2017 2019 8 7 16 2 1 3 4 4 3 1 4 2 1 1 0 2 2 2 towards this aim has been slow, and the proportion of women appointed as HWOs has remained below 40% from 2010 to 2019. Figure 5. Proportion of women HWOs, 2010–2019 (excluding acting HWOs) (%) 30 32 34 36 38 40 2010 2012 2015 2017 2019 31 39 34 3333 14 Ι WHO presence in countries, territories and areas The European Region is the only region currently where more than 50% of HWOs are women (59%), though 48% of HWOs in the Region of the Americas are women due to a six-percentage point increase since the 2017 country presence report. The proportion of women HWOs in the African Region increased from 23% to 32% during this time. While the number of women HWOs in the Eastern Mediterranean Region doubled between the 2017 and 2019 country presence reports from three to six, there remains only one female HWO in the South-East Asia Region and three in the Western Pacific Region. Women Men Figure 6. The proportion of men and women HWOs globally and by region (%) 01/03/2019 Total 1/1 Global 61% 39% AFR 68% 32% AMR 52%48% EMR 60% 40% EUR 41% 59% SEAR 91% 9% WPR 77% 23% 1.2.4 Region of origin of HWOs In 2012, the Director-General, in consultation with the WHO Global Policy Group (GPG), decided that at least 30% of HWOs should come from outside their WHO region of origin, to promote regional diversity. The proportion of HWOs serving outside their region of nationality has increased globally from 18% in 2010 to 28% in 2019. There is a high level of regional variance, with 67% of HWOs serving in the Eastern Mediterranean Region and Western Pacific Region originating from outside of these regions compared to 10% in the African Region and 7% in the European Region. Table 6. Number of HWOs serving outside of their WHO region of origin (excluding acting HWOs) Region Number of WHO country offices Number of HWOs serving outside their WHO region of origin (nationality) African Region 47 3 Region of the Americas 27 7 Eastern Mediterranean Region 18 10 European Region 31 2 South-East Asia Region 11 4 Western Pacific Region 15 8 1. Who we are Ι 15 1.2.5 Age and retirement of HWOs Over 60% of HWOs are aged 56 years or over. The 56–60 age bracket represented either the highest or shared highest proportion of HWOs across all six regions. As of 1 January 2019, WHO has extended the mandatory age of retirement to 65 for all staff members. All staff members who reached their retirement age of 60 or 62 in 2017 and 2018 separated from WHO on retirement except in exceptional circumstances. As a result, between 2019 and 2025, it is anticipated that nine HWOs, on average, will retire every year. By region, this represents 33% of the current HWOs in the European Region, over 50% of HWOS in the Regions of the Americas, Eastern Mediterranean, South-East Asia and Western Pacific; and 66% of the current HWOS in the African Region. AFR AMR EMR EUR SEAR WPR Figure 7. Age distribution of HWOs by WHO region (excluding acting HWOs) 0 2 4 6 8 10 12 14 16 36-40 41-45 46-50 51-55 56-60 61-62 63-65 1.2.6 HWOs’ length of service HWOs are selected through a roster-based competitive process. They are normally senior staff members who have worked for WHO for some time and should have a minimum of 10 years of professional experience at the national and international levels. Over three quarters of HWOs have over 11 years of service as WHO staff members, while three HWOs have served for more than 26 years. The most frequent length of service is between 11 to 15 years as a staff member. Over 60% of HWOs have served in their role for five years or less. Seven HWOs have been WHO representatives for over 10 years and seven HWOs have been in service for 16–20 years in several duty stations. 16 Ι WHO presence in countries, territories and areas AFR AMR EMR EUR SEAR WPR Figure 8. Number of HWOs by years of service as WHO staff members (fig. left) and years of service as HWOs (fig. right) 2/22/2019 HWOs service-length-1 1/1 <5 6-10 11-15 16-20 21-25 26 and above 2 4 25 10 3 3 3 9 4 3 3 2 11 3 2 7 12 9 2 2 3 3 4 7 3 2/22/2019 HWOs tenure-1 1/1 <5 6-10 11-15 16-20 29 13 20 38 10 11 10 8 9 12 3 1.2.7 WHO workforce in countries, territories and areas As shown in Figure 9 below, WHO has four categories of personnel at the country level: (1) internationally recruited professional officers, (2) locally recruited national professional officers, (3) locally recruited general service staff, and (4) non-staff contractors. Figure 9. Categories of WHO workforce 1.2.8 WHO country-level staffing situation As of 31 December 2018, WHO had a total of 3957 staff members working at country level across the six regions. This represents a 9% increase from the 3641 WHO staff members at the country level in 2015. There were also 5738 non-staff contractors working at the country level. Almost half of these staff are based in the African Region (46%); 19% are based in the Eastern Mediterranean Region; 11% in the South- East Asia Region; 9% in both the Region of the Americas and the Western Pacific Region and 6% in the European Region. Of the country-level workforce, 20% are professional and higher graded staff, 30% are national professional officers and 50% are general service staff members, maintaining the trend towards a higher proportion of professional staff at the country level (this staff category rose from 11% in 2010 to 47% in the 2017 country presence report). The proportion of professional and higher graded staff varies from 12% in the African Region up to 50% in the Region of the Americas and stands at 26% in the Western Pacific Region, 24% in the Eastern Mediterranean Region, 21% in the European Region, and 19% in the South-East Asia Region. The ratio of professional to general service staff is often lower in countries where WHO has significantly large operational activities. International professional officers • Recruited internationally in accordance with WHO Staff Rules and may be assigned to any official station outside their home country. • Perform functions of a professional nature requiring global knowledge, expertise and experience of an international dimension. National professional officers • Nationals of the country in which they are to serve, are recruited locally and are not subject to assignment to any official station outside the home country. • Perform functions of a professional nature requiring local knowledge, expertise and experience of a national dimension. General service staff • Perform clerical, custodial and subprofessional tasks in accordance with Staff Rule 1310. • All positions in the general service category are subject to local recruitment and must be filled, as far as possible, by people recruited in the local commuting area of each office. Non-staff contractor support • WHO country offices hire non-staff contractors to implement programme-specific and time- limited activities such as polio eradication and emergencies. • The status of non-staff contractors differs from that of international civil servants or national professionals. 1. Who we are Ι 17 Figure 10. Breakdown of WHO workforce across the six regions by job category and gender Female Male General service staff National professional officer Professional and higher graded staff AFR AMR EMR EUR SEAR WPR Professional and higher graded staff National professional officer General service staff Distribution of WHO country staff by category Gender distribution of WHO country staff by category 1.2.9 Gender distribution of WHO staff at the country level Of the total 3956 staff at country level, 62% are male and 38% are female, a shift from 64% and 36% respectively in the 2017 country presence report. Within the regions, up to 70% of country office staff are male as seen in the African Region and Eastern Mediterranean Region. In every region the proportion of male staff increases when considering professional staff to overall staff members, with the exception of a 1% fall in the Eastern Mediterranean Region. This is even more pronounced when the category of professional and higher graded staff is considered in isolation, with the difference being over 20% in the European Region. However, slight increases in the proportion of professional female staff between 2017 and 2019 have been observed in the African Region, Eastern Mediterranean Region and Western Pacific Region. 1.2.10 Diversity of WHO staff capacity at the country office level GPW 13 guides WHO’s priorities and work overall; however, the specific focus of and approach to the Secretariat’s engagement with each individual country will be flexible in order to take into account country context and country capacity, thus ensuring that support is relevant and effective. In some settings such engagement will be more upstream – policy- related, strategic and normative − and in others more downstream with a focus on technical assistance and strengthening service delivery. In many countries engagement will involve a mixture of approaches, and the focus of WHO support will evolve over time. The WHO country team capacity must be fit for purpose to carry out the core functions of WHO and support the Member State to address its national priorities. With a renewed focus on WHO’s impact in countries, a range of initiatives are underway to reprofile and build the capacities of WHO’s country offices. WHO’s country cooperation strategies and country support plans for instance, are the strategic and operational tools used by WHO at the country level to define priorities and identify WHO’s comparative advantage as well as any gaps in capacity. Country office functional reviews and the current transformation agenda provide further opportunities to rationalize and hone the expertise in country offices. This section highlights the current picture in terms of country capacity as it relates to specific programme areas. A total of 140 (94%) of 149 WHO country offices reported having human resource capacity to 18 Ι WHO presence in countries, territories and areas address programmatic/technical issues in at least one of the highlighted programme areas in Figure 11, while 56 WHO country offices (38%) reported having capacity for all seven areas of work. Human resource capacity for addressing issues related to health systems/universal health coverage and communicable diseases was reported in over 84% of WHO country offices, with the Region of the Americas and South-East Asia Region reporting 100% capacity. All WHO country offices in the Region of the Americas also reported having human resource capacity for health emergencies with many countries in that Region, particularly the Caribbean Islands, being vulnerable to extreme weather events. Within the African Region, WHO country offices reported having the highest level of human resource capacity in the technical area of communicable diseases, in line with the high burden of disease caused by communicable diseases across the Region. Health systems/ universal health coverage was the technical area with the highest reported level of human resource capacity in the Eastern Mediterranean Region, following protracted efforts for health system strengthening and the achievement of health equity in the Region. Figure 11. Proportion of WHO country offices reporting the availability of human resources to address programmatic/technical issues in various programme areas (%) AFR EMR SEAR WPR AMR EUR 1. Who we are Ι 19 Among WHO country offices in the European Region, 58% reported having capacity in health emergencies and noncommunicable diseases, with noncommunicable diseases a priority area for action in many countries, and others strengthening their response to the arrival of increased numbers of refugees/migrants. Communicable diseases, noncommunicable diseases and health systems/universal health coverage were reported in 87% of countries in the Western Pacific Region. As with the different technical areas, depth of capacity and competency in the functional processes which enable WHO office teams to carry out the core functions of the Organization at country level are equally important. The majority of WHO country offices have available capacity in policy dialogue/policy analysis, the Health in All Policies (HiAP) approach, including all WHO country offices in the Region of the Americas and South-East Asia Region. Over 85% of WHO country offices overall also have capacity in procurement and logistics, and project/programme management. Within the regions, between 61% and 96% of WHO country offices have capacity for multi-stakeholder collaboration for SDG implementation; the figure stands at 80% or above in the Region of the Americas, South-East Asia Region and Western Pacific Region. One hundred and twenty WHO country offices (81%) have capacity in at least five of the functional competencies, while 44 WHO country offices (30%) have capacity in at least nine of the 10 highlighted roles. 1.3 Facilities 1.3.1 Place Across the 149 countries, territories and areas where WHO is physically present, there are diverse housing arrangements for WHO offices. These offices include the categories of dedicated country offices, sub and field offices. The majority of premises (69%) across the world are made available to WHO at no charge; such offices are usually located within, or near Figure 12. Proportion of WHO country offices reporting availability of capacity in functional competencies (%) Community engagement Data/ Information processing/ Health statistics Monitoring and evaluation Multi-stakeholder collaboration for SDGs implementation Policy dialogue/ Policy analysis/ Health in All Policies (HiAP) approach Procurement and logistics Project/ programme Management Resource mobilisation and proposal drafting AFR EMR EUR SEAR WPRAMR Gender, equity and human rights Region Country offices In territories UN shared premises African Region 47 12 Region of the Americas 27 1 Eastern Mediterranean Region 17 1 (West Bank and Gaza Strip) 3 (Includes Tripoli) European Region 30 1 (Pristina) 8 South-East Asia Region 11 2 Western Pacific Region 15 2 Total 147 2 28 Table 7. Number of WHO offices in countries and areas housed in UN shared premises 20 Ι WHO presence in countries, territories and areas the premises of the health ministry. There are 28 country offices in common UN premises (19%), with 10% of country offices being independently owned by WHO. 1.3.2 Corporate communication capacity at country level WHO recognizes that effective, integrated and coordinated communication is integral to the achievement of its goal of building a better, healthier future for people all over the world. Two thirds of WHO country offices (66%) reported having dedicated communication staff, two thirds of whom are full-time; a further 24% are part-time and the remaining 10% are outsourced. Over 80% of WHO country offices in the African Region, Region of the Americas and South-East Asia Region have dedicated communication staff, with the proportion of full-time staff across regions varying from 13% to 62%. The proportion of full-time communication staff has increased overall from 41% to 44% since the 2010 country presence report and has doubled in the Eastern Mediterranean Region and Western Pacific Region, with increases also Region Sub and field offices UN shared premises African Region 60 9 Region of the Americas 0 0 Eastern Mediterranean Region 33 9 European Region 7 4 South-East Asia Region 489 2 Western Pacific Region 3 1 Total 592 25 Table 8. Number of WHO sub and field offices housed in UN shared premises Figure 13. Proportion of WHO country offices reporting having communication staff (%) Full-time Part-time Outsourced None 11/03/2019 Fig 13 1/1 0% 20% 40% 60% 80% 100% AFR AMR EMR EUR SEAR WPR 61% 55% 33% 13% 45% 40% 15% 15% 44% 74% 18% 40% 9% 15% 9% 7% 15% 15% 22% 13% 27% 13% 1. Who we are Ι 21 reported in the Region of the Americas and the European Region. 1.3.3 Information sharing WHO country offices in 133 countries, territories and areas (89%) reported the existence of a country-specific website in order to provide information to stakeholders. At least 83% of WHO country offices in each region reported having a country-specific website, with this figure as high as 100% in the Eastern Mediterranean Region. Engaging with social media allows WHO country offices to drive traffic to websites where more detailed and trusted content can be found. New social media platforms emerge and current platforms also constantly evolve to take advantage of novel film, broadcast, and other new technologies that enhance the ability for their subscribers to engage in conversations. WHO aims to constantly keep abreast of changes and identify areas for improvement. WHO country offices in 91 countries, territories and areas (61%) reported having at least one official account on social media, with 23 WHO country offices (15%) having three or more. WHO country offices are most likely to have reported the existence of a Facebook or Twitter account (48% and 42% of WHO country offices respectively) and at least 10% also reported using YouTube and Instagram/Flickr. At least 39% of WHO country offices in each region have at least one social media account with the highest levels of engagement reported in the Region of the Americas (85%) and the Eastern Mediterranean Region (72%). 1.3.4 Access to breastfeeding facilities in WHO country offices Breastfeeding gives children the healthiest start to life. Just under half of WHO country offices reported having an appropriate facility for breastfeeding for staff (49%); within regions this figure is between 58% and 67% in the Region of the Americas, Eastern Mediterranean Region, European Region, South-East Asia Region and Western Pacific Region, and 21% in the African Region. Figure 14. Proportion of WHO country offices reporting having a country-specific website or official accounts on social media (%) 06/03/2019 Fig 14 1/1 Website Facebook Twitter YouTube Instagram/Flickr Other local social media Google+/Google Play 89 48 42 11 10 5 1 22 Ι WHO presence in countries, territories and areas 05/03/2019 Q4 1/1 AFR AMR EMR EUR SEAR WPR 21 67 61 58 64 60 Overall 49 Figure 15. Proportion of WHO country offices reporting having an appropriate facility for breastfeeding for staff (%) 1. Who we are Ι 23

What we do 2. 2. What we do To drive impact in every country, WHO engages in policy dialogue and provides strategic support, technical assistance and operational support to Members States as required. WHO is a trusted partner to ministries of health and strives to build sustainable institutional capacity to protect health, keep people safe and serve the vulnerable in each country. WHO engagement with the health ministry is primarily delivered through its contribution to national health policies, strategies and plans for UHC and for ensuring financial protection; its role in convening and managing health sector coordination for better impact at country level; its participation in joint annual health sector reviews; its provision of policy advice and technical support for attainment of the three GPW 13 priorities; and mobilization of resources for health. Besides ministries of health, WHO collaborates with a range of other ministries and government entities beyond the health sector, including parliamentarians and Heads of State to advocate for multisectoral action to reduce risk factors and improve health as a cornerstone of the entire 2030 Agenda for Sustainable Development. Working with non-health ministries is increasingly being recognized and promoted as a significant vehicle for improving health outcomes related to non-health sector risk factors and influences. WHO’s collaboration with a wide range of partners is the key to leveraging the greatest gains for global public health. At the country level, WHO works with UN agencies, bilateral and mult i lateral agencies, funds and foundations, nongovernmental organizations and communities in planning, implementing and monitoring programmes to improve health. WHO country office roles and functions Articulating policy options • Lead health policy dialogue and provide policy advice to national counterparts and partners • Promote the engagement of countries in setting regional and global policies and strategies Providing leadership • Advocate for Health in All Policies and promote dialogue for intersectoral and multistakeholder collaboration • Lead WHO’s United Nations interagency work in integrating national health priorities into the development agenda and the United Nations Development Assistance Framework (UNDAF) • Lead the convening and coordination of the health response in emergencies • Lead in strengthening country capacity in health diplomacy for better engagement in national and international processes and global health governance Providing technical support and building capacity • Lead the development of a country cooperation strategy and its implementation • Lead and manage the provision and brokering of technical cooperation • Lead in implementing and monitoring international commitments, conventions and legal instruments • Lead emergency response and action during crises and emergencies Monitoring health trends • Lead WHO’s work in monitoring and evaluating national policies and programmes Setting norms and standards • Support countries in adapting and implementing guidelines, tools and methods • Contribute to setting global norms and standards by providing evidence from countries Shaping the research agenda • Promote research and strengthen research capacity in countries • Support and, when appropriate, conduct operational research and ensure the use of results • Contribute to the body of knowledge on best practices 26 Ι WHO presence in countries, territories and areas 2.1 Contributing to national health policies, strategies and plans to roll out UHC, ensure healthy lives and respond to health emergencies National Health Policies, Strategies and Plans (NHPSPs) play an essential role in outlining a country’s population health needs, vision, policy directions and investments to improve health and realize the SDGs. During the reporting period, a valid NHPSP was in place in 124 (83%) countries, territories and areas where WHO has an office. All countries in the South-East Asia Region had an up-to-date national health policy, strategy or plan at this time as well as over 80% of countries in the African Region, Region of the Americas, European Region and Western Pacific Region. WHO country offices in 147 countries, territories and areas have reported playing a role in the initiation, development, implementation and/ or monitoring of the national health policy, strategy or plan either at present or previously. Depending on the country context, WHO plays various roles in support of NHPSPs, with building national capacity for implementation being the most frequently reported activity by WHO country offices (89% of countries, territories and areas). Other roles are shown in Figure 16 below. In 105 (70%) country offices, WHO was engaged in at least five of the six active roles. Active participation (e.g. Co-Chair with Ministry of Health or other leadership session leading to formulation of NHPSP Actively engaged in the implementation of NHPSP Building national capacity for effective policy analysis, formulation, monitoring and review Building national capacity for implementation of NHPSP Improving national health governance through sustained and inclusive effective health sector policy dialogue Main technical partner in undertaking situation analyses Not involved One of the partner agencies attending the NHPSP development meetings (but not providing active support) 05/03/2019 Q7 1/1 100% SEAR 89% AMR 90% EUR 50% EMR 93% WPR 81% AFR AFR 18% 17% 17%16% 15% 14% 3% EMR 17% 17% 16%16% 15% 14% 3% EUR 20% 17% 17% 17% 13% 13% 2% 1% SEAR 17% 17% 16%16% 16% 12% 7% WPR 18% 16% 16%16% 15% 14% 4% AMR 17% 17% 17%16% 14% 13% 3% 1% Proportion of countries, territories and areas where the WHO is physically present with a valid national health policy, strategy or plan Figure 16. Proportion of WHO country offices in each region reporting engagement in supportive roles relating to the national health policy, strategy or plan (%) 2. What we do Ι 27 Figure 17. WHO country office support for the implementation of the Framework Convention on Tobacco Control The Framework Convention on Tobacco Control (FCTC) and the Protocol to Elimincate Illicit Trade in Tobacco Products Actions in Member States that are Parties Providing multi-level assistance to facilitate policy dialogue and to ensure full implementation of the Convention; collecting contributions from the Parties and encouraging them to join the Protocol to Eliminate Illicit Trade in Tobacco Products. Supporting the preparation of progress reports on treaty implementation. Actions in Member States that are Parties WHO country offices Actions in relation to the Convention's Secretariat Facilitating the communication with Parties' governments; working to integrate the Convention in the UN system at country level (UN funds, UN RC System, UNDAF), supporting need assessment missions and meeting with experts. Actions in Member States that are not Parties Providing support and advocacy to encourage the country to join the Convention. Countries with a WHO country office which have ratified the FCTC Countries without a WHO country office which have ratified the FCTC The FCTC has been ratified in 91% of the 149 countries, territories and areas where the WHO is physically present. WHO country offices play active roles to ensure ratification and implementation. A high level of ratification across a wide geographical spread is evident, with over 80% of countries, territories and areas within each region having ratified the FCTC, including 100% in the Western Pacific Region. An additional 37 countries, territories and areas where the WHO is physically present have ratified the Protocol to Eliminate Illicit Trade in Tobacco Products as of October 2018. WHO country offices in action: FCTC implementation Multiple WHO country offices have been actively engaged in numerous aspects of FCTC implementation. These efforts range from assisting with an economic study on tobacco and taxation in support of FCTC ratification in Morocco, to deploying international technical expertise for effective FCTC 2030 project implementation in Jordan. Having a lasting impact is key, and this aspect was addressed by the WHO country office in the Russian Federation through advocacy and the provision of evidence to ensure that tobacco control remains a high-level government priority with assured funding. The WHO country office in Slovenia engaged in situational analysis, promoting stakeholder policy dialogue, monitoring violations and evaluating impact. The WHO country office in Georgia was heavily involved in the endorsement and enforcement of a modern tobacco-control law. Assisting NGOs in organizing a study tour and initiating collaboration with members of parliament from different countries afforded decision-makers the opportunity to gain experience. WHO worked with partners to lead a strong communication campaign, critically contributing to robust public support for tobacco control measures. Continued WHO support and multisectoral collaboration seek to increase impact and prevent interference from the tobacco industry. A report on investing in FCTC implementation from WHO and partners played a significant role in the endorsement of the tobacco-control law in Georgia and in strengthening intersectoral collaboration at national level. 28 Ι WHO presence in countries, territories and areas WHO country offices have played a key role in supporting the implementation of WHO treaties such as the Framework Convention on Tobacco Control (FCTC), the first WHO treaty adopted under article 19 of the WHO Constitution. The types of action taken by WHO country offices to facilitate implementation of the FCTC are detailed in Figure 17. 2.2 Country Cooperation Strategy A Country Cooperation Strategy (CCS) is WHO’s country-level medium-term strategic vision to guide the Organization’s work in and with a country. It imprints the General Programme of Work at the country level and responds to the national health and development agenda.1 Based on evidence of health needs and strategic dialogue with Member States and partners working at the country level, the CCS identifies a set of jointly agreed priorities that will underpin collaboration with WHO over a four- to five-year period, covering areas in which WHO has a comparative advantage to drive public health impact. In line with WHO’s strategic shift towards impact in every country, the CCS also includes a GPW 13-aligned country impact framework covering the jointly identified priorities. Therefore, the CCS plays a unique and important role as the public expression of WHO’s results chain at the country level. It is also a critical input to support WHO’s biennial operational planning including country support plans (CSP) and programme budgets (PB). The role of the CCS is to strategically respond to a country’s specific priorities and institutional resources needed to achieve its national health policies, strategies and plans and the action needed to achieve its national health-related targets under the Sustainable Development Goals. 1 The term ‘national health and development agenda’ is used here to describe the totality of the country’s health-related priorities typically set out in government strategies, policies, plans and vision documents. These often include national health policies and plans, sustainable development plans, other sector policies and plans that influence health, the UN Development Assistance Framework (or equivalent), and government ‘vision’ documents. CCS: A snapshot of Global Analysis 2017 The WHO Country Cooperation Strategies – Global Analysis (2017), a review that is done every three years, reported that UHC through strengthening of health systems has been at the heart of WHO’s work at country level and has been recognized as a leading target within the recently adopted 2030 Agenda for Sustainable Development. Actions towards UHC are evident in 84% of the 64 CCSs reviewed. Emergency risk and crisis management (78%), IHR 2005 (69%) and alert and response capacities (61%) are the top strategic priorities/focus areas in the CCSs reviewed in 2017, followed by disease surveillance and early warning systems (52%) (in the context of emergencies). As recommended by the previous WHO global analysis, most CCSs now include a strategic priority on emergency risk assessment, preparedness, alert and response to epidemics and emergencies, as well as full support for the implementation of the IHR at national level. Twelve (19%) CCSs among the 64 that were reviewed in the 2017 Global Analysis have prioritized strategies addressing cross-cutting interventions. Thirty-five (95%) out of the 64 CCSs analyzed, addressed social determinants of health, 89% addressed equity, 86% gender and 65% addressed human rights issues. Following the introduction of the SDGs in 2016, CCSs have been oriented or reoriented to provide strategic direction for implementation of the SDGs at country level, while they have equally promoted the multisectorality of health, a critical pillar of the SDGs and GPW 13. The CCS is also used to define technical cooperation and provides a platform for integrating health and non-health issues. High-income countries, some of which are donors and supporters of health and development in many developing countries, have increasingly started using CCSs, leading to better structured partnership with WHO. A summary of the features of the country cooperation strategy and how it ties in with the WHO General Programme of Work is given in Figures 18 and 19. In the European Region, WHO uses an alternative tool called a Biennial Collaborative Agreement (BCA) for collaboration with countries. However, with the onset of the current mandate, the Regional Office for Europe has taken steps to align with other WHO regional offices and started to roll out country cooperation strategies at the request of Member States. 2. What we do Ι 29 Figure 18. Functions and features of the WHO country cooperation strategy It is tailored to the country's CAPACITY and CONTEXT Provides a FLEXIBLE time frame, adaptive to changing CIRCUMSTANCES It is a tool for TRANSPARENCY: CCS evaluation focuses on how the country and WHO collaborated to achieve local targets It is the basis for bottom-up PLANNING, guides BUDGET DECISIONS and directs RESOURCES to programmes and Member States ALIGNS country priorities to GPW 13 and WHO leadership priorities Identifies health NEEDS and PRIORITIES in line with the country's development agenda Promotes country OWNERSHIP in achieving the SDGs Creates opportunities for COLLABORATION with non-state stakeholders Country Cooperation Strategy What is it for ? Promotes health issues in the UNDAF, harmonizing it with other UN Agencies and the SDGs Links to the COUNTRY SUPPORT PLAN, using it as the results chain to measure CCS IMPACT and WHO's CONTRIBUTION Figure 19. The Thirteenth General Programme of Work planning process and linkages to the country cooperation strategy 30 Ι WHO presence in countries, territories and areas As of 31 October 2018, a total of 133 (72%) countries, territories and areas where WHO is physically present had a valid country cooperation strategy or biennial collaborative agreement or were in the process of developing or updating one. Of these, there are currently 83 valid country cooperation strategies, an increase from 62 in the 2017 country presence survey period during which many countries were renewing strategies to align them with the Sustainable Development Goals. Countries, territories and areas with a valid country cooperation strategy constitute 77% (36) of WHO country offices in the African Region, 63% (17) in the Region of the Americas, 22% (four) in the Eastern Mediterranean Region, one in the European Region, 91% (10) in the South-East Asia Region and all in the Western Pacific Region.2 2 The country cooperation strategy for Viet Nam is an internal document within UN ONE. The proportion of countries, territories and areas with valid country cooperation strategies has increased by over 50% in the African Region and Region of the Americas since the 2017 country presence report. An increasing number of countries in the European Region have a CCS, including six high-income countries (Belgium, Cyprus, Italy, Malta, Portugal and Switzerland) and one upper-middle income country where WHO is physically present (Russian Federation). Additionally, 26 countries in the European Region have valid BCAs. Of the 83 countries, territories and areas with a valid country cooperation strategy and for which further data is available, 94% of WHO country offices reported utilizing the document for the purposes of advocating for health issues and aligning financial and human resources to country priorities, and 93% for helping to Figure 20. Coverage of valid country cooperation strategies and biennial collaborative agreements across Member States with a WHO country office 2. What we do Ι 31 align WHO country office work with partners. Within each region, utilization of the CCS for these three purposes is over 85%, and 100% for all three in the Eastern Mediterranean Region, European Region and South-East Asia Region. Among WHO country offices with a valid country cooperation strategy, 87% reported using it for resource mobilization, while in 85% it is utilized for providing information on the WHO country office priorities for visits/missions to countries and 73% for informing the United Nations Development Assistance Framework (UNDAF). The country cooperation strategy is reported by all 83 of these WHO country offices to be used for at least one of these purposes and a total of 43 WHO country offices reported using the country cooperation strategy for all six highlighted purposes. Figure 21. Key areas of use of CCS as reported by WHO country offices across regions 01/03/2019 Page 3 1/1 prioritization resources alignmentadvocacy planningfinancial support country partners human information align countries missions informingprovide UNDAF visits mobilization resource Country cooperation strategies are reviewed by WHO country offices in collaboration with government and partner organizations to ensure optimal support and to allow for priorities to be updated if needed. This is reported to occur primarily at mid-term (39%) or at the end of the country cooperation strategy period (28%) for the country cooperation strategies that are currently valid. Within regions, reviews are most frequency conducted mid-term in the African Region, Region of the Americas, European Region and Western Pacific Region, at the end of the country cooperation strategy period in the Eastern Mediterranean Region, with mid-term and biennial time frames used with equal frequency in the South-East Asia Region. Figure 22. Frequency of strategy review among currently valid country cooperation strategies (%) At least once per year Biennially Mid-term End of CCS period 32 Ι WHO presence in countries, territories and areas In comparison with the 2017 country presence report, there has been a slight shift towards the shorter annual (+3 percentage points) and biennial (+2 percentage points) review time frames, suggesting an increased review frequency. 2.3 Joint WHO and government monitoring mechanisms The number of WHO country offices reporting the existence of a joint WHO and government mechanism to enhance implementation, monitoring and reporting on WHO technical cooperation has risen steadily from 77% to 89% between the 2015 and 2019 country presence reports. Coverage is consistently high across regions, with between 84% and 94% of countries within the six regions currently reporting a monitoring mechanism. Figure 23. Proportion of WHO country offices reporting the existence of a joint WHO and government monitoring mechanism (%) 05/03/2019 Extra 1/1 80 85 90 Country presence report year 2015 2017 2019 77 83 89 The majority of monitoring reviews are reported to be conducted either every six months (37%) or annually (33%) with these also being the most commonly used time frames within each region with the exception of the Western Pacific Region where reviews are most frequently carried out on a quarterly basis. AFR AMR EMR EUR SEAR WPR Figure 24. Number of WHO country offices reporting conducting a monitoring review at different time intervals 2. What we do Ι 33 2.4 Supporting implementation of the Sustainable Development Goals Following the adoption of the 2030 Agenda for Sustainable Development, WHO has supported governments and partners in developing the necessary technical tools, guidance and country and regional implementation plans. WHO has also been instrumental in establishing advisory groups to coordinate these activities in an effective and evidence-based manner. Of the 17 Sustainable Development Goals, SDG 3 is the main Goal with an explicit focus on health, although most other goals are also related to health. In total, more than 50 Sustainable Development Goal indicators have been agreed upon internationally to measure status and progress on health outcomes, determinants of health or health-service provision. In over three quarters of countries, territories and areas where WHO is physically present (149), Governments have established a national SDG coordination mechanism as a means to further implementation and monitoring of the SDGs. Two thirds of them reported that the government periodically monitors the progress of national SDG implementation plans or plans for mainstreaming SDGs in existing plans and programmes, while just under half reported annually to the United Nations High-Level Political Forum. With the Global Action Plan on the SDGs which has been approved by 12 UN and non-UN agencies, WHO country offices will be provided with a framework within which to coordinate the work of partners and governments and accelerate the implementation of SDG 3 in countries. Figure 25. Number of WHO country offices reporting priority actions being taken by governments to accelerate implementation of the SDGs Periodic monitoring of the progress of national implementation plans for SDGs, mainstreaming in existing plans Established national SDG coordination mechanism Annual reporting to the UN High Level Political Forum Other 34 Ι WHO presence in countries, territories and areas Worldwide, 93% of WHO country offices reported being active in advocacy for mainstreaming the SDGs into national plans, also accounting for over 80% of WHO country offices in every region and 100% of countries in the European Region where WHO is physically present. A high proportion of WHO country offices reported being also engaged in technical support for the mainstreaming of SDGs into national plans, policies and programmes (89%) as well as providing advice, facilitation and/or coordination on setting national targets and/or indicators (87%), the latter including all countries in the South-East Asia Region. Advice, facilitation and coordination on setting national targets and indicators Advocacy for mainstreaming SDGs in national plans Technical support for mainstreaming SDGs into national plans Support for measuring and reporting Promoting the establishment of alliances and a multisectoral approach Support for resource mobilization Capacity building for multisectoral approach Other Figure 26. Proportion of WHO country offices by region supporting the implementation of Sustainable Development Goals through various approaches (%) WHO country offices are further engaged in promoting the establishment of alliances and the use of a multisectoral approach (74%), providing support for measuring and reporting (70%), mobilizing resources (51%), and building capacity for a multisectoral approach (50%). Additional supportive roles played by individual WHO country offices include raising funds to operationalize SDG 3 and setting up a subnational coordination system. WHO country teams in 43 (29%) countries reported being engaged in all seven highlighted roles relating to the implementation of the Sustainable Development Goals while 89% are active in at least four of these roles. 2. What we do Ι 35 2.5 WHO support in health emergencies One of the three pillars of GPW 13 is about addressing health emergencies – 1 billion more people better protected from health emergencies. WHO has an essential role in building and sustaining resilient national capacities required to keep the world safe from epidemics and other health emergencies; and in ensuring that populations affected by acute and protracted emergencies have rapid access to essential life-saving health services including health promotion and disease prevention. Accordingly, WHO country offices are playing an important role in supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. The WHO Health Emergencies Programme brings together outbreak and emergency resources across the three levels of the Organization to ensure greater speed, flexibility and rapid impact. In 2017–2018 a total of 901 new health emergency events were documented on the WHE Event Management System (EMS); they occurred in 162 countries and areas as listed in Table 9. WHO country offices in action: implementation of the SDGs in Bulgaria WHO facilitated policy dialogue to discuss implementation of the Bulgarian National Health Strategy 2020 geared towards achieving the WHO Policy Framework for Health and Wellbeing in support of the SDG Agenda. Stakeholders at the workshop developed a framework for achieving the SDGs in Bulgaria through multisectoral collaboration and active engagement. In the programme area of national health policies (NHP), the Bilateral Cooperation Agreement (2018-2019) sets out the key dimensions of WHO’s support for improved country governance capacity to formulate, implement and review national health policies; promote and strengthen health information and data analysis and information sharing; and strengthen national capacity in knowledge translation and use of evidence in policy- making. At the request of the Ministry of Health, the WHO Regional Office for Europe through the WHO Country Office in Bulgaria provided technical assistance aimed at increasing technical capacity for policy review through training on mapping of evidence that will inform the upcoming NHS2020 review. Beyond the developed and tailor-made methodology for mapping of evidence, an online tool in the national language was developed to improve outreach in the evidence gathering process. Support was also provided in the form of expert advice for the process of mapping evidence of NHS2020 implementation which is conducted by the national technical group. This advice was to ensure appropriate use of methodology and the usefulness of the mapping of evidence report. Global Action Plan for healthy lives and well-being for all Despite all the reported action on the SDGs, it is clear that three years since the launch of the SDGs, the pace of progress must be rapidly accelerated if the SDGs are to be achieved by 2030. Recognizing this challenge, in 2018 Germany’s Chancellor, Angela Merkel, Ghana’s President, Nana Akufo-Addo, and Norway’s Prime Minister, Erna Solberg, wrote a joint letter to the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, requesting that he leads the development of a Global Action Plan for health and well-being for all. In consultation with 12 other global health organizations, WHO took up this challenge. A framework for the Global Action Plan was presented by Dr Tedros at the World Health Summit in Berlin in October 2018. The final Action Plan will be launched at the UN General Assembly in September 2019. The action framework of the Plan sets out three strategic approaches for all relevant actors at the global, regional, national and local levels to give expression to the historic commitment to unite for the health and well-being of all. They are: 1. Align – coordinating work better to reduce duplication and inefficiencies. 2. Accelerate – using seven cross-cutting areas of innovation to accelerate progress: (1) sustainable financing; (2) frontline health systems; (3) community and civil society engagement; (4) determinants of health; (5) research and development, innovation and access; (6) data and digital health; (7) innovative programming in fragile and vulnerable states and for disease outbreak response. 3. Account – assessing results and linking investments more closely to results. 36 Ι WHO presence in countries, territories and areas Region Number of new health emergency events African Region 283 Region of the Americas 249 Eastern Mediterranean Region 100 European Region 96 South-East Asia Region 73 Western Pacific Region 100 Table 9. Number of new health emergency events which occurred globally in 2017–2018 Of the 901 events, 676 (75%) were of an infectious nature (including zoonoses); 86 (10%) were disasters; 47 (5%) were related to food safety; 2.4% were of an undetermined nature; and the remaining 70 (8%) were radiological and nuclear, product, chemical, societal or nutrition deficiency-related events. Over the same period, a total of 191 Rapid Risk Assessments (RRA) were conducted, 124 were posted on the IHR Event Information Site (EIS) and 189 editions of Disease Outbreak News (DON) were published on the WHO website. The likelihood and causes of health emergencies vary globally and WHO country offices must adapt and respond to contextual factors. The joint external evaluation is a voluntary, collaborative, multisectoral process to assess country capacity to prevent, detect and rapidly respond to public health risks occurring naturally or due to deliberate or accidental events, with the purpose of assessing country-specific status and promoting progress in effective implementation of IHR. The IHR is an international legal instrument which aims to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. 2. What we do Ι 37 International Health Regulations (IHR 2005) Core Capacities Since 2010, all 196 States Parties have reported at least once to the Secretariat using the State Party Annual Reporting (SPAR) questionnaire. In 2018, a new version of the SPAR questionnaire was introduced. As at 28 January 2019, one hundred and fifty-four (79%) of the 196 States Parties had submitted the questionnaire sent out in June 2018; by region, 47 (100%) States Parties from the African Region, 26 (74%) from the Region of the Americas, 14 (67%) from the Eastern Mediterranean Region, 40 (73%) from the European Region, 11 (100%) from the South-East Asia Region, and 16 (59%) from the Western Pacific Region have done so. Detailed information on the 2018 annual reporting by States Parties is published on the WHO Global Health Observatory website.3 Globally, progress has been reported across the 13 core capacities, particularly in respect of surveillance, laboratory and IHR coordination, but the overall average scores suggest that further and sustained efforts are urgently needed in the areas of chemical events, capacities at points of entry and radiation emergencies.4 Joint External Evaluation (JEE) of IHR Throughout 2016-2018, joint external evaluations of IHR (2005) core capacities were completed in a total of 91 countries (AFR–39; AMR–4; EMR–16; EUR–13; SEAR–8; WPR–11). 3 http://apps.who.int/gho/data/node.main.IHR00ALLN?lang=en 4 Based on the analysis of information received from 129 States Parties as at 21 January 2019. Figure 27. Number of countries by region which have completed a JEE 2016 2017 2018 JEE Reports can be found at: http://www.who.int/ihr/procedures/mission-reports/en/. 38 Ι WHO presence in countries, territories and areas Development of National Action Plan A total of 74% of the countries that have conducted joint external evaluations have either developed or are developing a National Action Plan for Health Security (NAPHS). The NAPHS is a country-owned, multi-year, planning process that can accelerate the implementation of IHR core capacities and is based on the ‘one health’ and ‘whole-of-government’ approach for all hazards. It captures national priorities for health security, brings sectors together, identifies partners and allocates resources for health security capacity development. The NAPHS also provides an overarching process to capture all ongoing preparedness initiatives in a country along with a country governance mechanism for emergency and disaster risk management. Since 2016, WHO has been working closely with many countries and partners to support the development and implementation of NAPHS. Consequently, the number of countries with an NAPHS increased from two in 2016, to 16 in 2017, and 27 in 2018. As of February 2019, a further 24 countries are developing plans. WHO country office action: Responding to health emergencies in Cuba Hurricane Irma was one of the most devastating hurricanes in the history of the Atlantic, hitting Cuba as a Category 5 storm in September 2017. For over 900 kilometres, Hurricane Irma destroyed almost everything in its path, including infrastructure in most provinces and in Havana, Cuba’s capital. Authorities required assistance in responding to the population’s health needs, which included rehabilitating over 1000 affected health institutions, ensuring continuity of health services and preventing outbreaks of water-borne as well as vector- transmitted diseases. The WHO country office worked in close collaboration with the Ministry of Health (MoH) to ensure an effective response with substantial resource mobilization by AMRO/PAHO. Daily meetings with the national authorities contributed to produce timely information to support the health sector response. Additionally, AMRO/PAHO coordinated the health efforts from the United Nations Population Fund and other partners. Over US$ 3.5 million was mobilized to replenish stocks of medicines, anti-vector materials, and medical supplies. Due to this intervention and the timely support provided by WHO to the MoH, no outbreaks were reported in the areas affected by Hurricane Irma and provision of quality health care was maintained to the affected Cuban population. Figure 28. Status of National Action Plan for Health Security (NAPHS) Number of countries that developed a NAPHS in 2016–2018 Number of additional countries developing an NAPHS in 2019 Completed NAPHS are available at: https://extranet.who.int/sph/publications. 2. What we do Ι 39 Between 2017 and 2018, all WHO country offices provided support to governments on emergency preparedness, prevention, detection and response (see Fig. 29). The most common form of support provided during this period was for strengthening minimum core Figure 29. Number of WHO country offices by region reporting the provision of different types of support for emergency preparedness, prevention, detection and response Assessment and reporting of all hazards emergency preparedness (including IHR annual reporting JEEs, AARs Detection, verification and risk assessment of potential health emergencies Development of innovative tools, products and interventions for high threat infectious hazards Implementation of prevention strategies for priority pandemic/epidemic-prone diseases (including cholera, yellow fever, influenza) Mitigation and reduction of the risk of the emergence/re-emergence of high threat-infectious pathogens Provision of essential health services and system strengthening in fragile, conflict and vulnerable settings Response to acute health emergencies leveraging national and international capacities Strengthening minimum core capacities for emergency preparedness and disaster risk management Support for operational readiness to manage identified risks and vulnerabilities 40 Ι WHO presence in countries, territories and areas capacities for emergency preparedness and disaster risk management (87%). This was also the most frequent form of support in the African Region, Region of the Americas, European Region and Western Pacific Region, and 100% of WHO country offices in the Region of the Americas reported being engaged in this activity. All WHO country offices in the South-East Asia Region reported providing support to the country through assessment and reporting of all-hazards emergency preparedness, implementation of prevention strategies for priority pandemic/ epidemic-prone diseases and giving support for operational readiness to manage identified risks and vulnerabilities. All WHO country offices in the Eastern Mediterranean Region reported providing assistance through detection, verification and risk assessment of potential health emergencies. Over one third (36%) of WHO country offices reported being engaged in at least eight of the nine highlighted emergency preparedness, detection and response activities between July 2017 and August 2018, including 55% of WHO country offices in the South-East Asia Region and over 40% in the African Region, Region of the Americas and Western Pacific Region. 2.6 Supporting health sector coordination An important role of WHO country-level support is to act as a convener/neutral broker among partners and to support the government in effectively coordinating the health sector. As Article 33 of the WHO Constitution provides for direct access of the Director-General and his or her representative (the HWO) to the various departments and ministries of the government, this ensures a whole-of-government approach with HWOs advised to keep the health ministry informed of their engagement with other government departments. The existence of a government-led health sector coordination mechanism was reported by WHO country offices in 106 (71%) countries, territories and areas where WHO is physically present. In countries where a government-led health sector coordination mechanism exists, 57% of WHO country offices reported playing at least one role related to leadership and coordination, most frequently as a co-chair with the Ministry of Health or other partners. Figure 30. Proportion of WHO country offices reporting the existence of a government-led health sector coordination mechanism in each region (%) AFR AMR EMR EUR SEAR WPR 77% 67% 78% 58% 91% 67% 23% 33% 22% 42% 9% 33% Global 71% 29% 2. What we do Ι 41 Figure 31. Number of WHO country offices participating in government-led health sector coordination mechanisms Co-chair with the Ministry of Health or other partners Participant (but no leadership or coordination role) Other Secretariat for the coordination mechanism Chair or rotational chair 42 Ι WHO presence in countries, territories and areas How we do it 3. WHO addresses country needs through the provision of support in many ways, including backstopping missions and funding. One of the GPW 13 strategic shifts specifically focuses on driving public health impact in every country using a differentiated approach based on countries’ capacities and vulnerability. 3. How we do it This requires WHO to become more focused and effective in country-based operations, working closely with partners, engaging in policy dialogue, providing strategic support and technical assistance, and coordinating service delivery, depending on the country context. The following figure unpacks the various elements of this strategic shift. Figure 32. Driving impact in every country as a strategic shift Placing countries at the centre Ground the strategic vision at country level Ensure better impact Engage in upstream or downstream actions according to the context Build a platform for leadership and coordination Strengthen country office capacity WHO will place countries squarely at the centre of its work. This strategic shift is the epicentre of GPW 13 and will become the focus of all levels of the Organization. WHO will strengthen its work at country level in all settings to ensure better impact. In some settings such engagement will be more upstream – policy- related, strategic and normative – and in others more downstream with a focus on technical assistance and strengthening service delivery. Strengthening WHO’s work at the country level involves a combination of WHO country office leadership, a fit-for-purpose staffing structure, appropriate delegation of authority, and business processes that facilitate effectiveness and efficiency. WHO must ensure that a robust technical platform is in place and to act as a convenor and coordinator of many partners in support of national authorities. COUNTRIES AT THE CENTER Flexibility Health leadershipBottom-up planning COUNTRIES AT THE CENTRE Policy dialogue partner Strategic supporter Technical assistance partner Service delivery coordinator • Strengthen the normative function of WHO secretariat • Better tailor country expertise • Align with global priorities • Adapt policy dialogue to the maturity of the health system • Focus on country needs with a bottom-up approach • Solve bottlenecks • Attract financing • Build more robust institutions • Provide relevant support in weaker health systems and in vulnerable contexts • Guide and support countries experiencing protracted crises at the subnational level with appropriate presence on the ground • Provide strategic support to strengthen health systems • Help maximize performance in terms of results, equity and financial sustainability • Advise on Universal Health Coverage • Support the country with multilevel action (in-country, national, regional, and HQ level) • Strengthen service delivery in the most fragile settings • Coordinate the health cluster and the Humanitarian Response Plan • Operate through a combination of national and subnational presence This strategic shift is based on two of WHO’s core functions: articulating ethical and evidence-based policy options; and providing technical support, catalysing change, and building sustainable institutional capacity. The four approaches to WHO’s support at country level listed below provide a guiding framework. 44 Ι WHO presence in countries, territories and areas 3.1 Technical backstopping One of WHO’s core functions and comparative advantages is the provision of high-quality technical cooperation from across the three levels of the Organization in order to catalyse change and build sustainable institutional capacity at the country level to achieve health impact. WHO country offices do not always have the capacity to respond effectively to the range of support required by countries and their dynamic, changing set of needs. ‘Technical backstopping’ in the form of technical and normative support from regional offices and headquarters is a recognized and essential approach for flexibly supporting countries with the right skills and expertise at the right time. Staff members from all three levels engage in missions and other forms of technical support to collaborate with and between the countries, territories and areas where WHO works to implement national health policies, strategies and plans developed on the basis of the SDGs and GPW 13. Figure 33. The three interacting levels of WHO Regional officesCountry officesHeadquarters Over the reporting period, country offices received support from regional offices and headquarters in areas such as: policy dialogue; adaptation of global and regional policies, strategies, tools and guidelines to national contexts and on-the-ground support for developing national documents; organizing technical meetings/seminars; training and consultations; and emergency response. Between January 2017 and 31 July 2018, a total of 5870 backstopping missions were conducted to support WHO country offices in all six regions. A total of 68% of these missions were initiated by WHO country offices, which indicates an increasing trend of demand-driven backstopping. The proportion of backstopping missions initiated by WHO country offices increased steadily from 51% in 2013–2014 to 68% in 2017–2018. Figure 34. Trend of missions initiated by WHO country offices between 2013 and 2018 (%) 01/03/2019 Extra 1/1 50 55 60 65 70 2013-2014 2015-2016 2017-2018 51 68 63 3. How we do it Ι 45 As presented in Figure 35, there is an increased trend of backstopping missions supported by regional offices (57% in 2017–2018) compared to 49% in 2013–2014. Headquarters provided 19% of backstoping missions in 2017–2018, which represents a slight overall increase compared to 2013–2014 (18%), but a decrease compared to 2015–2016 (22%). Figure 35. Proportion of backstopping missions by organizational level 2013–2018 (%) Headquarters Regional office Subregional office (where applicable) Joint visit by HQ and regional office (and/or subregional office) 01/03/2019 Mission trend 1/1 10 20 30 40 50 60 2013-2014 2015-2016 2017-2018 18 19 22 13 10 8 49 57 52 20 14 19 For WHO country offices in all six regions, the majority of technical backstopping comes from the respective regional office (70% in the Region of the Americas, 60% in the Eastern Mediterranean Region, 79% in the European Region, 54% in the South-East Asia Region and 46% in the Western Pacific Region). In the African Region, while a large proportion of backstopping comes from the regional office (39%), subregional offices play the largest role in terms of missions compared to other subregional offices in other regions. The African Region also receives the greatest amount of support from joint missions compared to other regions. The relatively high number of backstopping missions to countries in the European Region is in accordance with a region-specific model by which regional staff members provide technical assistance to countries rather than having an expert in each technical area in each country office. Communicable diseases accounted for the highest proportion (33%) of backstopping missions overall. Health systems/UHC comprised the highest proportion (25%) of backstopping missions in the Eastern Mediterranean Region, and the second highest overall reason for conducting a country mission (21%). The number of backstopping missions pertaining to health emergencies has increased in every region except for the Western Pacific Region since the 2017 country presence report, with a 54% increase reported in the African Region. While the 2019 country presence report covers a slightly shorter survey period, an increased number of backstopping missions have been reported by WHO country offices in the Region of the Americas and South-East Asia Region. Categories of WHO’s backstopping missions to countries: already working towards the three Strategic Priorities of the GPW 13 Universal health coverage Strengthening health systems to move towards UHC, ensuring equitable access to affordable health services.Working to increase and sustain access to prevention, treatment and care for HIV, tuberculosis, malaria and neglected tropical diseases and to reduce vaccine-preventable diseases. Better protection from health emergencies Helping countries prepare for and respond to health emergencies including extreme weather events and disease outbreaks. Better health and well-being Supporting countries to prevent and treat noncommunicable diseases and look beyond the health sector for solutions. Addressing environmental risks and social determinants of health, as well as gender, equity and human rights. 46 Ι WHO presence in countries, territories and areas Figure 36. Number of backstopping missions received by WHO country offices in the six regions from different levels of the Organization Figure 37. Distribution of backstopping missions to WHO country offices by region and area of work 3. How we do it Ι 47 3.2 Funding WHO’s work at the country level WHO requires predictable, flexible funding to provide high-quality technical assistance to Member States and to achieve results for people at the country level. This subsection provides details on the funds available to support WHO programmes in countries, territories and areas as well as the sources, distribution and status of expenditure during the report period. 3.2.1 Availability of financial resources at the country level As of 31 December 2018, US$ 2.48 billion was available for WHO country-level work under the WHO programme budget, representing 79% of the total planned costs for the 2018–2019 biennium, and an increase of 20% from the 2016– 2017 biennium. Of this amount, 58% (US$ 1.44 billion) was allocated for polio, outbreak and crisis response and special programmes, and 42% (US$ 1.036 billion) for base programmes. Key terms Assessed contributions Funds from Member States and Associate Member States used to finance the programme budget. They are calculated based on each country’s population and wealth. Core voluntary contributions Fully flexible funds at the level of the programme budget, or highly flexible at category level. Voluntary contributions Contributions made by Member States (and other partners) in addition to the assessed contribution. Earmarked funding is the biggest portion of the budget. Base segment Budget segment where WHO has exclusive strategic and operational control over undertaking the associated activities. Planned costs Amount allocated in the budget. The African Region and Eastern Mediterranean Region received 75% of total funds (US$ 1.86 billion) and 88% of funds allocated for polio, outbreak and crisis response and special programmes. The Eastern Mediterranean Region received 57% of funds for polio, outbreak and crisis response and special programmes as this Region contains two polio-endemic countries and seven priority countries1 facing Grade 2 and 3 emergencies. Since 2017 the number of polio-endemic countries has decreased from three to two, with polio funding being instrumental in providing support towards the eradication of polio. The South-East Asia Region received 10% of the total programme budget, while the European Region and Western Pacific Region both received 7% and the Region of the Americas 2%. Figure 38. Proportion of available funding allocated by segment (%) Base Polio, outbreak and crisis response and special programmes AFR AMR EMR EUR SEAR WPR In terms of the total base programme allocation, country offices in the African Region received the highest share of funds (37%), followed by the Eastern Mediterranean Region (20%), South-East Asia Region (17%), Western Pacific Region (14%), European Region (8%) and the Region of the Americas (4%). Higher funding for the African Region is consistent with the previous biennium and reflects organizational commitment to address the higher burden of disease and challenges of fragile health systems in that region. 1 Iraq, Libya, occupied Palestinian territory, Somalia, Sudan, Syrian Arab Republic and Yemen. 48 Ι WHO presence in countries, territories and areas 3.2.2 Distribution of base funds by programmatic priorities and operations The largest share of base funds distributed by programmatic priorities and operations to country offices was for communicable diseases excluding polio (34%) followed by cooperate services and enabling functions (19%), health systems (16%), health emergencies (14%), promoting health through the life-course (10%) and noncommunicable diseases (8%). This is consistent with data on backstopping missions which show that communicable diseases and health systems are the most frequent categories of missions received by country offices. The share of funding distributed to country offices for communicable diseases increased from 29% to 34% and for health emergencies from 10% to 14% in comparison to the 2016–2017 biennium. 3.2.3 Sources of funding for WHO country- level work WHO’s programme budget is funded through a mix of assessed and voluntary contributions. Assessed contributions are dues Member States pay to be a member of WHO. Member States (and other partners) may make voluntary contributions in addition to the assessed contribution. These are fully flexible at the level of the programme budget or highly flexible at the category level. Specified voluntary contributions account for the greatest proportion of funding allocated for the work of WHO country offices (82%), including 37% from Member States (other than their assessed contribution), 11% from United Nations organizations, 10% from philanthropic foundations, 7% from partnerships, 6% from Figure 39. Comparison of the distribution of base programme funds by category (%) Communicable diseases Corporate services and enabling functions Health Emergencies Programme Health systems Noncommunicable diseases Promoting health through the life-course 2016-2017 2018-20192018–20192016–2017 3. How we do it Ι 49 nongovernmental organizations and 10% from other sources. Assessed contributions made up 14% of overall funds allocated for country activities, with the distribution between voluntary and assessed contributions as sources of funding for WHO having remained consistent over the last four bienniums. Programme support costs accounted for the other 4% of distributed funds at the mid-biennial point. The institutions which are reported by WHO Region Most frequent donor Second most frequent donor Third most frequent donor African Region Government of the United States (17) Gavi (14) Government of the United Kingdom (12) Region of the Americas Government of Canada (7) Government of the United Kingdom (6) European Union (5) Eastern Mediterranean Region Government of the United States (9) European Union (8) Gavi (3) Government of Japan (3) European Region European Union (9) Government of the United States (5) Gavi (4) Global Fund (4) Government of Japan (4) South-East Asia Region Gavi (6) Government of the United States (5) Global Fund (4) Western Pacific Region Government of the United States (9) Government of the Republic of Korea (7) Government of Australia (6) Table 10. Donors reported in the ‘top three’ by WHO country offices; (x) denotes number of WHO country offices in each region receiving funds from the donor country offices to be among the top three donors that provided financial support to WHO country offices in 2017–2018 are detailed in Table 10. The Government of the United States was reported to be the most frequently mentioned donor – and among the top three donors to WHO country offices overall and in the African Region, Eastern Mediterranean Region and The Government of the United States of America is reported to be among the top three donors to 49 out of 149 WHO country offices. The European Union is reported to be among the top three donors to 35 out of 149 WHO country offices. It is the most frequent donor in the European Region, the second most frequent in the Eastern Mediterranean Region, and the third most frequent in the Region of the Americas. Gavi, The Vaccine Alliance, is reported to be among the most frequent donors to 33 WHO country offices. It is the most frequent donor to country offices in the South-East Asia Region, the second most frequent in the African Region, and the third most frequent in the Region of the Americas and the European Region. The Government of the United Kingdom is reported to be among the top three donors to 25 WHO country offices, reportedly the second most frequent donor in the Region of the Americas and the third most frequent in the African Region. The Government of Japan is reported to be among the top three donors to 18 WHO country offices, being the third most frequent donor in Eastern Mediterranean Region and European Region. Figure 40. The top five institutions funding WHO’s work in countries globally 50 Ι WHO presence in countries, territories and areas Western Pacific Region. The United States is followed by the European Union which was reported to be among the top three donors to 35 WHO country offices and the most frequently reported top donor in the European Region and also among the top donors in all regions except the Western Pacific Region. Gavi, the Government of the United States, specifically USAID, and the Government of the United Kingdom, specifically the Department for International Development (DFID), were reported to be among the top three donors by at least one WHO country office in every region. 3.2.4 Distribution and spending of planned funds at the country level Considering the distribution of funds against the planned budget among regions at the mid-biennium point, the European Region had received 88%, the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region had received 80–85% of the planned budget and the African Region and the Region of the Americas had received 70–75%. This represents a slight decrease compared to the same point in the 2016–2017 biennium for the African Region, Eastern Mediterranean Region and European Region, an increase of 2–5 percentage points for the South-East Asia Figure 41. Planned, distributed and spent funding by region at mid-biennium point of 31 December 2018 (US$ billion) AFR AMR EMR EUR SEAR WPR Planned costs Distributed funds Expenditure 3. How we do it Ι 51 Region and Western Pacific Region, and an increase of 30 percentage points for the Region of the Americas. As of 31 December 2018, the mid-point of the 2018–2019 biennium, fifty-five per cent of funds distributed for the 2018–2019 biennium had been spent at the country level, in line with the previous biennium. 3.2.5 Mobilization of funds for Human Resource support In 2017–2018, eighty-one per cent of WHO country offices reported mobilizing financial resources for supporting human resource/ programmatic activities. The amount of mobilized resources reported by WHO country offices to support their human resources or programmatic activities Figure 42. Number and proportion of WHO country offices reporting mobilization of resources for human resource support 83% 89% 100% 100%48% 93% 52 Ι WHO presence in countries, territories and areas Figure 43. Number of WHO country offices which reported mobilizing varying amounts of resources Less than US$ 1 million Between US$ 1–5 million Between US$ 6–10 million Above US$ 10 million between January 2017 and 31 December 2018 was most frequently between US$ 1–5 million (33%), followed by less than US$ 1 million (28%). Variations between regions are evident, with a third of WHO country offices in the Eastern Mediterranean Region reporting mobilizing over US$ 10 million. WHO country offices in the South-East Asia Region reported mobilizing a varied amount of resources. Four WHO country offices reported mobilizing between US$ 1 and 5 million, while four others reported mobilizing over US$ 10 million, namely Bangladesh, India, Indonesia and Myanmar. 3. How we do it Ι 53

Who we work with 4. As outlined in the GPW 13 strategic shifts, WHO is promoting the vital role of health by fostering partnerships at all levels of government, within the United Nations system, and with a range of non-State actors, including civil society “If we are serious about serving humanity, we need collaboration and partnership.” dr tedros a. ghebreyesus who director-general 4. Who we work with and communities at country level. WHO recognizes that engaging with partners from all sectors is crucial for driving health impact in each country. Specifically, at the country level, the Global Action Plan for Healthy Lives and Well-Being for All1 provides an additional opportunity for WHO to work with different partners – including bilateral and multilateral agencies – the United Nations System, funds and foundations, nongovernmental organizations and civil society organizations with a view to leveraging available expertise and providing coherent support to the implementation of the 2030 Agenda. 1 The Global Action Plan for Healthy Lives and Well-Being for All is an initiative of 12 global health organizations, led by WHO to support countries to take action on the health-related SDGs. It will be launched in September 2019 at the UN General Assembly. https:// www.who.int/sdg/global-action-plan 56 Ι WHO presence in countries, territories and areas This partnership approach of WHO at the country level can be categorized into: • engagement with government; • engagement with the United Nations System; • engagement with non-State actors and global health initiatives; • engagement with bilateral agencies; and • South–South and triangular cooperation. WHO country offices also work and collaborate on health issues with other intergovernmental organizations and subregional partners. 4.1 Collaboration with the United Nations system WHO collaboration with the United Nations System has been further strengthened, especially in the context of the Sustainable Development Goals and the reform of the United Nations development system. Through various United Nations coordinating mechanisms across the three levels of the Organization, WHO continues to support its Member States in achieving national health priorities and promoting better health outcomes. This collaborative approach also reflects WHO’s efforts to increase coherence, effectiveness and efficiency in delivering results. In the GPW 13, WHO has clearly stated its commitment to supporting the United Nations Secretary- General’s proposal to work as “One UN” to improve the efficiency and effectiveness of operational activities at the country level to support countries towards achievement of the Sustainable Development Goals. Work at the country level is key to progress towards addressing priorities, and platforms such as UNDAF, One United Nations Programme and health clusters in emergencies provide avenues to position health as well as catalyse multisectoral approaches for improved health outcomes. Reforms in the United Nations development system The 2030 Agenda for Sustainable Development set new, ambitious goals for all people around the world and reshaped the way the UN will work together to deliver on a global blueprint of such unprecedented scale. WHO is committed to contributing to the success of this UN reform process as stated in the GPW 13 and considers it an opportunity to position health at the centre of the UN system’s work at country level for achieving the SDGs. To effectively engage in this reform process and deliver on its promise, WHO will strengthen mutual accountability among UNCT members and hold its HWOs and Resident Coordinators accountable for increased priority and a multisectoral, integrated approach to achieving the health-related SDGs in the UNDAFs. WHO support to its Member States, including through country presence, remains subject to the direct request of the host country. WHO country presence is determined on the basis of bilateral discussions with the host government and corresponds to agreed health priorities and an allocated budget, in accordance with discussions in the Governing Bodies and the Global Policy Group. It is believed that a stronger WHO role at country level will depend on focused and mutually supportive engagement across several areas. In terms of promoting the centrality of health to the development process and strengthening WHO’s contribution to improved health outcomes, United Nations Resident Coordinators can advance WHO’s work by advocating for multisectoral action in response to cross-cutting issues across the SDG agenda; by maximizing entry points for WHO in sectors that influence health outcomes; and by increasing UN coherence and accountability on health-related SDGs within the context of UNDAF. A repositioned UNDAF is expected to serve multiple purposes and help support effective implementation of the SDGs and realize national health goals. WHO is supportive of increasing efficiencies, reducing costs and partnering with other UN agencies where this makes sense financially. WHO already participates in some common services in most of its country offices. Key elements of WHO’s collaboration with the United Nations System include: • positioning health in the debates and decisions of United Nations intergovernmental bodies; • contributing to a coherent and effective United Nations System at the global, regional and country levels; • providing leadership in health-related humanitarian efforts, including as the health cluster lead; and • promoting alliances and interagency approaches to address health issues. 4. Who we work with Ι 57 4.1.1 Supporting the United Nations Resident Coordinators As a UN specialized agency, WHO is committed to working as part of the United Nations country team (UNCT) within the Resident Coordinator system in support of the implementation of the 2030 Agenda for Sustainable Development. The Resident Coordinator system aims to bring together the different UN agencies to improve the efficiency and effectiveness of operational activities at the country level. Resident Coordinators lead and strategically position the United Nations country team in support of national priorities, development strategies and plans, and that role is pivotal to the success of the United Nations in driving the 2030 Agenda for Sustainable Development in each of the countries it serves. WHO is engaged with Resident Coordinators to strengthen the health capacity of the United Nations country teams, while recognizing WHO’s constitutional mandate to act as the directing and coordinating authority on international health work. WHO country offices reported the presence of a Resident Coordinator in 85% of countries, territories and areas where the WHO is physically present. During the period from October 2016 to 31 October 2018, HWOs served as acting Resident Coordinators in 88 of the 149 countries, territories and areas where WHO is physically present, as reported by WHO country offices. In 86% (76) of these countries, that role was assumed for a period of less than three months, while it lasted for more than six months in 5% of the countries, showing an increase in both cases from the 2017 country presence report. In 26% of countries (24) with a Resident Coordinator, the WHO country offices reported contributing financially to the functioning of the Resident Coordinator office. Figure 44. Proportion of WHO country offices per region reporting that the HWO acted as the Resident Coordinator at some point during the survey period, and the average duration of the assignment 58 Ι WHO presence in countries, territories and areas 4.2 Engaging within the United Nations Country Teams WHO’s efforts count most when it works in countries as part of the United Nations system. Through its country offices, WHO actively participates in United Nations joint activities towards achievement of the SDGs within the context of national priorities. The United Nations country team is the platform through which WHO: • strengthens dialogue among UN funds, programmes and specialized agencies; • fosters a multisectoral response to health challenges; • mobilizes additional resources to achieve national health goals. There is a UNCT in 91% (135 of the 149) of countries, territories and areas where WHO is physically present. There is a UNCT in all countries, territories and areas in the African Region, Eastern Mediterranean Region and the South-East Asia Region, 93% of countries, territories and areas in the Region of the Americas, 74% in the European Region and 73% of countries, territories and areas in the Western Pacific Region. WHO is the only United Nations agency present in one country in the Region of the Americas and in eight countries in the European Region. 4.2.1 WHO participation in Joint National/ United Nations Steering Committees Joint National/United Nations Steering Committees are a mechanism for effective collaboration between the government and United Nations agencies towards the achievement of national development goals. These committees are established in 76 (51%) countries, territories and areas where WHO is physically present. WHO country offices in 68 countries, territories and areas reported participating in the Joint Steering Committee. 4.2.2 United Nations Development Assistance Framework The UNDAF is the planning and implementation instrument for United Nations development activities in each country, in support of the implementation of the 2030 Agenda for Sustainable Development. It describes the collective and coherent response of the United Nations to national development priorities. The UNDAF is sometimes referred to as a United Nations Development Plan or a One United Nations Plan. WHO actively engages in developing, implementing and monitoring the UNDAF, shapes its health dimension, and aligns its country cooperation strategy with UNDAF. The UNDAF or equivalent document is reported in 130 (87%) of the 149 countries, territories and areas where WHO is physically present, and in over 90% of countries, territories and areas in the African Region, Region of the Americas, South- East Asia Region and Western Pacific Region. Figure 45. Proportion of WHO country offices reporting the presence of and participation in different activities of UNCTs (%) United Nations country team Operations Management Team United Nations Resident Coordinator Thematic working groups/results groups UNDAF or equivalent Joint United Nations communications programme Joint resource mobilization Joint programmes Political/peacekeeping mission 01/03/2019 Q23 1/1 AMR 0 50 100 96 93 93 93 89 63 63 44 19 AFR 0 50 100 100 98 98 94 91 79 70 62 23 EMR 0 50 100 100 100 100 94 83 78 78 44 44 EUR 0 50 100 74 61 61 58 58 48 35 32 10 SEAR 0 50 100 100 100 100 100 100 73 73 36 9 WPR 0 50 100 87 87 73 73 67 67 47 33 4. Who we work with Ι 59 WHO country offices in 128 countries (98% of countries with an UNDAF) reported to have participated in the development of the UNDAF and to be contributing to its monitoring and evaluation. By aligning the WHO country cooperation strategy, biennial collaborative agreements and helping to shape the health dimension of the UNDAF, WHO aims to ensure a more coordinated and integrated support to countries in achieving the health-related goals of the 2030 Agenda for Sustainable Development. To respond in an integrated and coherent manner to national development priorities in a country, the United Nations country team identifies strategic priorities (sometimes called results, areas, pillars or clusters) in the UNDAF. These pillars, framed by the 2030 Agenda for Sustainable Development, reflect the country situation, and are in line with national priorities and needs. In some countries, the UNDAF has specific health pillars. To ensure better health outcomes in countries, the country cooperation strategy and the health dimension of UNDAF have been harmonized and are mutually reinforcing. Of the 130 countries, territories and areas with an UNDAF, 31 (24%) corresponding WHO country offices reported that it reflects all the priorities in the country cooperation strategy and 93 (72%) reported that it reflects some of the priorities. The UNDAF reflects some or all of the country cooperation strategy priorities in 100% of countries, territories and areas with the UNDAF in the Region of the Americas, Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region, 93% in the African Region and 83% in the European Region. WHO country offices reported that health is incorporated into the UNDAF at outcome level (107 countries) and output level (103 countries). Incorporation of health in UNDAF has increased in comparison to the 2017 country presence report at all four levels, with a 7% increase in incorporation at outcome level and a 22% increase in incorporation at output level. Overall, universal health coverage is the most frequently included health priority in UNDAF Figure 46. Total number of UNDAFs per region where the WHO country office was involved in its development, monitoring and evaluation and degree of alignment to CCS UNDAF reflects some CCS priorities UNDAF reflects all CCS priorities UNDAF does not include any CCS priority AFR AMR EMR EUR SEAR WPR 60 Ι WHO presence in countries, territories and areas (87%). From the regional perspective, universal health coverage was the most frequently included health priority in UNDAFs in the Region of the Americas, Eastern Mediterranean Region, European Region and Western Pacific Region. “Promoting health through the life course” is reflected in 82% of UNDAFs. Noncommunicable d i seases (NCDs) and communicable diseases were each included in UNDAFs in 78% of countries, territories and areas, 80% of which included both areas, highlighting the many settings facing a double burden of communicable and noncommunicable diseases. Inclusion of antimicrobial resistance as a health issue increased from 15% of UNDAFs in the 2017 country presence report to 24% in this reporting period. 4.2.3 WHO participation in the thematic groups of United Nations country teams To promote an integrated approach, the United Nations country teams establish thematic or results groups in which WHO actively participates. These groups function as a coordination mechanism at the operational level that contributes to the achievement of UNDAF outcomes and covers a variety of areas from health to human rights and the environment. WHO participates and assumes leadership roles across multiple thematic and results groups. The highest level of involvement reported by WHO country offices is in the health thematic group (91% of countries with a United Nations country team) followed by disaster risk reduction, gender, and Sustainable Development Goals implementation (79%) and monitoring and evaluation and nutrition/food safety (74%). Between 55% and 60% of WHO country offices in countries with a United Nations country team reported being involved in thematic groups dealing with access to social services/social protection, environment, human rights and water and sanitation. In 77% of countries, territories and areas, the health thematic group is reportedly chaired or co-chaired by WHO, an increase of 11 percentage points from the 2017 country presence report. Figure 47. The number of WHO country offices reporting inclusion of health at different levels in the UNDAF Joint work plan Outcome level Output level Results group 4. Who we work with Ι 61 Additionally, WHO chaired or co-chaired an increasing number of health-related thematic groups between the 2017 and 2019 country presence reports as reported by WHO country offices. Overall participation in five of the thematic or results groups has increased over this time frame, with the largest increases evident in the monitoring and evaluation group (+12 percentage points) and the Sustainable Development Goals implementation group (+10 percentage points). 4.2.4 WHO participation in United Nations common business operations and activities WHO country offices in 81% of countries, territories and areas reported participating in at least one of the United Nations common business operations and activities, an increase from 70% in the 2017 country presence report. This is most commonly security services (79% with 46% of WHO country offices contributing in-kind), followed by local procurement (39%), travel Table 11. Number of WHO country offices reporting participation in UN common business operations and activities Region Nu m be r o f W HO co un tr y of fic es Se cu rit y se rv ice s Lo ca l pr oc ur em en t Tr av el Ad m in ist ra tiv e se rv ice s In fo rm at io n te ch no lo gy Lo gi st ics an d tr an sp or t IC T Ba nk HR No ne Ot he r AFR 47 39 27 19 19 18 18 16 13 14 3 8 AMR 27 10 6 9 2 6 1 3 4 1 10 1 EMR 18 17 8 7 10 7 10 8 6 7 1 1 EUR 31 17 10 3 5 5 6 6 7 1 3 5 SEAR 11 9 3 3 3 1 0 2 1 1 1 1 WPR 15 9 4 3 4 2 3 2 1 3 2 0 Nutrition Disaster Risk Reduction  Monitoring and Evaluation Gender Access to services and social protection Water and sanitation Environment  Human RightsHealth SDG implementation Figure 48. Thematic/results groups of the United Nations country team in which WHO country offices reported participation 62 Ι WHO presence in countries, territories and areas (30%) and administrative services (29%). Eight WHO country offices (five in the African Region, two in the Eastern Mediterranean Region and one in the Western Pacific Region) reported partaking in at least nine of the ten activities. 4.2.5 WHO participation in joint activities of the United Nations resident coordinator office WHO’s commitment to work as “One UN” as part of the resident coordinator system, is also demonstrated by its participation in joint activities organized by the resident coordinator office in countries. A total of 132 WHO country offices reported participating in or contributing in-kind to joint activities organized by the United Nations resident coordinator office. This includes all countries, territories and areas in the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region, 98% in the African Region, 70% in the Region of the Americas 4. Who we work with Ι 63 Figure 49. Percentage of WHO country offices by region reporting participation in, and in-kind contribution to joint activities of the UN resident coordinator office Participating (%) Providing in-kind contribution (%) AFR SEAR WPR Common business operations UN Security UN Dispensary Committee Joint Resource mobilization strategy Joint Communication group Joint Assessments Functioning Resident Coordinator office (e.g. RC premises) and 74% in the European Region. Over 60% of WHO country offices reported participating in joint assessments, and joint communication groups. A participation level of over 75% was reported for joint communication groups and joint assessments in both the African Region and Eastern Mediterranean Region. Joint resource mobilization activities between the United Nations and WHO generate additional resources to fulfil United Nations commitments reflected in the UNDAF. Various mechanisms are in place to jointly mobilize resources at the country level. Joint resource mobilization is reported by WHO country offices in 46% of countries, territories and areas where WHO has a presence. Eleven WHO country off ices reported participating in all seven activities highlighted in Figure 49, with the highest proportion participating in security services (79%) or joint communication group (66%). 4.3 UN Multi-Partner Trust Funds The Multi-partner or Multi-Donor Trust Funds (MDTFs) are partnerships by which the United Nations system, national authorities and funding partners establish a joint fund that uses the “pass-through fund management” model. These funds can be established in a variety of ways and can have a thematic or geographic focus. These pooled funds have common guiding strategies:2 • involves a broad range of stakeholders in the decision-making process; • builds on existing structures (rather than creating parallel ones); • strengthens aid effectiveness through coordinated and harmonized interventions; • full transparency and accountability in funding, management and implementation; • focuses on effective and efficient delivery of results. 2 Drawn from the Multi-Partner Trust Fund Office Gateway (www.mptf. undp.org) MDTFs are generally established to support a country and/or global strategic priorities that are defined in national or strategic plans of the UNDAF, Delivering as One (DaO) and similar strategic frameworks. WHO, as a UN agency, participates in the development of UNDAFs at the country level and can apply for funds as relevant, where MDTFs exist in country programmes. WHO country offices in 24 countries, territories and areas received funds from United Nations Multi- Partner Trust Funds, such as the One Fund/MDTF and the Sustainable Development Goals fund. Figure 50. Number of WHO country offices reporting receiving funds from United Nations Multi-Partner Trust Funds AFR AMR EMR EUR SEAR WPR In May 2018, the International Labour Organization (ILO), the Organization for Economic Co-operation and Development (OECD) and WHO signed a memorandum of understanding operationalizing the Working for Health Multi-Partner Trust Fund (MPTF). The MPTF will enable partners to pool resources and drive implementation of the Working for Health five-year action plan, a collaborative partnership between ILO, OECD and WHO to support countries to invest in the health and social service workforce required to achieve universal health coverage and the Sustainable Development Goals. 64 Ι WHO presence in countries, territories and areas 4.4 WHO country-level engagement with global health initiatives Development partners play an increasingly important role in promoting and protecting the health of the population in a country. Global health initiatives are humanitarian initiatives that raise and disburse additional funds for infectious diseases such as AIDS, tuberculosis and malaria; for immunization; and for strengthening health systems in low and middle-income countries. WHO recognizes the significance of these contributors to health and development in a country and gives priority to closely collaborating with them. One objective of this collaboration is to support the health ministry and health sector in general, to raise adequate financial resources for health programmes. The existence of a donor coordination mechanism was reported by 89 (60%) WHO country offices overall, and between 39% and 77% of WHO country offices within each region. These coordination platforms include bilateral development partners, multilateral agencies, funds and philanthropic foundations, nongovernmental organizations and civil society, the private sector and academic institutions. WHO plays a leadership role as either chair, co-chair or rotational chair in 62 (70%) of the countries, territories and areas with a donor coordination mechanism for health, while it acts as the Secretariat in 31 (35%) and as a participant in a further 22 (25%) countries. 4.4.1 WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is one of the leading funders of the prevention and control of HIV, TB and malaria. WHO is the only technical partner of the Global Fund that has expertise in HIV, TB, malaria, health systems strengthening, reproductive, maternal and newborn, child and adolescent health. WHO has an office in every country with a Global Fund grant, this global reach being essential for making an impact in the prevention and control of the three diseases targeted by the Global Fund, as well as strengthening the systems needed to deliver critical services and reach vulnerable populations. Recognizing the critical role of funding from the Global Fund Figure 51. Proportion of WHO country offices reporting the existence of a donor coordination mechanism and number of WHO country offices playing various roles in the coordination mechanism Chair or rotational chair Secretariat for the coordination mechanism Co-chair with other partners Participant but no leadership or coordination role Other 4. Who we work with Ι 65 in preventing and controlling diseases and strengthening systems, WHO country offices work in close partnership and collaboration with governments and partners to avail and use Global Fund financial resources. Countries consider WHO as their first port of call for information and technical support. In 113 countries, territories and areas with a WHO office and eligibility for Global Fund grants, WHO has provided technical support and/or capacity building for accessing, implementing and reporting on Global Fund grants. WHO country offices are most frequently engaged in being active members of the Country Coordination Mechanism (89%) and in updating disease control strategic plans (88%), with over 80% also facilitating comprehensive Strategic Framework for Collaboration between WHO and the Global Fund WHO and the Global Fund share a common commitment to universal health coverage and the SDGs. In 2018, to further strengthen and optimize the partnership between the two organizations, a Strategic Framework for Collaboration was signed. The Framework is designed to improve collaboration and communication between WHO and the Global Fund on a wide spectrum of policy, technical and programmatic areas to combat HIV, TB and malaria and efforts to support countries in building health systems, improving reproductive, maternal, newborn, child and adolescent health and addressing wider determinants of health. The agreed principles for this partnership have been defined and include country focus and partnership; gender and human rights; respect for each other’s mandate; evidence-based implementation; alignment between and within agencies; transparency and accountability. While the heads of both organizations are expected to meet annually, a joint steering committee and working groups will be meeting periodically to review progress and support implementation. Figure 52. Percentage of Global Fund-eligible countries where WHO has an office and supports the government to access and implement grants Active Member of the Country Coordination Mechanism Updating disease control strategic plans Facilitating comprehensive country dialogue across HIV, tuberculosis, malaria and health systems strengthening to determine cross-cutting elements in the Global Fund allocation envelope Funding request Concept note or proposal development Updating disease epidemiology and key intervention coverage trends Reporting on monitoring and evaluation of grant progress and performance Grant negotiation and implementation for service delivery Procurement of medical and public health supplies and equipment Managing WHO technical staff funded by Global Fund Implementing activities funded by the Global Fund for WHO country offices 66 Ι WHO presence in countries, territories and areas country dialogue across HIV, tuberculosis, malaria and health system strengthening (HSS) to determine cross-cutting elements in the Global Fund allocation envelope. WHO also supports the development of funding proposals and updating of epidemiological data and intervention coverage trends. Fifteen WHO country offices reported being engaged in all 10 roles highlighted in Figure 52. WHO country offices across 52 countries, territories and areas reported acting as subrecipients of at least one Global Fund grant with 29 of these receiving a grant for more than one programme. Tuberculosis is the primary programme through which the WHO country offices act as subrecipients (63%) followed by HIV/AIDS (60%), malaria (42%), health systems strengthening (23%) and RMNCH (6%). The proportion of WHO country offices in each region acting as subrecipients of Global Fund grants was 80% in the Western Pacific Region, 64% in the South-East Asia Region, 44% in the Eastern Mediterranean Region, 26% in the African Region and European Region, and 19% in the Region of the Americas. WHO and the Global Fund have developed a long-term, sustainable partnership to promote prevention and control to end the epidemics of HIV, tuberculosis and malaria. Under this partnership, significant financial resources have been mobilized and spent to strengthen countries’ ability to develop strategic, results-oriented grant proposals and effectively implement the approved grants. This collaboration is executed through the following key elements: • in-country technical assistance; • building the capacity of technical assistance providers through regional offices; and • assuring the quality of the technical assistance provided. WHO staff members at the country, regional and headquarters levels provide invaluable support to help attract critical financial resources from the Global Fund for government and civil society organizations. More than 400 WHO staff members directly and indirectly contribute meaningfully Figure 53. Global and regional distribution of Global Fund programmes for which the WHO country office has received a sub-grant 4. Who we work with Ι 67 to Global Fund processes and support health ministries in effectively implementing grants. 4.4.2 WHO and Gavi, the Vaccine Alliance Gavi, the Vaccine Alliance (Gavi), is an international alliance that was created in 2000 to improve access to new and underused vaccines for children living in the world’s poorest countries. WHO is a key policy influencer and implementing partner of Gavi. Vaccines contribute to healthier populations and universal health coverage through the life course, and WHO has developed a strategic approach to immunization to be aligned with GPW 13, with one focus area devoted to driving immunization impact in countries. The ultimate goal is to fully align the WHO GPW 13 implementation with the bottom-up approach of the Gavi Partners’ Engagement Framework. Gavi aims to focus its support on the world’s poorest countries, with national incomes determining eligibility. WHO country offices in 73 (49%) countries, territories and areas reported contributing to accessing and implementing Gavi grants, the same number as in the 2017 country presence report. Over 90% of these WHO country offices were engaged in supporting programming, planning and implementation or supporting reporting and monitoring. The majority (84%) of WHO country offices involved in supporting Gavi grants reported being engaged in at least five of the roles highlighted in Figure 54. In the field, Gavi relies significantly on collaboration with WHO’s six regional offices and country offices in countries that receive Gavi support. This support is provided through: • regional working groups that coordinate support for country programmes working through a core group of partners usually led by WHO and UNICEF; • WHO country offices working closely with national health authorities and their partner organizations in identifying national health priorities, formulating policy and supporting immunization and health system development; and Figure 54. WHO country offices which reported providing support to Member States in accessing and implementing Gavi grants, showing (a) % of country offices in each region participating, and (b) % of country offices which reported providing different types of support Support for programming, planning and implementation Reporting and monitoring Application for new vaccine introduction Member of the Inter-Agency Coordinating Committee (ICC) and/or Health Sector Coordination Committee (HSCC) or equivalent Preparation and reporting of Joint Appraisals Proposal Development Support for transitioning out of Gavi support Channelling funding for cash grants Other 68 Ι WHO presence in countries, territories and areas • WHO offices also assisting country health authorities in drafting applications for Gavi support and drawing up a plan of action for introducing vaccines. In addition, WHO staff members provide technical support for implementing immunization programmes, including storage and logistics, and monitoring and evaluating vaccines and equipment after they are introduced. 4.4.3 South-South and triangular cooperation The 2030 Agenda reaffirms the need to enhance South-South and t r iangular (SSTC) as well as regional and international cooperation on access to science, technology and innovation for the achievement of the Sustainable Development Goals. South-South and triangular cooperation is also recognized as one of the means to strengthen international support for implementing capacity-building in developing countries to support national plans to implement all the Sustainable Development Goals. The Thirteenth General Programme of Work emphasizes that WHO will help develop and scale up innovative solutions using such approaches as South−South cooperation. Globally, half of the WHO offices in countries, territories and areas in the six regions reported supporting a total of 241 South-South and/or triangular cooperation initiatives. The highest proportion of country office support for SSTC initiatives was reported in the Region of the Americas (78%), followed by the South-East Asia Region (64%), the Western Pacific Region (60%), the African Region (55%), the Eastern Mediterranean Region (28%) and the European Region (19%). Figure 55. Number of WHO country offices in each region which reported supporting SSTC initiatives AFR AMR EMR EUR SEAR WPR WHO country offices not involved in supporting SSTC Figure 56. Proportion of WHO country offices which reported support of SSTC initiatives and number of initiatives per region AFR AMR EMR EUR SEAR WPR 4. Who we work with Ι 69 Of the countries, territories and areas that supported SSTC initiatives, 50 WHO country offices (68%) reported supporting initiatives related to communicable diseases, followed by health systems strengthening and universal health coverage by 35 WHO country offices (47%). Health emergencies and International Health Regulations (IHR) initiatives were supported by 28 country offices (38%), followed by noncommunicable disease in 23 countries (31%), and promoting health through the life- course in 22 countries (30%). Timor-Leste, Sri Lanka: Strengthening immunization programme management The health system in Timor-Leste is relatively underdeveloped due to several years of conflict. A wide geographical spread of demographics poses a challenge to implementing a responsive immunization programme. Coupled with constrained capacity of the health system and an understaffed immunization (EPI) unit, transitioning from Gavi support at the end of 2019 is considered a big challenge. To cushion the transition from Gavi support, there was an urgent need to develop capacities within the EPI unit and the Ministry of Health. Sri Lanka, which had also suffered the impact of internal conflict, transitioned out from Gavi support in 2016 and took control of its own EPI with full government funding. In June 2017, at the sidelines of the WHO SEAR ITAG Meeting, Gavi, WHO, Sri Lanka and Timor-Leste officials met and had a preliminary discussion on how the two nations could build a partnership to strengthen the immunization programmes in both countries. South-South collaboration became the proposed solution. WHO, UNICEF and Gavi are supporting both nations in their twinning partnership. Under this programme, Timor-Leste’s health professionals are learning directly from their peers from Sri Lanka. For Sri Lanka, this programme provided an opportunity to showcase the strengths of its immunization programme both globally and regionally. It also enhanced its capacities in EPI mentoring and coaching with the potential for future twinning arrangements with other countries. Through this mutual partnership, both nations are on the fast track to achieving good health and well-being for women and children. Timor- Leste is now the third country to eliminate rubella and measles in South Asia. Upon completion of this twinning programme, a horizontal collaboration especially between South-South nations will be recognized as an effective solution for other countries challenged by capacity building and health systems development. Figure 57. Number of WHO country offices by region supporting SSTC initiatives in various technical areas Communicable diseases Health Emergencies and International Health Regulations (2005) Health systems and universal health coverage Noncommunicable diseases Promoting health through the life course Other Global Global Global 70 Ι WHO presence in countries, territories and areas The major focus of the initiatives varies among regions. Countries in the Region of the Americas were most likely to have reported supporting initiatives which were related to health systems and universal health coverage along with communicable diseases. The African Region also reported that the most common type of initiative supported by countries pertained to communicable diseases along with health emergencies/IHR. The top focus on initiatives in the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region was also on communicable diseases, while it shifted to noncommunicable diseases in the European Region. Over three quarters of WHO country offices reported the existence of SSTC initiatives including support through technical backstopping, while 74% provided support through training and capacity building, 47% by establishing information sharing platforms and networks, 32% provided financial and equipment support and 18% provided other services. South-South and triangular cooperation has been mainstreamed into the policies and programmes of the Organization and has become a means of implementation for achieving the health-related Sustainable Development Goals. However, keeping in mind the significance and contribution of SSTC to the protection and promotion of health in developing countries, this form of cooperation must be further strengthened and WHO country offices enabled to promote it. Figure 58. Number of WHO country offices supporting SSTC initiatives by type of support provided 11/03/2019 Q18c 1/1 AFR 10 6 6 19 18 21 AMR 12 8 3 18 17 6 EMR 3 3 3 4 13 EUR 4 3 4 4 25 SEAR 4 2 1 7 5 4 WPR 2 2 1 5 7 6 35 24 13 56 55 Global Training and capacity building Technical support Other types of support Financial and equipment support Establishment of information sharing platforms and networks 4. Who we work with Ι 71

Our work and its results 5. 5. Our work and its results Reflecting the overarching objective set out in WHO’s Constitution1 of enjoyment by all peoples of “the highest attainable standard of health”, GPW 13 places countries at the centre of WHO’s work. The foundation of WHO’s work is Sustainable Development Goal 3: ensuring healthy lives and promoting well-being for all at all ages. To ensure its achievement, GPW 13 has set the ambitious ‘triple billion’ goal on: • Universal health coverage – 1 billion more people benefitting from universal health coverage; • Health emergencies – 1 billion more people better protected from health emergencies; • Healthier populations – 1 billion more people enjoying better health and well-being. Placing the focus on the most vulnerable people, the GPW 13 also strives to ‘leave no one behind’. To deliver on the ambitious GPW 13, WHO is undergoing a number of strategic shifts to become more focused and effective in driving progress/impact in its country-based operations, working closely with partners, engaging in policy dialogue, providing strategic support and technical assistance, 1 WHO constitution, entered into force 7 April 1946, available at https:// www.who.int/governance/eb/who_constitution_en.pdf (accessed 2.7.2019). and coordinating service delivery, depending on the country context. Across 149 offices in countries, territories and areas, WHO staff, backed by six regional offices and headquarters, provide ministries of health with policy advice and technical assistance in many areas, including scaling up essential prevention, treatment and care services to achieve better health outcomes for populations. To showcase the result of the work of WHO offices in countries, territories and areas, more than 200 country experiences and success stories on the role of WHO teams in the field were compiled from its field offices. These stories highlight progress in a range of SDGs such as those relating to: communicable diseases, noncommunicable diseases, promoting health through the life-course (including sexual and reproductive, maternal, newborn, child and adolescent health; social determinants of health; and health and environment), health systems and universal health coverage, health emergencies and the International Health Regulations (all country stories will soon be made available on the country presence portal). For illustrative purposes, selected country stories from across all WHO regions covering the three strategic priorities of the GPW 13 are included below. Figure 59. GPW 13 strategic priority outcomes – promoting health, keeping the world safe, serving the vulnerable PROTECTION FROM HEALTH EMERGENCIES • Countries prepared for health emergencies • Epidemics and pandemics prevented • Health emergencies rapidly detected and responded to BETTER HEALTH AND WELL-BEING • Determinants of health addressed • Risk factors reduced through multisectoral action • Healthy settings and Health-in-All- Policies promoted UNIVERSAL HEALTH COVERAGE • Improved access to quality essential health services • Reduced number of people suffering financial hardship • Improved access to essential medicines, vaccines, diagnostics and devices for primary health care 74 Ι WHO presence in countries, territories and areas Fi gu re 60 . E xa m pl es of W HO co un tr y o ffi ce ac tiv iti es w or ld w id e 5. Our work and its results Ι 75 The essence of universal health coverage is a strong and resilient people-centred health system with primary care as its foundation. WHO provides support to countries to progress towards universal health coverage and the goal of ensuring that all people and communities Expanding universal health coverage have access to, and can use the promotive, preventive, curative, rehabil itative and palliative health services that are appropriate to their needs, and that are of sufficient quality to be effective, while not exposing the user to financial hardship. SERVICE ACCESS AND QUALITY HEALTH WORKFORCE ACCESS TO MEDICINES, VACCINE AND HEALTH PRODUCTS GOVERNANCE AND FINANCE HEALTH INFORMATION SYSTEMS POLICY DIALOGUE 76 Ι WHO presence in countries, territories and areas SOLOMON ISLANDS Western Pacific Region The Ministry of Health & Medical Services (MHMS) established the National Health Strategic Plan 2016-2020 (NHSP) and the Solomon Islands Government (SIG) have since identified that the Role Delineation Policy (RDP) is the key implementation mechanism to operationalize the NHSP and move towards universal health coverage. Traditionally, service delivery has not been integrated, especially as 80% of the population lives in rural and remote areas. RDP promotes integrated and patient centered care through service delivery packages provided in each of six levels of service and facilities, with referral pathways as well. Packages include considerations of staffing, equipment, essential medicines, guidelines, clinical support services at each level. WHO responded to country needs and helped in building strong partnerships in health and mobilizing and coordinating all available resources. The WHO country office has a program of ongoing support for the MHMS as it embarks on the implementation of RDP in the years ahead. After consultations conducted by the RDP national and provincial health planners, local staff and communities now have a common reference to identify what range and quality of services they can expect and deliver. RDP provides a roadmap for the realization of universal health coverage for the country. Challenge: implementing the NHSP to move towards universal health coverage Action: promote decentralized service delivery packages Outcome: common reference on range and quality of health services SERVICE ACCESS AND QUALITY 5. Our work and its results Ι 77 ARGENTINA Region of the Americas The Argentine Public Health Virtual Campus of the Pan American Health Organization/World Health Organization (PAHO/WHO) plays a strategic role for professionals and health workers. With a total of 79 296 persons enrolled, the platform offers a wide range of courses, resources, services and educational activities, as well as information and knowledge management in health. This Virtual Campus is comprised of a network of committed people, institutions and organizations that collaborate with a shared objective of strengthening capacity in public health. It is an important tool resulting from the joint effort of the Ministry of Health and Social Development (MOHSD) and PAHO/WHO to train public health professionals. The MOHSD’s National Observatory on Human Resources for Health supports the management of the Virtual Campus and designs and promotes courses according to its needs in coordination with PAHO/WHO. As a result, in 2017 alone, more than 30 courses were provided through the Argentine node of the PAHO/WHO virtual campus including courses on primary care management, establishing electronic health records, environmental health practice, surveillance of non-communicable diseases, vaccines in medical practices and key aspects of essential medicines. In 2017, more than 19 000 people participated in courses through self-learning or with tutoring in the country. Most of these courses were developed with contributions from the government. As a result, the PAHO/WHO Virtual Campus has evolved into a key resource for learning and collaboration in Argentina and has served to strengthen the steering and governance role of the national health authorities. Challenge: providing a platform for training public health professionals Action: creation of Virtual Campus to deliver courses Outcome: strengthening the human resources for health HEALTH WORKFORCE 78 Ι WHO presence in countries, territories and areas INDIA South-East Asia Region In India, an estimated 40 million people are infected with hepatitis B and approximately 6 million people are infected with hepatitis C with 184 000 deaths annually due to complications, twice the number of HIV and malaria deaths combined. In 2017, the Government of India responded to this public health crisis by providing free nation-wide treatment for hepatitis C using generic direct acting antiviral (DAA) drugs. This decision was made based on the results of a hepatitis C treatment programme that was piloted in Punjab state and from two economic analyses that were conducted with WHO’s technical support, including a cost-effectiveness analysis of DAA treatment and a treatment cost analysis of the whole course of drugs based on the pilot project. The results showed that a 12-week course using DAAs would cost $300 and that this plan would continue to be cost-effective over time. From June 2016 to September 2018, over 50 000 hepatitis C patients started the free treatment in Punjab and there was a cure rate of more than 92%. Generic drugs are now being manufactured in India making them affordable by bringing the cost down from $300 to $70 for a 12-week course. The generic drug programme used a decentralized service delivery model called ECHO in which doctors in tertiary hospitals provide oversight and monitoring via WhatsApp to doctors in district hospitals. Patients are monitored and those with viral suppression are given a certificate to prove they are disease free. Challenge: hepatitis B and C are a public health crisis Action: providing evidence on cost-effectiveness of pilot Outcome: piloting the project in Punjab with a 92% cure rate ACCESS TO MEDICINES, VACCINE AND HEALTH PRODUCTS 5. Our work and its results Ι 79 RWANDA African Region Over 80% of the population in Rwanda had financial barriers in accessing health care. Rwanda introduced community-based health insurance (CBHI) to address this issue, but faced some challenges along the way. Collecting premiums, attaining optimal recovery levels, a regressive flat fee premium, and significant financial deficit in covering reimbursement costs to CBHI providers were all challenges. WHO worked with partners to support and develop national health financing and CBHI policy documents and laws, to promote institutional capacity building, and to categorize people and health financing systems by socio-economic health financing system reviews. The WHO country office also advocated for equitable health care access, financial protection, policy support to move CBHI from the Ministry of Health/Districts to Rwanda Social Security Board (RSSB), and resource mobilization through the United Nations Development Assistance Plan. Since CBHI transferred to RSSB, coverage increased from 76% to 81% and utilization rose from 0.9 to 1.72 visits per person per year. The financial risk protection situation has improved, with a decrease of households who faced catastrophic health expenditure by more than 1.5% and a decrease in inequities between poorer and wealthier and/or urban and rural households. Challenge: financial barriers to accessing healthcare Action: supporting the development of a community based health insurance Outcome: improvements in coverage, visit rates, and financial protection GOVERNANCE AND FINANCE 80 Ι WHO presence in countries, territories and areas TAJIKISTAN European Region Recognizing that the collection of accurate and up-to-date data is crucial for evidence-based policy-making to achieve universal health coverage, WHO provided support to the Agency for Statistics under the President of the Republic of Tajikistan to gather reliable data on key areas such as health services utilization, unmet need and financial burden. The work was focused on updating a health module of the Household Budget Survey (HBS) and providing in-depth training for over 100 survey interviewers from the Agency for Statistics. The training series was in July 2018 and focused on building the capacity of interviewers, at both national and regional levels, to collect data on health services utilization and household expenditures within the scope of the routinely conducted HBS. During the training, interviewers were given guidance on processing data from the questionnaires and on fieldwork using the computer-assisted personal interviewing (CAPI) application. Including the revised health module questionnaire with the regular HBS makes it possible to link utilization and health expenditure data to detailed information on household consumption, including costs associated with disability. This data helped in strengthening analysis on equity and poverty dimensions, and the relevant financial protection aspects per household. It has also allowed for the calculation of the burden of health-care expenditures and the estimation of the impact of catastrophic health expenditures. Challenge: improving evidence-based policy making Action: training 100 employees of the Agency of Statistics in health services data collection Outcome: building capacity to investigate equity and poverty dimensions in health HEALTH INFORMATION SYSTEMS 5. Our work and its results Ι 81 TUNISIA Eastern Mediterranean Region Absence of coherent health sector vision has been an important challenge to the achievement of universal health coverage in Tunisia. One of the aims of the Tunisian Jasmine Revolution was to create better conditions of life, including better access to quality public services, more accountability, and a more open society where people influence policymaking more directly. The WHO country office has been helping establish an innovative citizen participation mechanism called “Dialogue Sociétal en santé” to define a common vision in policy making for universal health coverage and will monitor implementation mid-2018. Seven thematic strategic documents had been developed through Dialogue which cover the following themes: people centered-care, health determinants and multisectoral action, health financing, drugs and medical devices, digital health, health research and health sector governance. Debates around these strategic documents have been organized with support from the WHO country office. The participatory process of the Dialogue Sociétal and its ownership by the different stakeholders, including civil society, is an example of health democracy that can inspire other countries. Tunisia is also rapidly moving towards having a technically sound and coherent vision as well as policy documents which will guide the health sector for many years to come. Challenge: enhancing participative policy making towards universal health coverage Action: helping to establish a citizen participation mechanism Outcome: producing strategic documents leading to a coherent vision POLICY DIALOGUE 82 Ι WHO presence in countries, territories and areas The threat of epidemics and emergencies is universal, and every country is vulnerable to one or more types of health emergencies. WHO works with Member States and partners using an ‘all-hazards’ approach to health emergency preparedness, prevention, detection and risk management, response and recovery. This is done through the implementation of the International Health Regulations (IHR 2005) and the Sendai Framework for Disaster Risk Reduction. In responding to emergencies, WHO plays a central role at the country level as the Addressing health emergencies humanitarian health cluster lead. Meanwhile, WHO’s work in the area of emergencies also intersects with the other two strategic priorities of the GPW 13. For instance, under the health and well-being strategic priority, mitigating and addressing climate change and climate sensitive diseases are essential in preventing emergencies. Similarly, in fragile and conflict- affected countries, WHO focuses on preventing health system collapse, maintaining critical services and rebuilding health systems after crises. ACCESS TO LIFE- SAVING TREATMENTS IN HUMANITARIAN CRISES MITIGATE RISKS FROM INFECTIOUS HAZARDS ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 5. Our work and its results Ι 83 YEMEN Eastern Mediterranean Region Nearly 16.4 million people lack access to basic healthcare in Yemen. To respond to this massive need, WHO, Health Cluster partners and other health sector actors are delivering health services despite the critical security situation, logistical difficulties and the collapsing health system. WHO and Health Cluster partners have scaled-up their presence to meet rising health needs, reaching 9.5 million beneficiaries out of the targeted 10.4 million people. This has been done through preventive and curative interventions in 1708 health facilities and with 239 emergency medical mobile teams (EMMTs). WHO and other health partners scaled up the overall operational response to infectious disease outbreaks. At the peak of the cholera outbreak, there were 229 Diarrhoea Treatment Centres (DTCs) with in-patient capacities, and 1095 Oral Rehydration Corners (ORCs) for early detection, treatment and referral of severe cholera cases. Rapid response teams (RRTs) were established across all 333 districts in Yemen. WHO supported the technical and operational work of the response to contain outbreaks and build local capacity at governorate and district level health facilities and at community levels. Despite all challenges such as accessibility to the conflict affected areas, with WHO support, it was possible to save or improve the lives of at least 9.5 million people in 2017. Challenge: health needs amid a humanitarian crisis Action: coordinating and supporting the Health Cluster Outcome: containing outbreaks and delivering essential services, reaching 9.5 million people in need ACCESS TO LIFE-SAVING TREATMENTS IN HUMANITARIAN CRISES 84 Ι WHO presence in countries, territories and areas UGANDA African Region Uganda faced outbreaks of newly emerging or re-emerging diseases that constitutes public health threats, such as Marburg virus disease, yellow fever, meningitis, hepatitis B, E and cholera. These outbreaks are due to poor disease detection, drug stock outs, non-adherence to treatments, inadequate training, lack of necessary equipment, weak health system functionality and poor service delivery. The WHO country office helped address these problems by building core capacities to prevent, detect, report, assess and respond to public health emergencies. The Ministry of Health has increased emergency preparedness and integrated disease surveillance. There is now an Emergency Operation Center and improved laboratory infrastructure. However, despite these improvements, a joint external evaluation (JEE) showed that Uganda had a demonstrated capacity of 20%, a developed capacity of 40% and limited capacity of 30% of JEE core indicators. This strengthened system capacity allowed for the quick detection and response to the Marburg virus disease, which was contained in 42 days. Cholera guidelines also prevented outbreak. Health system strengthening in Uganda has also helped to contain Congo Crimean haemorrhagic-fever (CCHF) with no deaths. All these measures have strengthened the health system, decreased morbidity, and reduced associated mortality. Challenge: containing re-emerging outbreaks Action: building capacity to monitor and respond to outbreaks Outcome: faster containments with fewer or no deaths MITIGATE RISKS FROM INFRECTIOUS HAZARDS 5. Our work and its results Ι 85 ROMANIA European Region The ongoing measles outbreak in Romania started in January 2016. Since then, WHO, in close collaboration with UNICEF, has been providing extensive support to the country to interrupt the outbreak that represents a serious public health threat not only for the country but also to the region. Technical assistance has been provided by WHO, in close collaboration with Regional Office and Headquarters in developing the communication plan to ensure protection among the individuals identified as being most susceptible, including those at the highest risk of infection. As part of the outbreak response, a survey was conducted to identify the main reasons for parents not vaccinating their children. WHO and UNICEF assisted the Ministry of Health in preparing supplemental immunization activities in the country to interrupt the measles outbreak. With WHO’s support and as part of preparation for the measles campaign, a communication plan was developed using the survey data. Through training activities, more nationals are now able to strengthen their risk communication response capacity during outbreaks. The draft outbreak response plan was developed in collaboration with the European Centre for Disease Control and applied WHO’s After Action Review (AAR) methodology. The vaccine supply shortage review was performed, and areas for improvement were identified aiming at strengthening the Ministry of Health’s vaccine procurement capacity. The Immunization Law provision was reviewed before the planned public debate. Challenge: responding to measles outbreak Action: providing technical assistance to develop communication plan Outcome: risk communication response capacity strengthened RESPONDING TO DISEASE OUTBREAK 86 Ι WHO presence in countries, territories and areas MYANMAR South-East Asia Region In Myanmar, the WHO country office was notified of 13 H1N1 cases by the Ministry of Health and Sports (MoHS) on 24 July 2017. WHO provided significant support to the MoHS in the form of influenza A(H1N1) pdm09 response activities. By 5 January 2018, MoHS reported 406 H1N1 lab confirmed cases, including 60 deaths, 38 of which were likely due to Influenza and 22 due to influenza with co-morbidities. The WHO country office supported national authorities in overcoming the H1N1 outbreak by providing influenza event management and clinical case management technical experts from SEARO, the WHO country office, and the National University of Singapore. WHO’s technical support was essential for the coordination of influenza immunizations, viral characterization, data management and coordination with partners to ensure a comprehensive response. WHO also provided essential preventive and diagnostic tools, such as influenza vaccines, laboratory reagents and personal protective equipment. Risk communication capacity building for public health professionals was implemented in close collaboration with MoHS. The collaboration between MoHS, WHO, and development partners resulted in a significant decrease in laboratory confirmed Influenza A (H1N1) pdm09 cases and deaths since mid-August 2017. This decreasing trend in diagnoses show that Myanmar has successfully controlled the situation within a short duration of time. Challenge: responding to H1N1 influenza outbreak Action: providing management expertise, technical support and essential tools Outcome: situation under control within a short time duration RESPONDING TO DISEASE OUTBREAK 5. Our work and its results Ι 87 BAHAMAS Region of the Americas The WHO country office collaborates with the national health authorities and National Emergency Management Agency in both The Bahamas (BHS) and Turks and Caicos Islands (TCA) to prepare for and respond to disasters and emergencies. Technical assistance has been provided to both countries to prepare All Hazards Emergency preparedness and response plans. Both BHS and TCA are highly vulnerable to weather related disasters because of their geographical location, small land masses, low elevations and vulnerable coastal areas. The islands were adversely impacted by hurricanes Irma and Maria in 2017, which caused damage to infrastructure and economic losses. The WHO country office provided water purification and vector control supplies post-hurricanes and donated funds for construction materials to repair a health clinic on Ragged Island in The Bahamas. Human resources were provided to support Emergency Operating Centres (EOCs) in both countries and for evaluating damage to health facilities. Training was provided for emergency responders and coordinators on “Psychological first aid” and “Incident Command Management Systems” in TCA. Equipment was procured to improve communication and EOC operational capacities in both countries. In BHS consultants were assigned to assist with health risk assessment and air pollution testing equipment was donated to the Ministry of the Environment in response to another emergency caused by a fire at the landfill in New Providence in 2017. Challenge: improve preparedness for extreme weather events Action: providing human, in-kind and monetary resources Outcome: improved infrastructure and human capital to respond to emergencies ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 88 Ι WHO presence in countries, territories and areas VANUATU Western Pacific Region Malaria used to be a main cause of morbidity and mortality in Vanuatu. The WHO Vanuatu country office is the major long term technical partner for malaria control and the office helps in resource mobilization, strategic planning, field assessments such as vector surveillance and case finding; monitoring and evaluation; supervision; and bed-net distribution. As a result, malaria incidence has decreased by 95% in the last 10 years. A major milestone was that TAFEA province was declared malaria free in 2017. Several other provinces are on track, but the main challenge is the decreasing availability of funding. Vanuatu is ranked by the UN as the country most at risk of being severely impacted by natural disasters. The WHO country office, as co-chair of the health cluster has helped with the health sector’s responses to the many disasters in Vanuatu, including Tropical Cyclone Pam in 2015, Cyclone Donna in 2017, earthquakes, and, most recently, a serious volcanic eruption that required the removal of 10 000 people from the affected island. Among other activities, the WHO country office assisted in the completion of impact assessments and nutritional surveys and helped with training health workers and setting up syndromic surveillance for detection of outbreaks among affected and displaced populations. Other support consisted of health cluster coordination, creating emergency medical teams, and data management. WHO country office support significantly strengthened the health sector’s response to these emergencies. Challenge: malaria control and emergency response Action: technical partner for malaria and co-chairing health cluster Outcome: 95% decrease in malaria incidence over the last 10 years and health sector emergency response strengthened ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 5. Our work and its results Ι 89 WHO will contribute to better health and well- being for people through five interconnected platforms (left). Each of them presents considerable 21st Century challenges to people’s health and calls for multisectoral action to address health determinants. Using Promoting better health and well-being an integrated approach across technical units and levels of the Organization, WHO has a unique comparative advantage to work with governments and partners to address these five areas. ACCELERATING ACTION ON PREVENTING NONCOMMUNICABLE DISEASES AND PROMOTING MENTAL HEALTH IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE HEALTH EFFECTS OF CLIMATE CHANGE ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES TACKLING ANTIMICROBIAL RESISTANCE 90 Ι WHO presence in countries, territories and areas BURUNDI African Region Cervical cancer is the leading cause of cancer deaths among women in Burundi. Cancer screening services are still very poor, and the detection and treatment of pre-cancerous lesions is quasi inexistent. Cancer registries are yet to be institutionalized. The human papillomavirus (HPV) vaccine has proven to be effective in preventing cervical cancer. In 2016, WHO Burundi advocated and successfully mobilized US$ 161 882 through the GAVI Alliance to conduct a demonstration project to introduce the vaccine in two pilot districts. This step was very useful to generate evidence on feasibility of vaccine introduction, to galvanize political support and mobilize additional resources to scale up the intervention nationwide. WHO conducted high level advocacy, leading to the engagement of the Burundi’s First Lady in the introduction of the HPV vaccine in 2016. The preparation and technical organization of this activity was entrusted to the EPI Program. WHO provided technical support for planning, implementation, monitoring and evaluation, documentation of the results of the campaign and facilitated resource disbursement. A total of 91% of girls aged between 9 and 13 years throughout schools and surrounding communities were protected after receiving the first and second doses in 2016 and 2017. Following this successful intervention, national authorities are now engaged and GAVI has expressed willingness to consider an application from Burundi to apply for funding to extend HPV vaccination to the entire country as from 2019. Challenge: reducing cervical cancer deaths Action: advocacy, resource mobilization and technical support Outcome: 91% of girls aged 9–13 received the two rounds HPV vaccination IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE 5. Our work and its results Ι 91 PARAGUAY Region of the Americas Paraguay faces high levels of maternal and newborn mortality and aims to reduce the number of women who die during childbirth each year. The current registered maternal mortality ratio (MMR) in Paraguay is 81.8 per hundred thousand live births (as measured in 2016). Paraguay promoted the “National Mobilization for the reduction of maternal and newborn mortality 2014-2018”. Within this framework, PAHO’s technical cooperation focused on improving components such as strengthening the integrated health services network; maternal and neonatal health surveillance; development of human resources competencies and capacities in the mother-child area of the three levels of care; and strengthening of the strategic information system in health. This program has resulted in important advances, such as the strengthening of Family Health Units with basic equipment, supplies and materials, improving the mortality information system and reinforced analysis capabilities. The program also strengthened capacity of human resources for comprehensive health care, which made technical and financial cooperation possible in hospitals and primary care units in hard to reach communities. A total of 6663 health professionals and technicians have been trained to date. As a result, there has been a 10% reduction in the number of maternal deaths recorded during the last three years, showing that the national mobilization for the reduction of maternal and newborn mortality 2014– 2018 has been effective in saving the lives of women and newborns in Paraguay. Challenge: reducing maternal mortality Action: strengthening surveillance and capacity and integrating services Outcome: 10% reduction in the number maternal deaths over the last three years IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE 92 Ι WHO presence in countries, territories and areas LITHUANIA European Region Lithuania has a high rate of alcohol consumption, binge-drinking patterns and high levels of alcohol-attributable mortality and burden of disease. In the latest comparative risk assessments, Lithuania ranked highest among all European Union countries, and sixth among all the WHO European Region countries in alcohol-attributable mortality, and highest in alcohol-attributable disability-adjusted life years. “Best buys” are a WHO created concept describing evidence-based, highly cost- effective and feasible interventions to reduce the impact of NCD risk factors. Currently, Lithuania is implementing all three best buy alcohol related policy options, namely increased taxation, restricting availability and banning marketing and advertising along with other policy changes with major changes being implemented between 2016 and 2018. The WHO country office in Lithuania contributed to this process by continuously prioritising the topic of alcohol consumption and related harm within the biennium cooperation agreements and providing on-going policy advice and technical support in raising awareness and sharing evidence and good practices. In 2017/2018, with new political leadership in the country and renewed commitment for introducing relevant alcohol control measures, WHO used this window of opportunity to support the Government and the Parliament in introducing alcohol control policies. With technical and political support from regional and headquarter levels, the WHO country office has actively engaged in policy dialogue and strategic communication with national stakeholders. It has clarified WHO’s approach on alcohol consumption estimates and highlighted the harm and burden of high alcohol use on health, despite opposition from the alcohol industry and related groups. It was considered key to monitor and evaluate the alcohol control policy situation and its impact on healthy. Currently the WHO country office is supporting the set-up of a study to rigorously evaluate these policies. Challenge: reducing alcohol abuse Action: advocacy, policy dialogue and evaluation on policies on alcohol-attributable health issues Outcome: the government prioritized alcohol control policies ACCELERATING ACTION ON PREVENTING NONCOMMUNICABLE DISEASES AND PROMOTING MENTAL HEALTH 5. Our work and its results Ι 93 SAMOA Western Pacific Region World Health Assembly Resolution 50.29 called on Member States to eliminate lymphatic filariasis as a public health problem. In response, WHO launched its Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000 with the aims of eliminating transmission and alleviating the suffering caused by lymphatic filariasis by 2020. In 1999, PacELF baseline surveys in Samoa revealed an antigenemia prevalence rate of 4.52%. The mass drug administration (MDA) strategy for the interruption of lymphatic filariasis transmission is 5-6 annual rounds of large-scale treatment of all eligible people in areas where infection is present. In efforts to accelerate elimination of lymphatic filariasis in Samoa, the Ministry of Health adopted the new treatment strategy recommended by the WHO in 2017 to implement MDA with triple drug therapy nationwide from 14 to 26 August 2018. WHO provided technical advice and financial assistance at each stage of the MDA campaign in Samoa. The rationale and purpose of WHO assistance is three-fold: stop transmission of lymphatic filariasis and prevent new infections by 2020; ensure the provision of basic care for people living with disability due to lymphatic filariasis; enhance Post-Mass Drug Administration Surveillance towards validation by 2024. The preliminary results based on Savaii Island demonstrate a high coverage of more than 90% of the entire eligible population. The results for Upolu Island and Apia are expected to be within a similar range. The MDA will be repeated in 2019 and if the rounds of MDA in 2018 and 2019 are successful then Samoa will be declared free of lymphatic filariasis by WHO. Challenge: eliminating lymphatic filariasis Action: providing technical and financial assistance Outcome: provision of basic care reached 90% of the eligible population ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES 94 Ι WHO presence in countries, territories and areas DJIBOUTI Eastern Mediterranean Region In 2017, Djibouti experienced a malaria epidemic, as confirmed by the WHO country office. The WHO country office supported the malaria control program to reduce the incidence of malaria by assisting in training 170 health workers regarding malaria diagnosis, case management, and community mobilization. To bolster malaria prevention, a total of 203 000 long lasting insecticide treated bed nets were distributed in the most affected areas. The malaria caseload reduced to below the epidemic threshold because of this WHO country office intervention. Of all confirmed malaria cases in Djibouti, 87% received the first line of treatment and 20 000 cases were effectively treated. A total of 91 788 rapid tests were provided and used. Additionally, WHO country office involvement led to strengthening of the national vector control capacity for malaria in terms of necessary equipment and support for the workforce. Challenge: responding to malaria epidemic Action: assisting in training and provision of bed nets Outcome: reduction of caseload to below epidemic threshold ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES 5. Our work and its results Ι 95 MALDIVES South-East Asia Region As part of the Joint UN program on Low Emission Climate Resilient Development (LeCRED), the WHO country office has collaborated with six other UN agencies to address issues related to climate change and health. Waste management and vector control activities were among some of the most challenging areas where opportunities to build on each agency’s comparative advantages were evident. Following the mapping of activities, the WHO country office prioritized focus on developing health care waste management activities which remained a neglected area in overall waste management approach. After agreeing to implement vector control activities with agency partners, the WHO country office provided technical assistance to develop health care waste management technology. As the work progressed it was noted that country did not have a Health Care Waste Management Policy, Strategic Plan and Operational Plan, subsequently the WR led development discussions at the highest level with the Health Minister. The WHO country office team then mobilized high quality technical assistance from the regional office which supported identification of a suitable expert to further the plan’s development and established sites for appropriate health care waste management with an autoclave at the regional hospital and a desktop autoclave in each of 11 island health centres as an example of policy implementation. Utilizing the opportunity, the WHO country office brought different agencies together to participate in elements of the campaign such as communication activities, facilitating participation of the women groups from islands and mobilizing local councils while the WHO country office mobilized the hospital and health centre staff for participation in the campaign which was launched by Health Minister, State Minister of Environment and Energy and attended by local council chief, members of atoll and island councils and several community representatives. Given the limited staff numbers at the WHO country office, the joint working with UN agencies made it possible to mobilize different partners, stakeholders and importantly ensured engagement of the community as well. Challenge: developing resilience to climate change Action: mobilizing high quality technical assistance and bringing other UN agencies to work together Outcome: achieving both community and high level engagement HEALTH EFFECTS OF CLIMATE CHANGE 96 Ι WHO presence in countries, territories and areas Annexes Annex 1 List of WHO Member States and Associate Member States Puerto Rico Tokelau A S S O C I AT E M E M B E R S TAT E S Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo (the) Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Democratic People’s Republic of Korea Democratic Republic of the Congo Denmark M E M B E R S TAT E S Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Republic of North Macedonia Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syrian Arab Republic Tajikistan Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe 98 Ι WHO presence in countries, territories and areas Annex 2 WHO offices and suboffices in countries, territories and areas A F R I C A N R E G I O N Country, territory, area Location Country, territory, area Location Algeria Algiers Lesotho Maseru Angola Luanda Liberia Monrovia Benin Cotonou Madagascar Antananarivo Botswana Gaborone Malawi Lilongwe Burkina Faso Ouagadougou Mali Bamako Burundi Bujumbura Mauritania Nouakchott Cabo Verde Praia Mauritius Port Louis Cameroon Yaoundé Mozambique Maputo Central African Republic Bangui Namibia Windhoek Chad N’Djamena Niger Niamey Comoros Moroni Nigeria Abuja Congo (the) Brazzaville Rwanda Kigali Côte d’Ivoire Abidjan São Tomé and Príncipe São Tomé Democratic Republic of the Congo Kinshasa Senegal Dakar Equatorial Guinea Malabo Seychelles Victoria, Mahé Eritrea Asmara Sierra Leone Freetown Eswatini Mbabane South Africa Pretoria Ethiopia Addis-Ababa South Sudan Juba Gabon Libreville Togo Lomé Gambia Banjul Uganda Kampala Ghana Accra United Republic of Tanzania (the) Dar es Salaam Guinea Conakry Zambia Lusaka Guinea-Bissau Bissau Zimbabwe Harare Kenya Nairobi W H O O F F I C E S Annexes Ι 99 Annex 2, continued R E G I O N O F T H E A M E R I C A S Country, territory, area Location Argentina Buenos Aires Bahamas Nassau, New Providence Barbados Bridgetown Belize Belize City Bolivia (Plurinational State of) La Paz Brazil Brasilia Chile Santiago Colombia Bogotá Costa Rica San Jose Cuba Havana Dominican Republic Santo Domingo Ecuador Quito El Salvador San Salvador Guatemala Guatemala City Guyana Georgetown Haiti Port-au-Prince Honduras Tegucigalpa Jamaica Kingston Mexico Mexico City Nicaragua Managua Panama Panama City Paraguay Asunción Peru Lima Suriname Paramaribo Trinidad and Tobago Port-of-Spain Uruguay Montevideo Venezuela (Bolivarian Republic of) Caracas E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Location Afghanistan Kabul Djibouti Djibouti Egypt Cairo Iran (Islamic Republic of) Tehran Iraq Baghdad Jordan Amman Lebanon Beirut Libya Tripoli Morocco Rabat Oman Muscat Pakistan Islamabad Saudi Arabia Riyadh Somalia Mogadishu Sudan Khartoum Syrian Arab Republic Damascus Tunisia Tunis West Bank & Gaza Strip Jerusalem Yemen Sana’a W H O O F F I C E S 100 Ι WHO presence in countries, territories and areas Annex 2, continued E U R O P E A N R E G I O N Country, territory, area Location Albania Tirana Armenia Yerevan Azerbaijan Baku Belarus Minsk Bosnia and Herzegovina Sarajevo Bulgaria Sofia Croatia Zagreb Czech Republic Prague Estonia Tallinn Georgia Tbilisi Greece Athens Hungary Budapest Kazakhstan Astana Kyrgyzstan Bishkek Latvia Riga Lithuania Vilnius Montenegro Podgorica Poland Warsaw Pristina Pristina Republic of Moldova Chisinau Republic of North Macedonia Skopje Romania Bucharest Russian Federation Moscow Serbia Belgrade Slovakia Bratislava Slovenia Ljubljana Tajikistan Dushanbe Turkey Ankara Turkmenistan Ashgabat Ukraine Kyiv Uzbekistan Tashkent S O U T H - E A S T A S I A R E G I O N Country, territory, area Location Bangladesh Dhaka Bhutan Thimphu Democratic People’s Republic of Korea Pyongyang India New Delhi Indonesia Jakarta Maldives Male Myanmar Yangon Nepal Kathmandu Sri Lanka Colombo Thailand Nonthaburi Timor-Leste Dili W E S T E R N PA C I F I C R E G I O N Country, territory, area Location Cambodia Phnom Penh China Beijing Kiribati Tarawa Lao People’s Democratic Republic (the) Vientiane Malaysia Kuala Lumpur Micronesia (Federated States of) Palikir Mongolia Ulaanbaatar Papua New Guinea Port Moresby Philippines Manila Samoa Apia Solomon Islands Honiara South Pacific Suva Tonga Nuku’alofa Vanuatu Port Villa Viet Nam Hanoi W H O O F F I C E S Annexes Ι 101 Annex 2, continued A F R I C A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Angola Luanda 0 Angola does not have suboffices, but does have an office in each of the 18 provinces, located within each of the provincial health directorates. The offices have all required equipment to function, including a vehicle, a driver, and technical staff with an epidemiological/surveillance background Central African Republic Bangui 3 Bambari, Kagabandoro and Bouar Chad N’Djamena 6 Abeche, Sarh, Moundou, Mongo, Mao and N’Djamena Democratic Republic of the Congo Kinshasa 11 Kinshaha, Matadi, Bandundu ville, Kananga, Mbuji Mayi, Lubumbashi, Bukavu, Goma, Kindu, Kinsagani and Mbandaka Ethiopia Addis-Ababa 1 Somali Region Ghana Accra 1 Tamale Guinea Conakry 2 Nzérékoré and Guéckédou Kenya Nairobi 4 Garissa (serving the North Eastern Province), Embu, Eldoret, Nakuru Nigeria Abuja 37 In each of the 37 states, including the Federal Capital Territory in Abuja South Sudan Juba 10 In all the capitals of the 10 States that constitute the country Uganda Kampala 1 Moroto United Republic of Tanzania (the) Dar es Salaam 5 Zanzibar, Tanga, Dodoma, Mwanza and Iringa W H O S U B O F F I C E S R E G I O N O F T H E A M E R I C A S Country, territory, area Location Number of suboffices Location of WHO suboffices Barbados Bridgetown 7 Anguilla, Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia and Saint Vincent Guatemala Guatemala City 1 San Marcos Mexico Mexico City 1 Tuxtla Gutiérrez Chiapas Paraguay Asunción 1 Boqueron, Filadelfia in El Chaco Paraguayo 102 Ι WHO presence in countries, territories and areas Annex 2, continued E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Afghanistan Kabul 8 Jalalabad, Gardez, Herat, Kandahar, Bamyan, Kunduz, Balkh and Badakhshan Iraq Baghdad 5 Erbil, Dohuk, Sulaimaniyah, Basrah and Baghdad (within the Ministry of Health) Jordan Amman 0 EMRO Regional Centre for Environmental Action (CEHA) EMRO Regional Centre for Polio Eradication and Emergency Libya Tripoli 2 Benghazi , Sabah Pakistan Islamabad 4 Lahore, Karachi, Peshawar and Quetta Somalia Mogadishu 4 Nairobi (Liaison Office), Hargeisa (serving Somaliland), Garowe (serving Puntland), and Baidoa (serving southwestern State) Sudan Khartoum 6 El-Fasher, Nyala, Geneina, Kassala, Kadugli and Damazine Syrian Arab Republic Damascus 4 Qamishly, Aleppo, Homs and Latakia West Bank & Gaza Strip Jerusalem 2 Ramallah, Gaza Yemen Sana’a 4 Aden, Al Hodeida, Ibb (serving Ibb and Taiz) and Sadaa W H O S U B O F F I C E S E U R O P E A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Bosnia and Herzegovina Sarajevo 1 Banja Luka Turkey Ankara 1 Gaziantep Ukraine Kyiv 4 Donetsk, Kramatorsk, Luhansk and Severodonetsk S O U T H - E A S T A S I A R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices India New Delhi 7 In all seven regional hubs in the country Indonesia Jakarta 2 Jakarta W E S T E R N PA C I F I C R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Philippines Manila 1 Davao City Viet Nam Hanoi 1 Ho Chi Minh City Annexes Ι 103 Annex 3 Number and categories of staff members working in WHO offices in countries, territories and areas A F R I C A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Algeria 15 2 7 6 Angola 53 12 15 26 Benin 25 1 9 15 Botswana 15 1 7 7 Burkina Faso 32 3 9 20 Burundi 25 3 7 15 Cameroon 28 1 11 16 Cabo Verde 8 1 3 4 Central African Republic 36 8 10 18 Chad 58 13 10 35 Comoros 16 0 5 11 Congo (the) 23 0 9 14 Côte d’Ivoire 34 3 11 20 Democratic Republic of the Congo 90 12 35 43 Equatorial Guinea 8 0 3 5 Eritrea 19 1 6 12 Eswatini 16 1 5 10 Ethiopia 131 15 59 57 Gabon 17 1 5 11 Gambia 16 1 5 10 Ghana 29 1 10 18 Guinea 34 3 9 22 Guinea-Bissau 11 2 2 7 Kenya 47 5 20 22 Lesotho 14 2 4 8 Liberia 32 5 5 22 Madagascar 27 3 9 15 Malawi 24 0 12 12 Mali 26 4 8 14 Mauritania 22 3 8 11 Mauritius 9 1 2 6 Mozambique 29 3 13 13 Namibia 18 3 4 11 Niger 40 4 15 21 Nigeria 403 34 144 225 Rwanda 21 2 10 9 São Tomé and Príncipe 7 0 3 4 Senegal 16 1 6 9 104 Ι WHO presence in countries, territories and areas Annex 3, continued R E G I O N O F T H E A M E R I C A S Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Argentina 11 4 2 5 Bahamas 3 2 1 0 Barbados 24 17 1 6 Belize 3 1 1 1 Bolivia (Plurinational State of) 14 7 1 6 Brazil 63 24 24 15 Chile 7 1 2 4 Colombia 15 6 3 6 Costa Rica 6 3 1 2 Cuba 1 1 — — Dominican Republic 11 7 1 3 Ecuador 14 5 4 5 El Salvador 12 8 0 4 Guatemala 15 7 1 7 Guyana 10 3 4 3 Haiti 17 10 0 7 Honduras 16 8 3 5 Jamaica 10 6 1 3 Mexico 15 9 2 4 Nicaragua 11 3 3 5 Panama 11 8 1 2 Paraguay 12 8 1 3 Peru 22 14 2 6 Suriname 5 3 1 1 Trinidad and Tobago 10 7 0 3 Uruguay 12 6 3 3 Venezuela (Bolivarian Republic of) 13 5 2 6 Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Seychelles 6 1 2 3 Sierra Leone 56 18 14 24 South Africa 36 7 9 20 South Sudan 73 23 19 31 Togo 17 2 3 12 Uganda 46 3 20 23 United Republic of Tanzania (the) 42 4 17 21 Zambia 32 2 16 14 Zimbabwe 40 2 12 26 A F R I C A N R E G I O N Annexes Ι 105 E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Afghanistan 105 23 19 63 Djibouti 10 3 0 9 Egypt 17 1 7 9 Iran (Islamic Republic of) 18 1 4 13 Iraq 66 21 16 29 Jordan 16 4 3 9 Lebanon 9 1 2 6 Libya 23 11 4 8 Morocco 10 1 3 6 Oman 9 1 0 8 Pakistan 127 38 31 58 Saudi Arabia 8 3 1 4 Somalia 56 25 13 18 Sudan 57 7 11 39 Syrian Arab Republic 61 5 22 34 Tunisia 14 2 1 11 West Bank & Gaza Strip 25 4 8 13 Yemen 123 29 29 65 Annex 3, continued 106 Ι WHO presence in countries, territories and areas E U R O P E A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Albania 6 1 3 2 Armenia 8 1 3 4 Azerbaijan 6 1 2 3 Belarus 5 1 2 2 Bosnia and Herzegovina 7 2 1 4 Bulgaria 3 1 1 1 Croatia 2 0 1 1 Czech Republic 2 1 0 1 Estonia 2 0 1 1 Georgia 9 1 5 3 Greece 1 1 0 0 Hungary 3 1 1 1 Kazakhstan 5 1 2 2 Kyrgyzstan 17 2 9 6 Latvia 1 0 1 0 Lithuania 2 0 1 1 Montenegro 2 0 1 1 Poland 3 1 0 2 Pristina 0 1 3 4 Republic of Moldova 7 0 5 2 Republic of North Macedonia 6 1 2 3 Romania 3 1 1 1 Russian Federation 9 1 4 4 Serbia 9 2 3 4 Slovakia 2 1 0 1 Slovenia 3 1 0 2 Tajikistan 17 2 8 7 Turkey 37 13 11 13 Turkmenistan 7 1 2 4 Ukraine 35 10 14 11 Uzbekistan 18 2 9 7 Annex 3, continued Annexes Ι 107 S O U T H - E A S T A S I A R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Bangladesh 63 13 19 31 Bhutan 15 2 3 10 Democratic People’s Republic of Korea 7 7 0 0 India 88 10 48 30 Indonesia 52 10 16 26 Maldives 21 3 4 14 Myanmar 54 12 8 34 Nepal 50 7 15 28 Sri Lanka 28 3 8 17 Thailand 28 7 5 16 Timor-Leste 22 7 4 11 Annex 3, continued W E S T E R N PA C I F I C R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Cambodia 46 13 11 22 China 31 5 14 12 Kiribati 2 0 0 2 Lao People’s Democratic Republic (the) 51 12 17 22 Malaysia 7 1 1 5 Micronesia (Federated States of) 2 1 0 1 Mongolia 16 1 6 9 Papua New Guinea 37 14 4 19 Philippines 28 7 8 13 Samoa 9 1 2 6 Solomon Islands 12 6 0 6 South Pacific 44 14 9 21 Tonga 4 1 0 3 Vanuatu 11 5 1 5 Viet Nam 45 9 13 23 108 Ι WHO presence in countries, territories and areas Annex 4 Global fund grants of which WHO is a subrecipient Region Country HIV/AIDS TB Malaria RMNCH Health systems strengthening African Region Democratic Republic of the Congo Madagascar Malawi Nigeria Senegal South Sudan Eastern Mediterranean Region Afghanistan Iran (Islamic Republic of) Iraq Lebanon Somalia Sudan Syrian Arab Republic Tunisia European Region Ukraine South-East Asia Region Bangladesh Democratic People's Republic of Korea India Indonesia Nepal Myanmar Sri Lanka Thailand Timor-Leste Western Pacific Region Cambodia Kiribati Lao People's Democratic Republic Micronesia (Federated States of) Mongolia Papua New Guinea Solomon Islands South Pacific (Fiji) Tonga Viet Nam Annexes Ι 109 Annex 5 Countries (with WHO presence) eligible for Gavi new vaccines support in 2018 Region Country African Region Benin Burkina Faso Burundi Cameroon Central African Republic Chad Comoros Côte d'Ivoire Democratic Republic of the Congo Eritrea Ethiopia Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mozambique Niger Rwanda São Tomé and Príncipe (grace year) Senegal Sierra Leone South Sudan Togo Uganda United Republic of Tanzania Zambia Zimbabwe Region Country Region of the Americas Haiti Eastern Mediterranean Region Afghanistan Djibouti Pakistan Somalia Sudan Yemen European Region Kyrgyzstan Tajikistan South-East Asia Region Bangladesh Democratic People’s Republic of Korea Myanmar Nepal Western Pacific Region Cambodia 110 Ι WHO presence in countries, territories and areas Annex 6 Planned costs and available funds for WHO work in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Algeria 3 354 850 2 979 382 89 Angola 24 299 010 17 693 432 73 Benin 8 200 207 5 351 466 65 Botswana 3 445 319 3 037 354 88 Burkina Faso 11 273 270 8 124 304 72 Burundi 6 660 682 5 587 156 84 Cameroon 17 577 558 13 326 433 76 Cabo Verde 4 730 065 3 448 769 73 Central African Republic 18 572 844 15 069 549 81 Chad 30 803 324 21 304 288 69 Comoros 3 414 705 2 176 013 64 Congo (the) 26 769 904 5 693 820 21 Côte d’Ivoire 12 252 284 7 286 136 59 Democratic Republic of the Congo 181 951 333 143 081 603 79 Equatorial Guinea 4 484 128 3 454 689 77 Eritrea 7 355 205 4 484 026 61 Eswatini 4 780 486 3 561 213 74 Ethiopia 53 761 403 43 172 305 80 Gabon 4 692 818 4 085 179 87 Gambia 3 751 184 2 170 860 58 Ghana 12 116 486 8 969 669 74 Guinea 16 349 029 10 726 905 66 Guinea-Bissau 5 535 346 4 182 410 76 Kenya 32 290 476 21 948 090 68 Lesotho 3 734 509 2 811 489 75 Liberia 14 428 682 11 661 850 81 Madagascar 16 366 539 14 370 110 88 Malawi 8 916 737 6 177 910 69 Mali 14 870 265 11 481 693 77 Mauritania 8 798 427 6 406 695 73 Mauritius 2 283 500 2 216 480 97 Mozambique 21 562 163 21 558 333 100 Namibia 9 235 202 4 011 953 43 Niger 24 563 396 16 650 933 68 Nigeria 274 225 293 230 135 696 84 Rwanda 8 145 971 6 429 951 79 Reunion 137 635 — — A F R I C A N R E G I O N Annexes Ι 111 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Saint Helena 27 000 — — São Tomé and Príncipe 2 538 691 1 950 664 77 Senegal 9 342 428 4 497 119 92 Seychelles 1 897 998 1 453 667 77 Sierra Leone 24 530 437 22 524 940 92 South Africa 11 132 639 9 286 472 83 South Sudan 53 479 013 41 280 367 77 Togo 5 774 562 4 302 253 75 Uganda 32 264 856 17 162 892 53 United Republic of Tanzania (the) 24 230 131 11 608 319 48 Zambia 14 482 869 11 815 824 82 Zimbabwe 18 242 013 14 258 706 78 Annex 6, continued A F R I C A N R E G I O N 112 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Antigua and Barbuda 11 033 129 090 1170 Argentina 1 366 845 1 124 521 82 Bahamas 522 520 320 000 61 Barbados — — — Belize 552 109 268 000 49 Bolivia (Plurinational State of) 4 206 424 2 148 605 51 Brazil 7 222 510 5 304 093 73 Chile 1 814 720 883 100 49 Colombia 5 469 985 3 676 606 67 Costa Rica 528 520 638 200 121 Cuba 1 680 281 1 274 856 76 Dominica 180 555 292 533 162 Dominican Republic 4 240 384 2 705 569 162 Ecuador 4 099 095 2 368 657 58 El Salvador 1 159 984 532 800 46 Guatemala 5 013 879 3 148 302 63 Guyana 1 699 937 946 642 56 Haiti 10 699 476 6 478 422 61 Honduras 3 181 013 2 149 729 68 Jamaica 1 953 417 1 162 255 59 Mexico 3 419 410 2 375 101 69 Nicaragua 1 995 827 1 080 370 54 Panama 521 229 579 600 111 Paraguay 820 959 924 635 113 Peru 3 001 846 2 349 296 78 Saint Kitts and Nevis — 112 600 — Saint Lucia 22 288 115 050 516 Saint Vincent and the Grenadines 121 622 72 900 60 Suriname 1 256 805 584 385 46 Trinidad and Tobago 819 424 811 100 99 Uruguay 169 640 276 000 163 Venezuela (Bolivarian Republic of) 5 925 824 7 340 856 124 R E G I O N O F T H E A M E R I C A S Annex 6, continued Annexes Ι 113 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Afghanistan 157 135 700 119 155 728 76 Bahrain 155 200 81 819 53 Djibouti 6 392 200 3 651 229 57 Egypt 11 798 300 8 509 450 72 Iran (Islamic Republic of) 7 988 500 3 867 272 48 Iraq 110 262 700 94 300 408 86 Jordan 10 154 800 5 713 004 56 Kuwait 172 000 60 331 35 Lebanon 21 098 700 14 236 270 67 Libya 26 599 700 19 313 886 73 Morocco 5 176 085 4 287 802 83 Oman 2 836 700 2 147 231 76 Pakistan 257 405 000 191 394 534 74 Qatar 432 800 321 881 74 Saudi Arabia 4 298 800 3 047 146 71 Somalia 62 832 300 42 188 661 67 Sudan 62 733 100 43 565 790 69 Syrian Arab Republic 105 299 661 76 488 688 73 Tunisia 4 123 500 2 706 712 66 United Arab Emirates 326 900 174 838 53 West Bank & Gaza Strip 27 218 000 22 310 493 82 Yemen 373 507 300 369 137 766 99 Annex 6, continued E A S T E R N M E D I T E R R A N E A N R E G I O N 114 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Albania 1 831 260 1 457 596 80 Armenia 3 145 420 2 320 690 74 Azerbaijan 1 207 745 887 159 73 Belarus 3 199 699 2 569 017 80 Bosnia and Herzegovina 3 416 290 2 609 555 76 Bulgaria 1 043 872 824 894 79 Croatia 968 792 675 620 70 Czech Republic 972 651 691 455 71 Estonia 784 164 434 453 55 Georgia 3 964 069 3 070 140 77 Greece 2 373 327 2 138 895 90 Hungary 1 148 856 939 293 82 Kazakhstan 3 752 448 2 591 150 69 Kyrgyzstan 9 416 911 8 125 086 86 Latvia 552 689 332 185 60 Lithuania 1 423 195 1 114 997 78 Malta 70 894 60 108 85 Montenegro 864 005 460 531 53 Poland 844 397 651 686 77 Portugal 67619 — — Pristina 3 143 169 2 357 184 75 Republic of Moldova 6 276 964 4 756 292 76 Republic of North Macedonia 1 701 757 1 326 068 78 Romania 2 519 260 1 624 509 64 Russian Federation 5 970 404 4 597 918 77 Serbia 5 901 876 4 806 787 81 Slovakia 960 705 795 682 83 Slovenia 1 046 199 606 170 58 Tajikistan 7 676 342 5 559 447 72 Turkey 83 390 473 85 718 788 103 Turkmenistan 3 890 947 2 664 082 68 Ukraine 19 590 756 13 983 726 71 Uzbekistan 6 389 891 6 602 945 103 E U R O P E A N R E G I O N Annex 6, continued Annexes Ι 115 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Bangladesh 49 640 875 43 834 788 88 Bhutan 4 861 688 4 016 623 83 Democratic People’s Republic of Korea 17 377 145 15 462 803 89 India 93 858 328 81 296 126 87 Indonesia 28 943 767 25 001 023 86 Maldives 4 553 397 4 179 797 92 Myanmar 30 521 648 23 331 055 76 Nepal 19 131 618 13 459 360 70 Sri Lanka 7 662 773 6 776 800 88 Thailand 12 136 200 9 861 971 81 Timor-Leste 10 900 823 9 625 720 88 Annex 6, continued S O U T H - E A S T A S I A R E G I O N 116 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) American Samoa 69 000 69 000 100 Brunei Darussalam 36 000 36 000 100 Cambodia 18 823 279 13 752 325 73 China 20 350 734 15 822 108 78 Commonwealth of the Northern Mariana Islands 37 000 37 000 100 Cook Islands 363 660 413 994 114 Fiji 4 714 772 4 232 239 90 French Polynesia 53 628 36 000 67 Guam 36 000 36 000 100 Kiribati 1261 550 965 027 76 Lao People’s Democratic Republic (the) 17 868 331 14 625 881 82 Malaysia 1 964 802 1 935 218 98 Marshall Islands 348 925 282 951 81 Micronesia (Federated States of) 2 026 031 1 949 584 96 Mongolia 6 385 632 5 224 683 82 Nauru 126 000 101 000 80 Niue 94 000 94 080 100 Pacific Island Countries 19 260 182 17 580 263 91 Palau 181 000 124 000 69 Papua New Guinea 35 398 591 34 000 257 96 Philippines 14 608 471 12 730 708 87 Samoa 3 385 657 3 321 791 98 Singapore 37 000 37 000 100 Solomon Islands 11 685 543 12 021 731 103 Tokelau 92 941 95 973 103 Tonga 1 000 414 1 167 082 117 Tuvalu 125 976 107 360 85 Vanuatu 4 470 244 4 279 321 96 Viet Nam 22 382 432 17 256 130 77 W E S T E R N PA C I F I C R E G I O N Annex 6, continued Annexes Ι 117 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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Contact World Health Organization Department of Country Cooperation and Collaboration with the United Nations System Avenue Appia 20 1211 Geneva 27 Switzerland Tel: +41 22 791 21 11 Fax: +41 22 791 31 11 http://www.who.int 2019 Report WHO presence in countries, territories and areas W H O P R E S E N C E IN C O U N T R IE S , T E R R IT O R IE S A N D A R E A S Ι 2019 R E P O R T

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Photos and figures: WHO Design and layout: L’IV Com Sàrl, Switzerland Printed in France Contents FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Methodology for data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Limitations of the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1. WHO WE ARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.1 World Health Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.1.1 Governance and Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.1.2 Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1.3 WHO country offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1.4 WHO country offices covering more than one country, territory or area . . . . . . . . . . . . . . . . . . . . . 10 1.1.5 Countries and areas covered by WHO regional offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.1.6 Suboffices in countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.2 People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.1 WHO country office leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.2 Status of acting HWOs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.3 Gender distribution of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.2.4 Region of origin of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.2.5 Age and retirement of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.2.6 HWOs’ length of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.2.7 WHO workforce in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2.8 WHO country-level staffing situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2.9 Gender distribution of WHO staff at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.2.10 Diversity of WHO staff capacity at the country office level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.3 Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.3.1 Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.3.2 Corporate communication capacity at country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 1.3.3 Information sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1.3.4 Access to breastfeeding facilities in WHO country offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. WHAT WE DO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.1 Contributing to national health policies, strategies and plans to roll out UHC, ensure healthy lives and respond to health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.2 Country Cooperation Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.3 Joint WHO and government monitoring mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.4 Supporting implementation of the Sustainable Development Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 2.5 WHO support in health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6 Supporting health sector coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3. HOW WE DO IT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 3.1 Technical backstopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3.2 Funding WHO’s work at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.1 Availability of financial resources at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.2 Distribution of base funds by programmatic priorities and operations . . . . . . . . . . . . . . . . . . . . . . . 49 3.2.3 Sources of funding for WHO country-level work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 3.2.4 Distribution and spending of planned funds at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 3.2.5 Mobilization of funds for Human Resource support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 iii 4. WHO WE WORK WITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.1 Collaboration with the United Nations system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.1.1 Supporting the United Nations Resident Coordinators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.2 Engaging within the United Nations Country Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.2.1 WHO participation in Joint National/United Nations Steering Committees . . . . . . . . . . . . . . . . . . . . 59 4.2.2 United Nations Development Assistance Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.2.3 WHO participation in the thematic groups of United Nations country teams . . . . . . . . . . . . . . . . . . 61 4.2.4 WHO participation in United Nations common business operations and activities . . . . . . . . . . . . . . 62 4.2.5 WHO participation in joint activities of the United Nations resident coordinator office . . . . . . . . . . . . 63 4.3 UN Multi-Partner Trust Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.4 WHO country-level engagement with global health initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4.1 WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4.2 WHO and Gavi, the Vaccine Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 4.4.3 South-South and triangular cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5. OUR WORK AND ITS RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Expanding universal health coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Addressing health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Promoting better health and well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 ANNEXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annex 1: List of WHO Member States and Associate Member States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annex 2: WHO offices and suboffices in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Annex 3: Number and categories of staff members working in WHO offices in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Annex 4: Global Fund grants of which WHO is a subrecipient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Annex 5: Countries eligible for Gavi new vaccines support in 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Annex 6: Planned costs and available funds for WHO work in countries, territories and areas . . . . . . . . . . . . 111 iv Ι WHO presence in countries, territories and areas Foreword T he ultimate measure of WHO’s success is not the number of reports we publish or the meetings we hold, but the difference we make to the health of the world’s people. That’s why delivering impact in countries is the essence of both WHO’s 13th General Programme of Work (GPW13) and the Sustainable Development Goals (SDGs). The “triple billion” targets of GPW13 are designed to make us focus on delivering results for the people we serve, and value for money for our donors. To support those efforts, WHO is now embarking on a comprehensive transformation, to make sure we empower and enable the entire organization – and especially our country offices – to make a measurable difference at country level. It’s impossible to adequately summarise the extraordinary work that WHO does all over the world every day, but the 2019 country presence report is an excellent snapshot of the Organization’s work in 149 countries, territories and areas across six regions. This year’s report attempts for the first time to provide additional information on the role of WHO country offices in supporting governments and partners to achieve the SDGs and provide support for South-South and triangular cooperation initiatives. It also features several country stories highlighting achievements relating to each of the “triple billion” targets. While we have achieved significant results, we cannot be content. The world remains dangerously off-course for the SDGs, and we have a lot of work to do to support countries to get on track and stay on track. One of the principles of both the SDGs and GPW13 is that they are for all countries, rich and poor. No health system is perfect, and WHO has something to offer every country. Our new policy dialogue process is designed to give us a robust mechanism, based on solid data and projections, for identifying weaknesses in health systems and recommending policy solutions. We are also improving the way we develop “global goods” including norms and standards, to ensure we develop the highest-quality products that address the needs of countries. WHO’s new aligned structure will help to ensure we work more seamlessly across all three levels of the organization to deliver results. But delivering results in countries is not a job for WHO alone. Partnership is key. The Global Action Plan for Healthy Lives and Well-Being for All, which was launched last year and will be presented at the United Nations General Assembly in September 2019, is a vital platform for ensuring enhanced collaboration in the global health community. WHO is pleased to be leading the development of this ground-breaking instrument, in which 12 global health and development agencies have committed to align their operating practices, identify ways to accelerate progress, and develop shared milestones to keep ourselves accountable. The challenge now is to turn good intentions, bold promises and ambitious documents into concrete changes that make a difference. I am optimistic that future editions of this report will highlight even greater results in pursuit of our mission to promote health, keep the world safe and serve the vulnerable. Dr Tedros Adhanom Ghebreyesus Director-General World Health Organization Foreword Ι v Executive summary WHO as an intergovernmental organization has a governance system that comprises the World Health Assembly, the Executive Board and Regional Committees. The WHO Secretariat is headed by the Director-General and comprises country and regional offices, headquarters and associated offices. The six regional offices are headed by regional directors. WHO has one of the largest field presences within the UN system. Working with 194 Member States across six regions and from 149 offices in countries, territories and areas, WHO through its large network of staff, provides support to countries through policy dialogue, technical assistance in strategic areas as well as operational support, depending on the country context. WHO has placed countries squarely at the centre of its work. Through its transformation programme, WHO is stepping up efforts to continue strengthening its country office leadership, ensure a fit-for-purpose staffing structure, and provide optimal tools and processes for enhanced effectiveness and efficiency. In addition, other levels of the Organization have been supporting country offices to strengthen their capacity to achieve greater impact in each country. WHO’s engagement with Member States and partners ensures that a robust technical platform is in place and that the Organization acts as an impartial convenor and coordinator of health in support of national authorities. To highlight WHO’s work in countries as envisioned by the Director-General, the 2019 country presence report provides information on: who we are as WHO, what the Organization does, with whom it works and with what resources. Compared to the 2017 country presence report, this year’s report provides additional information on: the role of the WHO country office in supporting governments and partners in implementing the SDGs; support for South-South and/or triangular cooperation initiatives; WHO`s collaboration with the United Nations system; and selected country stories categorized by the strategic priorities of GPW 13 from countries where WHO teams are contributing in making a difference in systems and in the lives of people. The information contained in this report was obtained through an online country presence survey administered to all 149 Heads of WHO offices (HWOs) in 2018, the WHO Global Management System and other internal and external information systems and sources. As of January 2019, WHO opened a new country office in Greece and eight subnational offices in different countries to strengthen its field presence. The Organization is represented across the six regions by 123 Heads of WHO offices in countries, territories and areas and by 26 acting HWOs, indicating the continuing need to improve succession planning. Gender and geographic diversity is increasing among WHO leadership. In 2017, the Director-General announced a new management team at HQ with 60% women leaders. At country level, a similar growing trend is being observed as the proportion of women HWOs has increased to 39% from the 33% The 2030 Agenda for Sustainable Development views health as vital for the future of our world. With a commitment to achieving Goal 3, which calls on all stakeholders to “ensure healthy lives and promote well-being for all at all ages”, the World Health Organization (WHO), as a specialized agency of the UN system, leads and coordinates global health, and supports countries in reaching all health-related SDG targets. vi Ι WHO presence in countries, territories and areas reported in the 2017 country presence report. In five of the six regions there has been an increase in the proportion of HWOs serving outside their region of origin. The proportion of HWOs serving outside their region of nationality has increased from 18% in 2010 to 28% in 2019 – which falls just short of the 30% target. Over 60% of HWOs in WHO are aged 56 years and above. From 2019 until 2025 an average of nine HWOs are expected to retire each year. With the increasing focus on country impact, the WHO workforce is also increasing, including professional and support staff as well as others recruited on non-staff contracts. As of 31 December 2018, WHO had a total of 3956 staff members working at country level across the six regions. This figure represents a 9% increase on that of the 2015 country presence report. Of the country level workforce, 20% are professional and higher graded staff (1% higher compared to the 2017 report), 30% are national professional officers (a 2% increase compared to the 2017 Report) and 50% are general service staff members (3% less than in the 2017 report), continuing a trend towards a higher proportion of professional staff. Sixty-nine per cent of WHO office premises across the world are made available to the Organization at no cost to it. There are 28 country offices in common UN premises (19%), with 10% of country offices being independently owned or rented by WHO. WHO corporate communication capacity is gradually being enhanced with the proportion of full-time communication staff increasing from 41% to 44% between the 2010 country presence report and the 2019 report. WHO is also increasingly using digital media to extend its outreach to stakeholders as 89% of WHO country offices reported having a country-specific website and 49% reported using the social media platform, Facebook. WHO delivers its technical cooperation based on biennial workplans developed through country cooperation strategies and biennial collaborative agreements (European Region only) – country support plans have been developed for the Programme budget 2020–2021. Currently, there are 83 valid country cooperation strategies and 26 valid biennial collaborative agreements in place, while a further 24 countries, territories and areas are in the process of developing or updating one, in line with the GPW 13 strategic priorities. Joint WHO and government mechanisms are used to enhance implementation, monitoring and reporting on WHO technical cooperation, and are reported to be present by 89% of WHO country offices, an increase from 83% in the 2017 country presence report. WHO country offices are supporting governments and partners in implementing the Sustainable Development Goals by contributing to national SDG coordination platforms, advocacy, resource mobilization, coordinating the setting of national targets and monitoring and evaluation. A high proportion of WHO country offices reported being engaged in providing technical support for the mainstreaming of SDGs into national plans, policies and programmes (89%). Such support is in line with WHO’s engagement strategy to promote health in the 2030 Agenda for Sustainable Development. During the reporting period, WHO was able to successfully respond to public health and humanitarian emergencies and support countries in enhancing their national capacity for preparedness, which is key to mounting effective responses. In 2017–2018, a total of 901 new health emergency events occurring in 162 countries, territories and areas were reported to WHO. All WHO country offices reported having provided at least one form of support to national authorities and partner organizations for emergency preparedness, prevention, detection and response during this period. Following events that occurred over this period such as Hurricane Irma in the Caribbean and Cyclone Donna in the Pacific as well as the Ebola outbreak in the DRC, WHO country offices in the Bahamas, Cuba, Vanuatu, Nigeria and the DRC among others, reported providing multifaceted support for the emergency response and preventing disease outbreaks. Since 2010, all 196 States Parties to the international Health Regulations (IHR 2005) have reported at Executive summary Ι vii least once to the Secretariat using the State Party Annual Reporting (SPAR) questionnaire. Globally, progress has been reported across the 13 core capacities, particularly in respect of surveillance, laboratory and IHR coordination, but the overall average scores suggest that further and sustained efforts are urgently needed in the areas of chemical events, capacities at points of entry and radiation emergencies. Throughout 2016-2018, joint external evaluations of IHR (2005) core capacities were completed in a total of 91 Countries (AFRO–39; AMRO/PAHO–4; EMRO–16; EURO–13; SEARO–8; WPRO–11). To augment WHO country office capacity for effective and responsive technical cooperation, WHO regional offices and HQ have been increasingly providing technical backstopping to its country offices to better support Member States towards the implementation of their national health policies, strategies and plans. With the focus on putting countries at the centre of WHO’s work, the demand for technical support is also growing. A total of 5870 missions were reported between January 2017 and 31 July 2018 to support WHO country offices in all six regions. A total of 68% of these missions were initiated by WHO country offices, which indicates an increasing trend of demand-driven backstopping. Between the 2015 and 2019 country presence reports, a 17% increase was observed in backstopping missions initiated by country offices. Communicable diseases and health systems/universal health coverage were the most frequently mentioned focus areas of such backstopping missions, covering 54% of all missions. In accordance with the vision of the Director General as expressed in GPW 13 regarding the transfer of more resources to countries, resources allocated to countries are also gradually increasing. A total of US$ 2.48 billion was made available for WHO country-level work under the WHO programme budget, representing 79% of the total planned costs for the 2018-2019 biennium, which indicated some gaps between the planned budget and actual funds made available to countries. However, almost 60% of these funds were allocated for polio, outbreak and crisis response and special programmes, leaving 42% (US$ 1.036 billion) for technical cooperation executed through base programmes. As of 31 December 2018, fifty-five per cent of the funds distributed for the 2018–2019 biennium had been spent at country level; it should be noted that this date marks the midpoint of the biennium. The Government of the United States of America, the European Union, Gavi, the Vaccine Alliance, the Government of the United Kingdom (DFID) and the Government of Japan are among the key donors of WHO at country level. As part of the UN Country Team, WHO has been proactively engaged in the UN reform at country level to enhance the effectiveness of UN presence in countries in support of their efforts to achieve the SDGs. With the global plan of action on SDG 3, WHO will be more involved in coordinating health, especially among UN agencies at country level. WHO’s engagement as part of UNCT within the UN Resident Coordinator system includes: participating in initiatives such as joint national/United Nations steering committees; joint thematic/ results groups; the Business Innovations group; development, implementation and evaluation of the United Nations Development Assistance Framework (UNDAF) within the purview of the SDGs. One hundred and twenty-eight (128) WHO country offices reported having participated in the development of UNDAF in their country of assignment. Most of the priorities of the country cooperation strategies are reflected in the UNDAF, which echoes the synergies between these two strategic frameworks and the work of WHO and the UN. However, 24% of WHO offices in the field reported that the UNDAF of their respective countries reflected all the priorities identified in the CCS. Compared to the 2017 country presence report, an increase of 11% percentage points was observed (70% in the 2017 and 81% in 2019) in the WHO offices in the field reporting participating in at least one of the United Nations common business operations and services. WHO country offices are increasingly involved in the health thematic/results group, with an viii Ι WHO presence in countries, territories and areas increase of 11 percentage points compared to the 2017 report, of WHO office staff who chair or co-chair this group, indicating an increasing level of cooperation. Integration and cooperation in the field have become of paramount importance in the SDGs era and WHO continues to lead or co-lead donor coordination mechanisms with governments. WHO country offices reported increasingly playing a leadership role in 70% of the countries, territories and areas in such mechanisms. These coordination platforms provide a hub for dialogue among multilateral, bilateral and nongovernmental agencies. United Nations Multi- Partner Trust Funds, such as One Fund/MDTF and the Sustainable Development Goals Fund are partnerships whereby the United Nations system, national authorities and funding partners establish a joint fund that uses the “pass-through fund management model”. WHO country offices in 24 countries, territories and areas receive financial support from such funds. In 2018, WHO and the Global Fund signed a new strategic framework for collaboration to strengthen the coordination and effectiveness of joint support to countries. WHO country offices in all 113 countries, territories and areas which are eligible for Global Fund grants have been active in at least one significant aspect relating to the grant process. Fifty-two (52) country offices reported acting as subrecipients of Global Fund grants to strengthen national programmes and systems to address HIV, TB, Malaria and relevant areas of work. The level of involvement in providing technical support and capacity building for accessing, implementing and reporting Global Fund grants has generally risen among WHO country offices, particularly the number of countries which are active members of the country coordination mechanism. WHO and Gavi, the Vaccine Alliance, are partners in improving access to new and underused vaccines for children. Between the 2017 and 2019 country presence reports, the number of WHO country offices reporting contributing to accessing and implementing Gavi grants has remained stable at 73 (49%). Engagement in certain elements of the funding process has generally remained the same. However, an almost 50% increase in WHO country offices channelling funding for cash grants was observed. The 2030 Agenda reaffirms the need to enhance South-South and triangular cooperation (SSTC) as well as regional and international cooperation on access to science, technology and innovation for the achievement of the Sustainable Development Goals. Globally, half of the WHO offices in countries, territories and areas in the six regions reported supporting a total of 241 South- South and/or triangular cooperation initiatives. GPW 13 focuses on driving impact in countries – while its implementation started in January 2019, an effort was made to collect country experiences, stories and achievements to highlight WHO’s contribution in terms of protecting and promoting health and serving the vulnerable. Over 200 stories of achievements and progress made by WHO country offices and interagency collaboration with other UN agencies were shared by these offices as part of the data collection exercise for the 2019 country presence report. Among the WHO country success stories collected in 2018, over a third referred to contributions made to the expansion of universal health coverage and the strengthening of health systems at country level, demonstrating the level of the work being carried out, which is key to meeting the triple billion goal of having 1 billion more people benefitting from universal health coverage, 1 billion more people protected from health emergencies and 1 billion more people enjoying better health and well-being under GPW 13. Over 60% of stories of interagency collaboration and partnership were related to promotion of health through the life-course. This reflects the fact that efforts outside the health sector are required to ensure effective implementation of the third billion, which is to improve the health of populations to achieve the goal of 1 billion more people enjoying better health and well-being. Executive summary Ι ix

Introduction Introduction Overview The country presence report is a biennial document produced by the Department of Country Cooperation and Collaboration with the United Nations System. The Report is a joint effort of the Country Support Unit Network – a network of focal points based in all six regional offices – heads of WHO offices in countries, territories and areas (HWOs) and relevant departments at WHO Headquarters. The 2019 country presence report aims to capture a wide range of relevant information to give a snapshot of the work of WHO in the field. It provides information on: 1 Who we are: WHO, people and places – infrastructure, leadership, capabilities and resources at the country level; 2 What we do: WHO at country level through the country cooperation strategy, implementation of the Sustainable Development Goals, and preparation for and response to health emergencies among other areas; 3 How we do it: technical back- stopping provided by the regional, subregional and headquarters levels and financial details including budgeting, funding and expenditure by the country offices; 4 Who we work with: collaboration with United Nations and non-United Nations partner organizations, c o u n t r y - l e v e l c o o r d i n a t i o n , contribution to implementation of global health initiatives and promotion of South-South and triangular cooperation; and 5 Work and results achieved by the WHO country offices: in relation to strategic priorities such as expanding universal health coverage, addressing health emergencies and promoting better health and well-being. In addition to the information provided in the 2017 report, it highlights country presence and performance information through the lens of the Thirteenth General Programme of Work (GPW 13), keeping in mind that 2019 is a year of transition for its implementation. It analyses more in-depth information on WHO country office human resource capacity, WHO’s contribution to the Sustainable Development Goals and WHO’s engagement in South-South and triangular cooperation. Methodology for data collection The information contained in this report was obtained through: • an online presence survey administered to all 149 HWOs in 2018; • WHO’s Global Management System (information on human resources and finance) and the database of the Department of Country Cooperation and United Nations Collaboration on the HWOs; • information obtained from the relevant departments, e.g. WHE and HTM Cluster. The data was collected through a cross- sectional quantitative and qualitative global survey administered to all WHO offices in countries, territories and areas. The survey was also translated into French and Spanish, enabling HWOs to provide the information in their preferred language. The survey was administered to all 149 HWOs in the six regions, with a 100% response rate. 2 Ι WHO presence in countries, territories and areas Limitations of the report The data and draft of this report were shared with the regions and different WHO departments at headquarters for review and validation. While due diligence has been undertaken to ensure the quality and consistency of data, the data collection, analysis and writing process had a few limitations. The respective HWOs self-reported the survey responses with no alternative mechanism to verify the accuracy of reported data. In certain instances, this may have led to minor discrepancies in data analysis or interpretation which could not be fully explained. It is also pertinent to mention that, though the survey instrument was administered with a set of detailed instructions and a glossary of terms, there is a possibility that the survey questions may not have been interpreted consistently or uniformly. To overcome these challenges, regular contacts were maintained with all six regional offices through the Country Support Unit Network, which made it possible to clarify any questions during the submission of the online survey. In instances where no responses were provided to some questions, direct contacts were made, where necessary, with the relevant WHO country offices. Introduction Ι 3

Who we are 1. “Health is a human right. No one should get sick or die just because they are poor, or because they cannot access the services they need.” dr tedros a. ghebreyesus who director-general 1. Who we are 1.1 World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations and acts as the directing and coordinating authority on international health. It was established in 1948 and is headquartered in Geneva, Switzerland. WHO’s Constitution1 entered into force on 7 April 1948 – a date now celebrated around the globe every year as World Health Day. 1 The Constitution of the World Health Organization entered into force on 7 April 1948. Available at http://apps.who.int/gb/bd/PDF/bd48/ basic-documents-48th-edition-en.pdf#page=7 (accessed 7 February 2019). Figure 1. Thirteen General Programme of Work framework 6 Ι WHO presence in countries, territories and areas WHO fulfils its role in public health through a set of six core functions which are grounded in the WHO Constitution and were first articulated in the Eleventh General Programme of Work. They remain relevant today and are reiterated in the Thirteenth General Programme of Work, 2019–2023 (GPW 13). They are: 1 providing leadership on matters critical to health and engaging in partnerships in which joint action is needed; 2 shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3 setting norms and standards and promoting and monitoring their implementation; 4 articulating ethical and evidence-informed policy options; 5 providing technical support, catalysing change and building sustainable institutional capacity; and 6 monitoring the health situation and assessing health trends. GPW 13 sets out WHO’s vision and strategic direction for 2019–2023, outlining how the Organization will proceed with its implementation and providing a framework to measure progress in this effort. GPW 13 is structured around three interconnected strategic priorities to ensure healthy lives and well-being for all at all ages: achieving universal health coverage, addressing health emergencies and promoting healthier populations. These strategic priorities are supported by three strategic shifts which are further supported by five organizational shifts as presented in Figure 1. 1.1.1 Governance and Structure The WHO Secretariat, headed by the Director- General, mainly comprises 149 offices in countries, territories and areas, as well as six regional offices and headquarters (see Fig. 2). It is governed by its 194 Member States and two Associate Member States (Puerto Rico and Tokelau). Annex 1 lists WHO Member States and Associate Member States. The World Health Assembly is WHO’s supreme decision-making body. Its main function is to determine the policies of the Organization. The World Health Assembly appoints the Director- General, supervises the financial policies of the Organization and reviews and approves the proposed programme budget. It similarly considers reports of the Executive Board,2 which it instructs on matters that may require further action, study, investigation or reporting. The Executive Board implements the decisions and policies of the World Health Assembly, advises it and generally facilitates its work. WHO’s Regional Committees meet each year to set policies and approve budgets and programmes of work for each of the six WHO regions. Each session addresses the specific public health needs and challenges of the area represented by the region. 2 The Executive Board comprises of 34 health experts at any time who are nominated by Member States. 1. Who we are Ι 7 3 There are also several subregional and geographically dispersed offices. Figure 2. The three levels of organization in WHO3 WHO Headquarters HQ outpost offices Global Service Centre in Kuala Lumpur, Malaysia, houses the administrative services of the Secretariat WHO office at the United Nations, in New York, represents the interests of WHO at the UN These are located in Addis Ababa, Ethiopia; Bangkok, Thailand; and Brussels, Belgium and managed, respectively, by the WHO Regional Office for Africa, WHO Regional Office for South-East Asia and WHO WHO Regional Offices 149 WHO offices in countries, territories and areas Outpost offices managed by regional offices 2 field offices in territories and areas 147 WHO country offices WHO country offices covering more than one country, territory or area WHO Centre for Health Development in Kobe, Japan, conducts research on the consequences of social, economic and environmental change and their implications for health policies Regional Office for the Europe. Some sub-regional offices related to WHO Region Office for the Eastern Mediterranean are located in Amman, Jordan. Further sub-regional offices in the African Region are located in Harare, Libreville and Ouagadougou. Geneva, Switzerland WHO suboffices in countries Figure 3. Map of WHO’s presence in countries, territories and areas WHO headquarters WHO HQ outpost office WHO regional office (*) includes 1 WHO field office in a territory or area Country, territory or area with a WHO office WHO headquarters WHO HQ outpost office WHO regional office Country, territory or area with a WHO office 8 Ι WHO presence in countries, territories and areas 1.1.2 Regional Offices WHO Member States are grouped into six regions, each having a regional office. 1.1.3 WHO country offices WHO as a specialized agency of the United Nations (UN) system, leads and coordinates global health and supports countries in reaching all health-related SDG targets under the 2030 Agenda for Sustainable Development. With its 149 offices in countries, territories and areas, WHO has one of the largest global footprints. To effectively support Member States, WHO has developed one of the largest in- country networks of offices compared to other UN Agencies. These offices, equipped with infrastructure and human and financial resources, are the foundation of WHO’s support to its Member States; providing a platform for effective cooperation to advance the global health agenda and contribute to national health policies, strategies and plans. Table 1. WHO regional offices, location and Member States covered Region Regional office Location Number of Member States covered African Region Regional Office for Africa Brazzaville, Congo 47 Region of the Americas Regional Office for the Americas Washington DC, USA 35 Eastern Mediterranean Region Regional Office for the Eastern Mediterranean Cairo, Egypt 21 European Region Regional Office for Europe Copenhagen, Denmark 53 South-East Asia Region Regional Office for South-East Asia New Delhi, India 11 Western Pacific Region Regional Office for the Western Pacific Manila, Philippines 27 Total 194 WHO’s newest country office opens in 2018 in Athens, Greece In June 2018, WHO and the Greek Ministry of Health inaugurated the new WHO Country Office in Athens. WHO Director-General, Dr Tedros Adhanom Ghebreyesus, and the WHO Regional Director for Europe, Dr Zsuzsanna Jakab joined the Minister of Health for Greece, Dr Andreas Xanthos for the official opening. Considering past achievements, the new office represents a deepening of bilateral cooperation between WHO and Greece. 1. Who we are Ι 9 1.1.4 WHO country offices covering more than one country, territory or area Some WHO country offices provide support for WHO’s activities in locations outside the boundaries of the countries in which they are located. The following table shows the WHO offices that provide support to more than one country, territory or area. 4 The Director of the Division of Pacific Technical Support/WHO Representative in the South Pacific coordinates WHO’s intercountry programmes in the Pacific with WHO representatives based in Samoa and Solomon Islands and with the WHO country liaison officers in Kiribati, Northern Micronesia, Tonga and Vanuatu. Table 2. WHO country offices covering more than one country, territory or area Region WHO office Additional countries, territories and areas covered African Region Madagascar (based in Antananarivo) Réunion Island (French Overseas Department) Region of the Americas Bahamas (based in Nassau, New Providence) Turks and Caicos Islands PAHO/WHO Office of the Eastern Caribbean Coordination (based in Bridgetown, Barbados) Antigua and Barbuda, Anguilla, British Virgin Islands, Dominica, Montserrat, Grenada, Saint Lucia, Saint Vincent and the Grenadines, Saint Kitts and Nevis and the French departments in the Caribbean (Guadeloupe, Martinique, French Guiana and French Saint Martin) Jamaica (Kingston, Jamaica) Bermuda and Cayman Islands Trinidad and Tobago Aruba, Curaçao and Sint Maarten and the special municipalities of the Kingdom of the Netherlands in the Caribbean (Bonaire, Saba and St Eustatius) Western Pacific Region Malaysia, Brunei Darussalam and Singapore (based in Kuala Lumpur) Brunei Darussalam, Malaysia and Singapore American Samoa, Cook Islands, Niue and Tokelau (based in Apia) Samoa, American Samoa (United States of America), Cook Islands, Niue and Tokelau (New Zealand) Division of Pacific Technical Support/ WHO Representative Office in the South Pacific (Suva, Fiji)4 Fiji, French Polynesia (France), Commonwealth of the Northern Mariana Islands (United States of America), New Caledonia (France), New Zealand, Nauru, Palau, Solomon Islands, Tuvalu, Wallis and Futuna (France) and Pitcairn Islands (United Kingdom) The Director of the Division of Pacific Technical Support/WHO Representative in the South Pacific coordinates WHO's intercountry programmes in the Pacific with WHO representatives based in Samoa and Solomon Islands and the WHO country liaison officers in Kiribati, Northern Micronesia, Tonga and Vanuatu Northern Micronesia (Country Liaison Office based in Palikir, Pohnpei, Federated States of Micronesia) Federated States of Micronesia, Marshall Islands and Palau In the Eastern Mediterranean Region, on account of ongoing emergencies in several Member States, WHO offices in some countries provide logistic and operational support to neighbouring or nearby countries. For example, the WHO Country Office in Afghanistan has a liaison office in Pakistan (Islamabad); the WHO Country Office in Somalia has one liaison office in Kenya (Nairobi); and the WHO Country Office in Yemen has a liaison office in Djibouti (Djibouti) and another in Jordan (Amman). 10 Ι WHO presence in countries, territories and areas 1.1.5 Countries and areas covered by WHO regional offices WHO does not have a physical presence in all 196 of its Member and Associate Member States and areas. In 36 of these, WHO provides technical and normative support from its respective regional offices and headquarters. Table 3. WHO Member and Associate Member States and areas without WHO offices Region Member States, Associate Member States and areas Region of the Americas Canada, United States of America and Puerto Rico (Associate Member State) Eastern Mediterranean Region Bahrain, Kuwait, Qatar and United Arab Emirates European Region Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland and United Kingdom Western Pacific Region Australia, Guam (United States of America), Hong Kong Special Administrative Region (China), Japan, Macao Special Administrative Region (China) and Republic of Korea 1.1.6 Suboffices in countries In some countries, suboffices are established as subsidiaries of a country office to provide support for implementing field activities to a programme or to facilitate effective coverage of WHO activities in geographically large countries as well as in countries facing complex emergencies or countries affected by polio outbreaks. A suboffice is normally located at the subnational level and led by a senior staff member who reports to the Head of WHO Office (HWO). HWOs usually delegate authority to these officers to effectively execute their responsibilities in accordance with the WHO mandate and under the rules and regulations of the Organization. WHO has a total of 147 suboffices, distributed throughout 32 countries. That number includes 81 suboffices in the African Region, 10 in the Region of the Americas, 39 in the Eastern Mediterranean Region, six in the European Region, nine in the South-East Asia Region and two in the Western Pacific Region. Since the 2017 country presence report, nine suboffices have been opened and one closed. Four new suboffices have been opened in the African 1. Who we are Ι 11 Table 4. Number and location of WHO suboffices in countries by WHO region Region Country, territory or area Number of subofffices Location of suboffices African Region Nigeria 37 In each of the 37 States, including the Federal Capital Territory in Abuja Democratic Republic of the Congo 11 Kinshasa, Matadi, Bandundu ville, Kananga, Mbuji Mayi, Lubumbashi, Bukavu, Goma, Kindu, Kinsagani and Mbandaka South Sudan 10 In all the capitals of the 10 States that constitute the country Chad 6 Abeche, Sarh, Moundou, Mongo, Mao and Ndjamena United Republic of Tanzania 5 Zanzibar, Tanga, Dodoma, Mwanza and Iringa Kenya 4 Garissa (serving the North Eastern Province), Embu, Eldoret, Nakuru Central African Republic 3 Bambari, Kagabandoro and Bouar Guinea 2 Nzérékoré and Guéckédou Ethiopia 1 Somali Region Ghana 1 Tamale Uganda 1 Moroto Region of the Americas Barbados 7 Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia, Saint Vincent and the Grenadines, and Anguilla Guatemala 1 San Marcos Mexico 1 Tuxtla Gutiérrez Chiapas Paraguay 1 Boqueron, Filadelfia in El Chaco Paraguayo Eastern Mediterranean Region Afghanistan 8 Jalalabad, Gardez, Herat, Kandahar, Bamyan, Kunduz, Balkh and Badakhshan Sudan 6 El-Fasher, Nyala, Geneina, Kassala, Kadugli and Damazine Iraq 5 Erbil, Dohuk, Sulaimaniyah, Basrah and Baghdad (within the Ministry of Health) Pakistan 4 Lahore, Karachi, Peshawar and Quetta Somalia 4 Nairobi (Liaison Office), Hargeisa (serving Somaliland), Garowe (serving Puntland), and Baidoa (serving southwestern state) Syrian Arab Republic 4 Qamishly, Aleppo, Homs and Latakia Yemen 4 Aden, Al Hodeida, Ibb (serving Ibb and Taiz) and Sadaa Libya 2 Benghazi , Sabah West Bank & Gaza Strip 2 Ramallah, Gaza European Region Ukraine 4 Donetsk, Kramatorsk, Luhansk and Severodonetsk Bosnia and Herzegovina 1 Banja Luka Turkey 1 Gaziantep South-East Asia Region India 7 In all seven regional hubs in the country Indonesia 2 Jakarta Western Pacific Region Philippines 1 Davao City Viet Nam 1 Ho Chi Minh City Region (three in Kenya and one in Ethiopia), one in the Region of the Americas (Paraguay), three in the Eastern Mediterranean Region (two in Libya and one in Somalia) and one in the European Region (Ukraine). In Uganda, one of the two suboffices was closed (Table 4 shows the distribution of these suboffices by WHO region). 12 Ι WHO presence in countries, territories and areas 1.2 People 1.2.1 WHO country office leadership A WHO office in a country, territory or area is usually headed by a Head of WHO Office (HWO). The designations included in this report under the term HWO include: WHO representative (WR); PAHO/WHO representative (PWR); liaison officer, and country liaison officer. While different regions use different titles in some cases, the roles and functions of the position have been standardized across the Organization. Profile of an HWO As the designated representative of the Director-General and under the guidance of the Regional Director, the HWO is the most senior WHO staff member at the country level. She/ he is responsible for leading, managing, implementing and coordinating WHO’s strategic and operational functions in the country of assignment towards the realization of health outcomes in line with national priorities, regional and global commitments, the WHO General Programme of Work and the SDGs. The HWO serves as a credible, trusted, neutral broker, an effective, influential and accountable leader in health at the country level, working across different sectors and at all levels of government, as well as with the UNCT, other partners, non-State actors, civil society and communities. Supported by all levels of the Secretariat, the HWO delivers excellence in her/his various policy, technical, political, diplomatic, managerial and advocacy roles. 5 The desk officers for Bahrain, Kuwait, Qatar and the United Arab Emirates are not considered HWOs. 6 Country Liaison Officers are internationally recruited staff members. An HWO represents the Director-General and the respective Regional Director in the country of assignment and is the responsible officer for all aspects of the collaborative activities of WHO. The generic roles and functions of an HWO (detailed terms of reference that have been revised to reflect the SDGs, GPW 13 and UN reform are available on request) include: • convening, representation, partnership and advocacy; • technical cooperation, policy advice and dialogue; and • administration and management. As of January 2019, WHO was represented across the six regions by 123 appointed and 26 acting HWOs, as represented in Table 5. 1.2.2 Status of acting HWOs Across all regions, between 2015 and 2019 the number of acting HWOs increased from 18 to 26, highlighting the need for timely recruitment of HWOs and better succession planning to ensure uninterrupted presence of a full time HWO in each country office. As shown below, the greatest increase in acting HWOs was observed in the African Region. Table 5. HWOs in countries, territories and areas by WHO region (excluding acting HWOs) Region WHO Representative PAHO/WHO Representative WHO Representative or Head of Country Office Other Comments Total African Region 31 31 Region of the Americas 24 24 Eastern Mediterranean Region5 14 1 “Other” refers to the head of the WHO Office in the West Bank and Gaza Strip 15 European Region 13 16 29 South-East Asia Region 11 11 Western Pacific Region 11 2 “Other” refers to the Country Liaison Officers in Northern Micronesia and Vanuatu6 13 Total 80 24 16 3 123 1. Who we are Ι 13 1.2.3 Gender distribution of HWOs WHO is committed to advancing gender equality in its workforce. However, progress AFR AMR EMR EUR SEAR WPR Figure 4. Number of acting HWOs by WHO region 2015–2019 0 2 4 6 8 10 12 14 16 2015 2017 2019 8 7 16 2 1 3 4 4 3 1 4 2 1 1 0 2 2 2 towards this aim has been slow, and the proportion of women appointed as HWOs has remained below 40% from 2010 to 2019. Figure 5. Proportion of women HWOs, 2010–2019 (excluding acting HWOs) (%) 30 32 34 36 38 40 2010 2012 2015 2017 2019 31 39 34 3333 14 Ι WHO presence in countries, territories and areas The European Region is the only region currently where more than 50% of HWOs are women (59%), though 48% of HWOs in the Region of the Americas are women due to a six-percentage point increase since the 2017 country presence report. The proportion of women HWOs in the African Region increased from 23% to 32% during this time. While the number of women HWOs in the Eastern Mediterranean Region doubled between the 2017 and 2019 country presence reports from three to six, there remains only one female HWO in the South-East Asia Region and three in the Western Pacific Region. Women Men Figure 6. The proportion of men and women HWOs globally and by region (%) 01/03/2019 Total 1/1 Global 61% 39% AFR 68% 32% AMR 52%48% EMR 60% 40% EUR 41% 59% SEAR 91% 9% WPR 77% 23% 1.2.4 Region of origin of HWOs In 2012, the Director-General, in consultation with the WHO Global Policy Group (GPG), decided that at least 30% of HWOs should come from outside their WHO region of origin, to promote regional diversity. The proportion of HWOs serving outside their region of nationality has increased globally from 18% in 2010 to 28% in 2019. There is a high level of regional variance, with 67% of HWOs serving in the Eastern Mediterranean Region and Western Pacific Region originating from outside of these regions compared to 10% in the African Region and 7% in the European Region. Table 6. Number of HWOs serving outside of their WHO region of origin (excluding acting HWOs) Region Number of WHO country offices Number of HWOs serving outside their WHO region of origin (nationality) African Region 47 3 Region of the Americas 27 7 Eastern Mediterranean Region 18 10 European Region 31 2 South-East Asia Region 11 4 Western Pacific Region 15 8 1. Who we are Ι 15 1.2.5 Age and retirement of HWOs Over 60% of HWOs are aged 56 years or over. The 56–60 age bracket represented either the highest or shared highest proportion of HWOs across all six regions. As of 1 January 2019, WHO has extended the mandatory age of retirement to 65 for all staff members. All staff members who reached their retirement age of 60 or 62 in 2017 and 2018 separated from WHO on retirement except in exceptional circumstances. As a result, between 2019 and 2025, it is anticipated that nine HWOs, on average, will retire every year. By region, this represents 33% of the current HWOs in the European Region, over 50% of HWOS in the Regions of the Americas, Eastern Mediterranean, South-East Asia and Western Pacific; and 66% of the current HWOS in the African Region. AFR AMR EMR EUR SEAR WPR Figure 7. Age distribution of HWOs by WHO region (excluding acting HWOs) 0 2 4 6 8 10 12 14 16 36-40 41-45 46-50 51-55 56-60 61-62 63-65 1.2.6 HWOs’ length of service HWOs are selected through a roster-based competitive process. They are normally senior staff members who have worked for WHO for some time and should have a minimum of 10 years of professional experience at the national and international levels. Over three quarters of HWOs have over 11 years of service as WHO staff members, while three HWOs have served for more than 26 years. The most frequent length of service is between 11 to 15 years as a staff member. Over 60% of HWOs have served in their role for five years or less. Seven HWOs have been WHO representatives for over 10 years and seven HWOs have been in service for 16–20 years in several duty stations. 16 Ι WHO presence in countries, territories and areas AFR AMR EMR EUR SEAR WPR Figure 8. Number of HWOs by years of service as WHO staff members (fig. left) and years of service as HWOs (fig. right) 2/22/2019 HWOs service-length-1 1/1 <5 6-10 11-15 16-20 21-25 26 and above 2 4 25 10 3 3 3 9 4 3 3 2 11 3 2 7 12 9 2 2 3 3 4 7 3 2/22/2019 HWOs tenure-1 1/1 <5 6-10 11-15 16-20 29 13 20 38 10 11 10 8 9 12 3 1.2.7 WHO workforce in countries, territories and areas As shown in Figure 9 below, WHO has four categories of personnel at the country level: (1) internationally recruited professional officers, (2) locally recruited national professional officers, (3) locally recruited general service staff, and (4) non-staff contractors. Figure 9. Categories of WHO workforce 1.2.8 WHO country-level staffing situation As of 31 December 2018, WHO had a total of 3957 staff members working at country level across the six regions. This represents a 9% increase from the 3641 WHO staff members at the country level in 2015. There were also 5738 non-staff contractors working at the country level. Almost half of these staff are based in the African Region (46%); 19% are based in the Eastern Mediterranean Region; 11% in the South- East Asia Region; 9% in both the Region of the Americas and the Western Pacific Region and 6% in the European Region. Of the country-level workforce, 20% are professional and higher graded staff, 30% are national professional officers and 50% are general service staff members, maintaining the trend towards a higher proportion of professional staff at the country level (this staff category rose from 11% in 2010 to 47% in the 2017 country presence report). The proportion of professional and higher graded staff varies from 12% in the African Region up to 50% in the Region of the Americas and stands at 26% in the Western Pacific Region, 24% in the Eastern Mediterranean Region, 21% in the European Region, and 19% in the South-East Asia Region. The ratio of professional to general service staff is often lower in countries where WHO has significantly large operational activities. International professional officers • Recruited internationally in accordance with WHO Staff Rules and may be assigned to any official station outside their home country. • Perform functions of a professional nature requiring global knowledge, expertise and experience of an international dimension. National professional officers • Nationals of the country in which they are to serve, are recruited locally and are not subject to assignment to any official station outside the home country. • Perform functions of a professional nature requiring local knowledge, expertise and experience of a national dimension. General service staff • Perform clerical, custodial and subprofessional tasks in accordance with Staff Rule 1310. • All positions in the general service category are subject to local recruitment and must be filled, as far as possible, by people recruited in the local commuting area of each office. Non-staff contractor support • WHO country offices hire non-staff contractors to implement programme-specific and time- limited activities such as polio eradication and emergencies. • The status of non-staff contractors differs from that of international civil servants or national professionals. 1. Who we are Ι 17 Figure 10. Breakdown of WHO workforce across the six regions by job category and gender Female Male General service staff National professional officer Professional and higher graded staff AFR AMR EMR EUR SEAR WPR Professional and higher graded staff National professional officer General service staff Distribution of WHO country staff by category Gender distribution of WHO country staff by category 1.2.9 Gender distribution of WHO staff at the country level Of the total 3956 staff at country level, 62% are male and 38% are female, a shift from 64% and 36% respectively in the 2017 country presence report. Within the regions, up to 70% of country office staff are male as seen in the African Region and Eastern Mediterranean Region. In every region the proportion of male staff increases when considering professional staff to overall staff members, with the exception of a 1% fall in the Eastern Mediterranean Region. This is even more pronounced when the category of professional and higher graded staff is considered in isolation, with the difference being over 20% in the European Region. However, slight increases in the proportion of professional female staff between 2017 and 2019 have been observed in the African Region, Eastern Mediterranean Region and Western Pacific Region. 1.2.10 Diversity of WHO staff capacity at the country office level GPW 13 guides WHO’s priorities and work overall; however, the specific focus of and approach to the Secretariat’s engagement with each individual country will be flexible in order to take into account country context and country capacity, thus ensuring that support is relevant and effective. In some settings such engagement will be more upstream – policy- related, strategic and normative − and in others more downstream with a focus on technical assistance and strengthening service delivery. In many countries engagement will involve a mixture of approaches, and the focus of WHO support will evolve over time. The WHO country team capacity must be fit for purpose to carry out the core functions of WHO and support the Member State to address its national priorities. With a renewed focus on WHO’s impact in countries, a range of initiatives are underway to reprofile and build the capacities of WHO’s country offices. WHO’s country cooperation strategies and country support plans for instance, are the strategic and operational tools used by WHO at the country level to define priorities and identify WHO’s comparative advantage as well as any gaps in capacity. Country office functional reviews and the current transformation agenda provide further opportunities to rationalize and hone the expertise in country offices. This section highlights the current picture in terms of country capacity as it relates to specific programme areas. A total of 140 (94%) of 149 WHO country offices reported having human resource capacity to 18 Ι WHO presence in countries, territories and areas address programmatic/technical issues in at least one of the highlighted programme areas in Figure 11, while 56 WHO country offices (38%) reported having capacity for all seven areas of work. Human resource capacity for addressing issues related to health systems/universal health coverage and communicable diseases was reported in over 84% of WHO country offices, with the Region of the Americas and South-East Asia Region reporting 100% capacity. All WHO country offices in the Region of the Americas also reported having human resource capacity for health emergencies with many countries in that Region, particularly the Caribbean Islands, being vulnerable to extreme weather events. Within the African Region, WHO country offices reported having the highest level of human resource capacity in the technical area of communicable diseases, in line with the high burden of disease caused by communicable diseases across the Region. Health systems/ universal health coverage was the technical area with the highest reported level of human resource capacity in the Eastern Mediterranean Region, following protracted efforts for health system strengthening and the achievement of health equity in the Region. Figure 11. Proportion of WHO country offices reporting the availability of human resources to address programmatic/technical issues in various programme areas (%) AFR EMR SEAR WPR AMR EUR 1. Who we are Ι 19 Among WHO country offices in the European Region, 58% reported having capacity in health emergencies and noncommunicable diseases, with noncommunicable diseases a priority area for action in many countries, and others strengthening their response to the arrival of increased numbers of refugees/migrants. Communicable diseases, noncommunicable diseases and health systems/universal health coverage were reported in 87% of countries in the Western Pacific Region. As with the different technical areas, depth of capacity and competency in the functional processes which enable WHO office teams to carry out the core functions of the Organization at country level are equally important. The majority of WHO country offices have available capacity in policy dialogue/policy analysis, the Health in All Policies (HiAP) approach, including all WHO country offices in the Region of the Americas and South-East Asia Region. Over 85% of WHO country offices overall also have capacity in procurement and logistics, and project/programme management. Within the regions, between 61% and 96% of WHO country offices have capacity for multi-stakeholder collaboration for SDG implementation; the figure stands at 80% or above in the Region of the Americas, South-East Asia Region and Western Pacific Region. One hundred and twenty WHO country offices (81%) have capacity in at least five of the functional competencies, while 44 WHO country offices (30%) have capacity in at least nine of the 10 highlighted roles. 1.3 Facilities 1.3.1 Place Across the 149 countries, territories and areas where WHO is physically present, there are diverse housing arrangements for WHO offices. These offices include the categories of dedicated country offices, sub and field offices. The majority of premises (69%) across the world are made available to WHO at no charge; such offices are usually located within, or near Figure 12. Proportion of WHO country offices reporting availability of capacity in functional competencies (%) Community engagement Data/ Information processing/ Health statistics Monitoring and evaluation Multi-stakeholder collaboration for SDGs implementation Policy dialogue/ Policy analysis/ Health in All Policies (HiAP) approach Procurement and logistics Project/ programme Management Resource mobilisation and proposal drafting AFR EMR EUR SEAR WPRAMR Gender, equity and human rights Region Country offices In territories UN shared premises African Region 47 12 Region of the Americas 27 1 Eastern Mediterranean Region 17 1 (West Bank and Gaza Strip) 3 (Includes Tripoli) European Region 30 1 (Pristina) 8 South-East Asia Region 11 2 Western Pacific Region 15 2 Total 147 2 28 Table 7. Number of WHO offices in countries and areas housed in UN shared premises 20 Ι WHO presence in countries, territories and areas the premises of the health ministry. There are 28 country offices in common UN premises (19%), with 10% of country offices being independently owned by WHO. 1.3.2 Corporate communication capacity at country level WHO recognizes that effective, integrated and coordinated communication is integral to the achievement of its goal of building a better, healthier future for people all over the world. Two thirds of WHO country offices (66%) reported having dedicated communication staff, two thirds of whom are full-time; a further 24% are part-time and the remaining 10% are outsourced. Over 80% of WHO country offices in the African Region, Region of the Americas and South-East Asia Region have dedicated communication staff, with the proportion of full-time staff across regions varying from 13% to 62%. The proportion of full-time communication staff has increased overall from 41% to 44% since the 2010 country presence report and has doubled in the Eastern Mediterranean Region and Western Pacific Region, with increases also Region Sub and field offices UN shared premises African Region 60 9 Region of the Americas 0 0 Eastern Mediterranean Region 33 9 European Region 7 4 South-East Asia Region 489 2 Western Pacific Region 3 1 Total 592 25 Table 8. Number of WHO sub and field offices housed in UN shared premises Figure 13. Proportion of WHO country offices reporting having communication staff (%) Full-time Part-time Outsourced None 11/03/2019 Fig 13 1/1 0% 20% 40% 60% 80% 100% AFR AMR EMR EUR SEAR WPR 61% 55% 33% 13% 45% 40% 15% 15% 44% 74% 18% 40% 9% 15% 9% 7% 15% 15% 22% 13% 27% 13% 1. Who we are Ι 21 reported in the Region of the Americas and the European Region. 1.3.3 Information sharing WHO country offices in 133 countries, territories and areas (89%) reported the existence of a country-specific website in order to provide information to stakeholders. At least 83% of WHO country offices in each region reported having a country-specific website, with this figure as high as 100% in the Eastern Mediterranean Region. Engaging with social media allows WHO country offices to drive traffic to websites where more detailed and trusted content can be found. New social media platforms emerge and current platforms also constantly evolve to take advantage of novel film, broadcast, and other new technologies that enhance the ability for their subscribers to engage in conversations. WHO aims to constantly keep abreast of changes and identify areas for improvement. WHO country offices in 91 countries, territories and areas (61%) reported having at least one official account on social media, with 23 WHO country offices (15%) having three or more. WHO country offices are most likely to have reported the existence of a Facebook or Twitter account (48% and 42% of WHO country offices respectively) and at least 10% also reported using YouTube and Instagram/Flickr. At least 39% of WHO country offices in each region have at least one social media account with the highest levels of engagement reported in the Region of the Americas (85%) and the Eastern Mediterranean Region (72%). 1.3.4 Access to breastfeeding facilities in WHO country offices Breastfeeding gives children the healthiest start to life. Just under half of WHO country offices reported having an appropriate facility for breastfeeding for staff (49%); within regions this figure is between 58% and 67% in the Region of the Americas, Eastern Mediterranean Region, European Region, South-East Asia Region and Western Pacific Region, and 21% in the African Region. Figure 14. Proportion of WHO country offices reporting having a country-specific website or official accounts on social media (%) 06/03/2019 Fig 14 1/1 Website Facebook Twitter YouTube Instagram/Flickr Other local social media Google+/Google Play 89 48 42 11 10 5 1 22 Ι WHO presence in countries, territories and areas 05/03/2019 Q4 1/1 AFR AMR EMR EUR SEAR WPR 21 67 61 58 64 60 Overall 49 Figure 15. Proportion of WHO country offices reporting having an appropriate facility for breastfeeding for staff (%) 1. Who we are Ι 23

What we do 2. 2. What we do To drive impact in every country, WHO engages in policy dialogue and provides strategic support, technical assistance and operational support to Members States as required. WHO is a trusted partner to ministries of health and strives to build sustainable institutional capacity to protect health, keep people safe and serve the vulnerable in each country. WHO engagement with the health ministry is primarily delivered through its contribution to national health policies, strategies and plans for UHC and for ensuring financial protection; its role in convening and managing health sector coordination for better impact at country level; its participation in joint annual health sector reviews; its provision of policy advice and technical support for attainment of the three GPW 13 priorities; and mobilization of resources for health. Besides ministries of health, WHO collaborates with a range of other ministries and government entities beyond the health sector, including parliamentarians and Heads of State to advocate for multisectoral action to reduce risk factors and improve health as a cornerstone of the entire 2030 Agenda for Sustainable Development. Working with non-health ministries is increasingly being recognized and promoted as a significant vehicle for improving health outcomes related to non-health sector risk factors and influences. WHO’s collaboration with a wide range of partners is the key to leveraging the greatest gains for global public health. At the country level, WHO works with UN agencies, bilateral and mult i lateral agencies, funds and foundations, nongovernmental organizations and communities in planning, implementing and monitoring programmes to improve health. WHO country office roles and functions Articulating policy options • Lead health policy dialogue and provide policy advice to national counterparts and partners • Promote the engagement of countries in setting regional and global policies and strategies Providing leadership • Advocate for Health in All Policies and promote dialogue for intersectoral and multistakeholder collaboration • Lead WHO’s United Nations interagency work in integrating national health priorities into the development agenda and the United Nations Development Assistance Framework (UNDAF) • Lead the convening and coordination of the health response in emergencies • Lead in strengthening country capacity in health diplomacy for better engagement in national and international processes and global health governance Providing technical support and building capacity • Lead the development of a country cooperation strategy and its implementation • Lead and manage the provision and brokering of technical cooperation • Lead in implementing and monitoring international commitments, conventions and legal instruments • Lead emergency response and action during crises and emergencies Monitoring health trends • Lead WHO’s work in monitoring and evaluating national policies and programmes Setting norms and standards • Support countries in adapting and implementing guidelines, tools and methods • Contribute to setting global norms and standards by providing evidence from countries Shaping the research agenda • Promote research and strengthen research capacity in countries • Support and, when appropriate, conduct operational research and ensure the use of results • Contribute to the body of knowledge on best practices 26 Ι WHO presence in countries, territories and areas 2.1 Contributing to national health policies, strategies and plans to roll out UHC, ensure healthy lives and respond to health emergencies National Health Policies, Strategies and Plans (NHPSPs) play an essential role in outlining a country’s population health needs, vision, policy directions and investments to improve health and realize the SDGs. During the reporting period, a valid NHPSP was in place in 124 (83%) countries, territories and areas where WHO has an office. All countries in the South-East Asia Region had an up-to-date national health policy, strategy or plan at this time as well as over 80% of countries in the African Region, Region of the Americas, European Region and Western Pacific Region. WHO country offices in 147 countries, territories and areas have reported playing a role in the initiation, development, implementation and/ or monitoring of the national health policy, strategy or plan either at present or previously. Depending on the country context, WHO plays various roles in support of NHPSPs, with building national capacity for implementation being the most frequently reported activity by WHO country offices (89% of countries, territories and areas). Other roles are shown in Figure 16 below. In 105 (70%) country offices, WHO was engaged in at least five of the six active roles. Active participation (e.g. Co-Chair with Ministry of Health or other leadership session leading to formulation of NHPSP Actively engaged in the implementation of NHPSP Building national capacity for effective policy analysis, formulation, monitoring and review Building national capacity for implementation of NHPSP Improving national health governance through sustained and inclusive effective health sector policy dialogue Main technical partner in undertaking situation analyses Not involved One of the partner agencies attending the NHPSP development meetings (but not providing active support) 05/03/2019 Q7 1/1 100% SEAR 89% AMR 90% EUR 50% EMR 93% WPR 81% AFR AFR 18% 17% 17%16% 15% 14% 3% EMR 17% 17% 16%16% 15% 14% 3% EUR 20% 17% 17% 17% 13% 13% 2% 1% SEAR 17% 17% 16%16% 16% 12% 7% WPR 18% 16% 16%16% 15% 14% 4% AMR 17% 17% 17%16% 14% 13% 3% 1% Proportion of countries, territories and areas where the WHO is physically present with a valid national health policy, strategy or plan Figure 16. Proportion of WHO country offices in each region reporting engagement in supportive roles relating to the national health policy, strategy or plan (%) 2. What we do Ι 27 Figure 17. WHO country office support for the implementation of the Framework Convention on Tobacco Control The Framework Convention on Tobacco Control (FCTC) and the Protocol to Elimincate Illicit Trade in Tobacco Products Actions in Member States that are Parties Providing multi-level assistance to facilitate policy dialogue and to ensure full implementation of the Convention; collecting contributions from the Parties and encouraging them to join the Protocol to Eliminate Illicit Trade in Tobacco Products. Supporting the preparation of progress reports on treaty implementation. Actions in Member States that are Parties WHO country offices Actions in relation to the Convention's Secretariat Facilitating the communication with Parties' governments; working to integrate the Convention in the UN system at country level (UN funds, UN RC System, UNDAF), supporting need assessment missions and meeting with experts. Actions in Member States that are not Parties Providing support and advocacy to encourage the country to join the Convention. Countries with a WHO country office which have ratified the FCTC Countries without a WHO country office which have ratified the FCTC The FCTC has been ratified in 91% of the 149 countries, territories and areas where the WHO is physically present. WHO country offices play active roles to ensure ratification and implementation. A high level of ratification across a wide geographical spread is evident, with over 80% of countries, territories and areas within each region having ratified the FCTC, including 100% in the Western Pacific Region. An additional 37 countries, territories and areas where the WHO is physically present have ratified the Protocol to Eliminate Illicit Trade in Tobacco Products as of October 2018. WHO country offices in action: FCTC implementation Multiple WHO country offices have been actively engaged in numerous aspects of FCTC implementation. These efforts range from assisting with an economic study on tobacco and taxation in support of FCTC ratification in Morocco, to deploying international technical expertise for effective FCTC 2030 project implementation in Jordan. Having a lasting impact is key, and this aspect was addressed by the WHO country office in the Russian Federation through advocacy and the provision of evidence to ensure that tobacco control remains a high-level government priority with assured funding. The WHO country office in Slovenia engaged in situational analysis, promoting stakeholder policy dialogue, monitoring violations and evaluating impact. The WHO country office in Georgia was heavily involved in the endorsement and enforcement of a modern tobacco-control law. Assisting NGOs in organizing a study tour and initiating collaboration with members of parliament from different countries afforded decision-makers the opportunity to gain experience. WHO worked with partners to lead a strong communication campaign, critically contributing to robust public support for tobacco control measures. Continued WHO support and multisectoral collaboration seek to increase impact and prevent interference from the tobacco industry. A report on investing in FCTC implementation from WHO and partners played a significant role in the endorsement of the tobacco-control law in Georgia and in strengthening intersectoral collaboration at national level. 28 Ι WHO presence in countries, territories and areas WHO country offices have played a key role in supporting the implementation of WHO treaties such as the Framework Convention on Tobacco Control (FCTC), the first WHO treaty adopted under article 19 of the WHO Constitution. The types of action taken by WHO country offices to facilitate implementation of the FCTC are detailed in Figure 17. 2.2 Country Cooperation Strategy A Country Cooperation Strategy (CCS) is WHO’s country-level medium-term strategic vision to guide the Organization’s work in and with a country. It imprints the General Programme of Work at the country level and responds to the national health and development agenda.1 Based on evidence of health needs and strategic dialogue with Member States and partners working at the country level, the CCS identifies a set of jointly agreed priorities that will underpin collaboration with WHO over a four- to five-year period, covering areas in which WHO has a comparative advantage to drive public health impact. In line with WHO’s strategic shift towards impact in every country, the CCS also includes a GPW 13-aligned country impact framework covering the jointly identified priorities. Therefore, the CCS plays a unique and important role as the public expression of WHO’s results chain at the country level. It is also a critical input to support WHO’s biennial operational planning including country support plans (CSP) and programme budgets (PB). The role of the CCS is to strategically respond to a country’s specific priorities and institutional resources needed to achieve its national health policies, strategies and plans and the action needed to achieve its national health-related targets under the Sustainable Development Goals. 1 The term ‘national health and development agenda’ is used here to describe the totality of the country’s health-related priorities typically set out in government strategies, policies, plans and vision documents. These often include national health policies and plans, sustainable development plans, other sector policies and plans that influence health, the UN Development Assistance Framework (or equivalent), and government ‘vision’ documents. CCS: A snapshot of Global Analysis 2017 The WHO Country Cooperation Strategies – Global Analysis (2017), a review that is done every three years, reported that UHC through strengthening of health systems has been at the heart of WHO’s work at country level and has been recognized as a leading target within the recently adopted 2030 Agenda for Sustainable Development. Actions towards UHC are evident in 84% of the 64 CCSs reviewed. Emergency risk and crisis management (78%), IHR 2005 (69%) and alert and response capacities (61%) are the top strategic priorities/focus areas in the CCSs reviewed in 2017, followed by disease surveillance and early warning systems (52%) (in the context of emergencies). As recommended by the previous WHO global analysis, most CCSs now include a strategic priority on emergency risk assessment, preparedness, alert and response to epidemics and emergencies, as well as full support for the implementation of the IHR at national level. Twelve (19%) CCSs among the 64 that were reviewed in the 2017 Global Analysis have prioritized strategies addressing cross-cutting interventions. Thirty-five (95%) out of the 64 CCSs analyzed, addressed social determinants of health, 89% addressed equity, 86% gender and 65% addressed human rights issues. Following the introduction of the SDGs in 2016, CCSs have been oriented or reoriented to provide strategic direction for implementation of the SDGs at country level, while they have equally promoted the multisectorality of health, a critical pillar of the SDGs and GPW 13. The CCS is also used to define technical cooperation and provides a platform for integrating health and non-health issues. High-income countries, some of which are donors and supporters of health and development in many developing countries, have increasingly started using CCSs, leading to better structured partnership with WHO. A summary of the features of the country cooperation strategy and how it ties in with the WHO General Programme of Work is given in Figures 18 and 19. In the European Region, WHO uses an alternative tool called a Biennial Collaborative Agreement (BCA) for collaboration with countries. However, with the onset of the current mandate, the Regional Office for Europe has taken steps to align with other WHO regional offices and started to roll out country cooperation strategies at the request of Member States. 2. What we do Ι 29 Figure 18. Functions and features of the WHO country cooperation strategy It is tailored to the country's CAPACITY and CONTEXT Provides a FLEXIBLE time frame, adaptive to changing CIRCUMSTANCES It is a tool for TRANSPARENCY: CCS evaluation focuses on how the country and WHO collaborated to achieve local targets It is the basis for bottom-up PLANNING, guides BUDGET DECISIONS and directs RESOURCES to programmes and Member States ALIGNS country priorities to GPW 13 and WHO leadership priorities Identifies health NEEDS and PRIORITIES in line with the country's development agenda Promotes country OWNERSHIP in achieving the SDGs Creates opportunities for COLLABORATION with non-state stakeholders Country Cooperation Strategy What is it for ? Promotes health issues in the UNDAF, harmonizing it with other UN Agencies and the SDGs Links to the COUNTRY SUPPORT PLAN, using it as the results chain to measure CCS IMPACT and WHO's CONTRIBUTION Figure 19. The Thirteenth General Programme of Work planning process and linkages to the country cooperation strategy 30 Ι WHO presence in countries, territories and areas As of 31 October 2018, a total of 133 (72%) countries, territories and areas where WHO is physically present had a valid country cooperation strategy or biennial collaborative agreement or were in the process of developing or updating one. Of these, there are currently 83 valid country cooperation strategies, an increase from 62 in the 2017 country presence survey period during which many countries were renewing strategies to align them with the Sustainable Development Goals. Countries, territories and areas with a valid country cooperation strategy constitute 77% (36) of WHO country offices in the African Region, 63% (17) in the Region of the Americas, 22% (four) in the Eastern Mediterranean Region, one in the European Region, 91% (10) in the South-East Asia Region and all in the Western Pacific Region.2 2 The country cooperation strategy for Viet Nam is an internal document within UN ONE. The proportion of countries, territories and areas with valid country cooperation strategies has increased by over 50% in the African Region and Region of the Americas since the 2017 country presence report. An increasing number of countries in the European Region have a CCS, including six high-income countries (Belgium, Cyprus, Italy, Malta, Portugal and Switzerland) and one upper-middle income country where WHO is physically present (Russian Federation). Additionally, 26 countries in the European Region have valid BCAs. Of the 83 countries, territories and areas with a valid country cooperation strategy and for which further data is available, 94% of WHO country offices reported utilizing the document for the purposes of advocating for health issues and aligning financial and human resources to country priorities, and 93% for helping to Figure 20. Coverage of valid country cooperation strategies and biennial collaborative agreements across Member States with a WHO country office 2. What we do Ι 31 align WHO country office work with partners. Within each region, utilization of the CCS for these three purposes is over 85%, and 100% for all three in the Eastern Mediterranean Region, European Region and South-East Asia Region. Among WHO country offices with a valid country cooperation strategy, 87% reported using it for resource mobilization, while in 85% it is utilized for providing information on the WHO country office priorities for visits/missions to countries and 73% for informing the United Nations Development Assistance Framework (UNDAF). The country cooperation strategy is reported by all 83 of these WHO country offices to be used for at least one of these purposes and a total of 43 WHO country offices reported using the country cooperation strategy for all six highlighted purposes. Figure 21. Key areas of use of CCS as reported by WHO country offices across regions 01/03/2019 Page 3 1/1 prioritization resources alignmentadvocacy planningfinancial support country partners human information align countries missions informingprovide UNDAF visits mobilization resource Country cooperation strategies are reviewed by WHO country offices in collaboration with government and partner organizations to ensure optimal support and to allow for priorities to be updated if needed. This is reported to occur primarily at mid-term (39%) or at the end of the country cooperation strategy period (28%) for the country cooperation strategies that are currently valid. Within regions, reviews are most frequency conducted mid-term in the African Region, Region of the Americas, European Region and Western Pacific Region, at the end of the country cooperation strategy period in the Eastern Mediterranean Region, with mid-term and biennial time frames used with equal frequency in the South-East Asia Region. Figure 22. Frequency of strategy review among currently valid country cooperation strategies (%) At least once per year Biennially Mid-term End of CCS period 32 Ι WHO presence in countries, territories and areas In comparison with the 2017 country presence report, there has been a slight shift towards the shorter annual (+3 percentage points) and biennial (+2 percentage points) review time frames, suggesting an increased review frequency. 2.3 Joint WHO and government monitoring mechanisms The number of WHO country offices reporting the existence of a joint WHO and government mechanism to enhance implementation, monitoring and reporting on WHO technical cooperation has risen steadily from 77% to 89% between the 2015 and 2019 country presence reports. Coverage is consistently high across regions, with between 84% and 94% of countries within the six regions currently reporting a monitoring mechanism. Figure 23. Proportion of WHO country offices reporting the existence of a joint WHO and government monitoring mechanism (%) 05/03/2019 Extra 1/1 80 85 90 Country presence report year 2015 2017 2019 77 83 89 The majority of monitoring reviews are reported to be conducted either every six months (37%) or annually (33%) with these also being the most commonly used time frames within each region with the exception of the Western Pacific Region where reviews are most frequently carried out on a quarterly basis. AFR AMR EMR EUR SEAR WPR Figure 24. Number of WHO country offices reporting conducting a monitoring review at different time intervals 2. What we do Ι 33 2.4 Supporting implementation of the Sustainable Development Goals Following the adoption of the 2030 Agenda for Sustainable Development, WHO has supported governments and partners in developing the necessary technical tools, guidance and country and regional implementation plans. WHO has also been instrumental in establishing advisory groups to coordinate these activities in an effective and evidence-based manner. Of the 17 Sustainable Development Goals, SDG 3 is the main Goal with an explicit focus on health, although most other goals are also related to health. In total, more than 50 Sustainable Development Goal indicators have been agreed upon internationally to measure status and progress on health outcomes, determinants of health or health-service provision. In over three quarters of countries, territories and areas where WHO is physically present (149), Governments have established a national SDG coordination mechanism as a means to further implementation and monitoring of the SDGs. Two thirds of them reported that the government periodically monitors the progress of national SDG implementation plans or plans for mainstreaming SDGs in existing plans and programmes, while just under half reported annually to the United Nations High-Level Political Forum. With the Global Action Plan on the SDGs which has been approved by 12 UN and non-UN agencies, WHO country offices will be provided with a framework within which to coordinate the work of partners and governments and accelerate the implementation of SDG 3 in countries. Figure 25. Number of WHO country offices reporting priority actions being taken by governments to accelerate implementation of the SDGs Periodic monitoring of the progress of national implementation plans for SDGs, mainstreaming in existing plans Established national SDG coordination mechanism Annual reporting to the UN High Level Political Forum Other 34 Ι WHO presence in countries, territories and areas Worldwide, 93% of WHO country offices reported being active in advocacy for mainstreaming the SDGs into national plans, also accounting for over 80% of WHO country offices in every region and 100% of countries in the European Region where WHO is physically present. A high proportion of WHO country offices reported being also engaged in technical support for the mainstreaming of SDGs into national plans, policies and programmes (89%) as well as providing advice, facilitation and/or coordination on setting national targets and/or indicators (87%), the latter including all countries in the South-East Asia Region. Advice, facilitation and coordination on setting national targets and indicators Advocacy for mainstreaming SDGs in national plans Technical support for mainstreaming SDGs into national plans Support for measuring and reporting Promoting the establishment of alliances and a multisectoral approach Support for resource mobilization Capacity building for multisectoral approach Other Figure 26. Proportion of WHO country offices by region supporting the implementation of Sustainable Development Goals through various approaches (%) WHO country offices are further engaged in promoting the establishment of alliances and the use of a multisectoral approach (74%), providing support for measuring and reporting (70%), mobilizing resources (51%), and building capacity for a multisectoral approach (50%). Additional supportive roles played by individual WHO country offices include raising funds to operationalize SDG 3 and setting up a subnational coordination system. WHO country teams in 43 (29%) countries reported being engaged in all seven highlighted roles relating to the implementation of the Sustainable Development Goals while 89% are active in at least four of these roles. 2. What we do Ι 35 2.5 WHO support in health emergencies One of the three pillars of GPW 13 is about addressing health emergencies – 1 billion more people better protected from health emergencies. WHO has an essential role in building and sustaining resilient national capacities required to keep the world safe from epidemics and other health emergencies; and in ensuring that populations affected by acute and protracted emergencies have rapid access to essential life-saving health services including health promotion and disease prevention. Accordingly, WHO country offices are playing an important role in supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. The WHO Health Emergencies Programme brings together outbreak and emergency resources across the three levels of the Organization to ensure greater speed, flexibility and rapid impact. In 2017–2018 a total of 901 new health emergency events were documented on the WHE Event Management System (EMS); they occurred in 162 countries and areas as listed in Table 9. WHO country offices in action: implementation of the SDGs in Bulgaria WHO facilitated policy dialogue to discuss implementation of the Bulgarian National Health Strategy 2020 geared towards achieving the WHO Policy Framework for Health and Wellbeing in support of the SDG Agenda. Stakeholders at the workshop developed a framework for achieving the SDGs in Bulgaria through multisectoral collaboration and active engagement. In the programme area of national health policies (NHP), the Bilateral Cooperation Agreement (2018-2019) sets out the key dimensions of WHO’s support for improved country governance capacity to formulate, implement and review national health policies; promote and strengthen health information and data analysis and information sharing; and strengthen national capacity in knowledge translation and use of evidence in policy- making. At the request of the Ministry of Health, the WHO Regional Office for Europe through the WHO Country Office in Bulgaria provided technical assistance aimed at increasing technical capacity for policy review through training on mapping of evidence that will inform the upcoming NHS2020 review. Beyond the developed and tailor-made methodology for mapping of evidence, an online tool in the national language was developed to improve outreach in the evidence gathering process. Support was also provided in the form of expert advice for the process of mapping evidence of NHS2020 implementation which is conducted by the national technical group. This advice was to ensure appropriate use of methodology and the usefulness of the mapping of evidence report. Global Action Plan for healthy lives and well-being for all Despite all the reported action on the SDGs, it is clear that three years since the launch of the SDGs, the pace of progress must be rapidly accelerated if the SDGs are to be achieved by 2030. Recognizing this challenge, in 2018 Germany’s Chancellor, Angela Merkel, Ghana’s President, Nana Akufo-Addo, and Norway’s Prime Minister, Erna Solberg, wrote a joint letter to the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, requesting that he leads the development of a Global Action Plan for health and well-being for all. In consultation with 12 other global health organizations, WHO took up this challenge. A framework for the Global Action Plan was presented by Dr Tedros at the World Health Summit in Berlin in October 2018. The final Action Plan will be launched at the UN General Assembly in September 2019. The action framework of the Plan sets out three strategic approaches for all relevant actors at the global, regional, national and local levels to give expression to the historic commitment to unite for the health and well-being of all. They are: 1. Align – coordinating work better to reduce duplication and inefficiencies. 2. Accelerate – using seven cross-cutting areas of innovation to accelerate progress: (1) sustainable financing; (2) frontline health systems; (3) community and civil society engagement; (4) determinants of health; (5) research and development, innovation and access; (6) data and digital health; (7) innovative programming in fragile and vulnerable states and for disease outbreak response. 3. Account – assessing results and linking investments more closely to results. 36 Ι WHO presence in countries, territories and areas Region Number of new health emergency events African Region 283 Region of the Americas 249 Eastern Mediterranean Region 100 European Region 96 South-East Asia Region 73 Western Pacific Region 100 Table 9. Number of new health emergency events which occurred globally in 2017–2018 Of the 901 events, 676 (75%) were of an infectious nature (including zoonoses); 86 (10%) were disasters; 47 (5%) were related to food safety; 2.4% were of an undetermined nature; and the remaining 70 (8%) were radiological and nuclear, product, chemical, societal or nutrition deficiency-related events. Over the same period, a total of 191 Rapid Risk Assessments (RRA) were conducted, 124 were posted on the IHR Event Information Site (EIS) and 189 editions of Disease Outbreak News (DON) were published on the WHO website. The likelihood and causes of health emergencies vary globally and WHO country offices must adapt and respond to contextual factors. The joint external evaluation is a voluntary, collaborative, multisectoral process to assess country capacity to prevent, detect and rapidly respond to public health risks occurring naturally or due to deliberate or accidental events, with the purpose of assessing country-specific status and promoting progress in effective implementation of IHR. The IHR is an international legal instrument which aims to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. 2. What we do Ι 37 International Health Regulations (IHR 2005) Core Capacities Since 2010, all 196 States Parties have reported at least once to the Secretariat using the State Party Annual Reporting (SPAR) questionnaire. In 2018, a new version of the SPAR questionnaire was introduced. As at 28 January 2019, one hundred and fifty-four (79%) of the 196 States Parties had submitted the questionnaire sent out in June 2018; by region, 47 (100%) States Parties from the African Region, 26 (74%) from the Region of the Americas, 14 (67%) from the Eastern Mediterranean Region, 40 (73%) from the European Region, 11 (100%) from the South-East Asia Region, and 16 (59%) from the Western Pacific Region have done so. Detailed information on the 2018 annual reporting by States Parties is published on the WHO Global Health Observatory website.3 Globally, progress has been reported across the 13 core capacities, particularly in respect of surveillance, laboratory and IHR coordination, but the overall average scores suggest that further and sustained efforts are urgently needed in the areas of chemical events, capacities at points of entry and radiation emergencies.4 Joint External Evaluation (JEE) of IHR Throughout 2016-2018, joint external evaluations of IHR (2005) core capacities were completed in a total of 91 countries (AFR–39; AMR–4; EMR–16; EUR–13; SEAR–8; WPR–11). 3 http://apps.who.int/gho/data/node.main.IHR00ALLN?lang=en 4 Based on the analysis of information received from 129 States Parties as at 21 January 2019. Figure 27. Number of countries by region which have completed a JEE 2016 2017 2018 JEE Reports can be found at: http://www.who.int/ihr/procedures/mission-reports/en/. 38 Ι WHO presence in countries, territories and areas Development of National Action Plan A total of 74% of the countries that have conducted joint external evaluations have either developed or are developing a National Action Plan for Health Security (NAPHS). The NAPHS is a country-owned, multi-year, planning process that can accelerate the implementation of IHR core capacities and is based on the ‘one health’ and ‘whole-of-government’ approach for all hazards. It captures national priorities for health security, brings sectors together, identifies partners and allocates resources for health security capacity development. The NAPHS also provides an overarching process to capture all ongoing preparedness initiatives in a country along with a country governance mechanism for emergency and disaster risk management. Since 2016, WHO has been working closely with many countries and partners to support the development and implementation of NAPHS. Consequently, the number of countries with an NAPHS increased from two in 2016, to 16 in 2017, and 27 in 2018. As of February 2019, a further 24 countries are developing plans. WHO country office action: Responding to health emergencies in Cuba Hurricane Irma was one of the most devastating hurricanes in the history of the Atlantic, hitting Cuba as a Category 5 storm in September 2017. For over 900 kilometres, Hurricane Irma destroyed almost everything in its path, including infrastructure in most provinces and in Havana, Cuba’s capital. Authorities required assistance in responding to the population’s health needs, which included rehabilitating over 1000 affected health institutions, ensuring continuity of health services and preventing outbreaks of water-borne as well as vector- transmitted diseases. The WHO country office worked in close collaboration with the Ministry of Health (MoH) to ensure an effective response with substantial resource mobilization by AMRO/PAHO. Daily meetings with the national authorities contributed to produce timely information to support the health sector response. Additionally, AMRO/PAHO coordinated the health efforts from the United Nations Population Fund and other partners. Over US$ 3.5 million was mobilized to replenish stocks of medicines, anti-vector materials, and medical supplies. Due to this intervention and the timely support provided by WHO to the MoH, no outbreaks were reported in the areas affected by Hurricane Irma and provision of quality health care was maintained to the affected Cuban population. Figure 28. Status of National Action Plan for Health Security (NAPHS) Number of countries that developed a NAPHS in 2016–2018 Number of additional countries developing an NAPHS in 2019 Completed NAPHS are available at: https://extranet.who.int/sph/publications. 2. What we do Ι 39 Between 2017 and 2018, all WHO country offices provided support to governments on emergency preparedness, prevention, detection and response (see Fig. 29). The most common form of support provided during this period was for strengthening minimum core Figure 29. Number of WHO country offices by region reporting the provision of different types of support for emergency preparedness, prevention, detection and response Assessment and reporting of all hazards emergency preparedness (including IHR annual reporting JEEs, AARs Detection, verification and risk assessment of potential health emergencies Development of innovative tools, products and interventions for high threat infectious hazards Implementation of prevention strategies for priority pandemic/epidemic-prone diseases (including cholera, yellow fever, influenza) Mitigation and reduction of the risk of the emergence/re-emergence of high threat-infectious pathogens Provision of essential health services and system strengthening in fragile, conflict and vulnerable settings Response to acute health emergencies leveraging national and international capacities Strengthening minimum core capacities for emergency preparedness and disaster risk management Support for operational readiness to manage identified risks and vulnerabilities 40 Ι WHO presence in countries, territories and areas capacities for emergency preparedness and disaster risk management (87%). This was also the most frequent form of support in the African Region, Region of the Americas, European Region and Western Pacific Region, and 100% of WHO country offices in the Region of the Americas reported being engaged in this activity. All WHO country offices in the South-East Asia Region reported providing support to the country through assessment and reporting of all-hazards emergency preparedness, implementation of prevention strategies for priority pandemic/ epidemic-prone diseases and giving support for operational readiness to manage identified risks and vulnerabilities. All WHO country offices in the Eastern Mediterranean Region reported providing assistance through detection, verification and risk assessment of potential health emergencies. Over one third (36%) of WHO country offices reported being engaged in at least eight of the nine highlighted emergency preparedness, detection and response activities between July 2017 and August 2018, including 55% of WHO country offices in the South-East Asia Region and over 40% in the African Region, Region of the Americas and Western Pacific Region. 2.6 Supporting health sector coordination An important role of WHO country-level support is to act as a convener/neutral broker among partners and to support the government in effectively coordinating the health sector. As Article 33 of the WHO Constitution provides for direct access of the Director-General and his or her representative (the HWO) to the various departments and ministries of the government, this ensures a whole-of-government approach with HWOs advised to keep the health ministry informed of their engagement with other government departments. The existence of a government-led health sector coordination mechanism was reported by WHO country offices in 106 (71%) countries, territories and areas where WHO is physically present. In countries where a government-led health sector coordination mechanism exists, 57% of WHO country offices reported playing at least one role related to leadership and coordination, most frequently as a co-chair with the Ministry of Health or other partners. Figure 30. Proportion of WHO country offices reporting the existence of a government-led health sector coordination mechanism in each region (%) AFR AMR EMR EUR SEAR WPR 77% 67% 78% 58% 91% 67% 23% 33% 22% 42% 9% 33% Global 71% 29% 2. What we do Ι 41 Figure 31. Number of WHO country offices participating in government-led health sector coordination mechanisms Co-chair with the Ministry of Health or other partners Participant (but no leadership or coordination role) Other Secretariat for the coordination mechanism Chair or rotational chair 42 Ι WHO presence in countries, territories and areas How we do it 3. WHO addresses country needs through the provision of support in many ways, including backstopping missions and funding. One of the GPW 13 strategic shifts specifically focuses on driving public health impact in every country using a differentiated approach based on countries’ capacities and vulnerability. 3. How we do it This requires WHO to become more focused and effective in country-based operations, working closely with partners, engaging in policy dialogue, providing strategic support and technical assistance, and coordinating service delivery, depending on the country context. The following figure unpacks the various elements of this strategic shift. Figure 32. Driving impact in every country as a strategic shift Placing countries at the centre Ground the strategic vision at country level Ensure better impact Engage in upstream or downstream actions according to the context Build a platform for leadership and coordination Strengthen country office capacity WHO will place countries squarely at the centre of its work. This strategic shift is the epicentre of GPW 13 and will become the focus of all levels of the Organization. WHO will strengthen its work at country level in all settings to ensure better impact. In some settings such engagement will be more upstream – policy- related, strategic and normative – and in others more downstream with a focus on technical assistance and strengthening service delivery. Strengthening WHO’s work at the country level involves a combination of WHO country office leadership, a fit-for-purpose staffing structure, appropriate delegation of authority, and business processes that facilitate effectiveness and efficiency. WHO must ensure that a robust technical platform is in place and to act as a convenor and coordinator of many partners in support of national authorities. COUNTRIES AT THE CENTER Flexibility Health leadershipBottom-up planning COUNTRIES AT THE CENTRE Policy dialogue partner Strategic supporter Technical assistance partner Service delivery coordinator • Strengthen the normative function of WHO secretariat • Better tailor country expertise • Align with global priorities • Adapt policy dialogue to the maturity of the health system • Focus on country needs with a bottom-up approach • Solve bottlenecks • Attract financing • Build more robust institutions • Provide relevant support in weaker health systems and in vulnerable contexts • Guide and support countries experiencing protracted crises at the subnational level with appropriate presence on the ground • Provide strategic support to strengthen health systems • Help maximize performance in terms of results, equity and financial sustainability • Advise on Universal Health Coverage • Support the country with multilevel action (in-country, national, regional, and HQ level) • Strengthen service delivery in the most fragile settings • Coordinate the health cluster and the Humanitarian Response Plan • Operate through a combination of national and subnational presence This strategic shift is based on two of WHO’s core functions: articulating ethical and evidence-based policy options; and providing technical support, catalysing change, and building sustainable institutional capacity. The four approaches to WHO’s support at country level listed below provide a guiding framework. 44 Ι WHO presence in countries, territories and areas 3.1 Technical backstopping One of WHO’s core functions and comparative advantages is the provision of high-quality technical cooperation from across the three levels of the Organization in order to catalyse change and build sustainable institutional capacity at the country level to achieve health impact. WHO country offices do not always have the capacity to respond effectively to the range of support required by countries and their dynamic, changing set of needs. ‘Technical backstopping’ in the form of technical and normative support from regional offices and headquarters is a recognized and essential approach for flexibly supporting countries with the right skills and expertise at the right time. Staff members from all three levels engage in missions and other forms of technical support to collaborate with and between the countries, territories and areas where WHO works to implement national health policies, strategies and plans developed on the basis of the SDGs and GPW 13. Figure 33. The three interacting levels of WHO Regional officesCountry officesHeadquarters Over the reporting period, country offices received support from regional offices and headquarters in areas such as: policy dialogue; adaptation of global and regional policies, strategies, tools and guidelines to national contexts and on-the-ground support for developing national documents; organizing technical meetings/seminars; training and consultations; and emergency response. Between January 2017 and 31 July 2018, a total of 5870 backstopping missions were conducted to support WHO country offices in all six regions. A total of 68% of these missions were initiated by WHO country offices, which indicates an increasing trend of demand-driven backstopping. The proportion of backstopping missions initiated by WHO country offices increased steadily from 51% in 2013–2014 to 68% in 2017–2018. Figure 34. Trend of missions initiated by WHO country offices between 2013 and 2018 (%) 01/03/2019 Extra 1/1 50 55 60 65 70 2013-2014 2015-2016 2017-2018 51 68 63 3. How we do it Ι 45 As presented in Figure 35, there is an increased trend of backstopping missions supported by regional offices (57% in 2017–2018) compared to 49% in 2013–2014. Headquarters provided 19% of backstoping missions in 2017–2018, which represents a slight overall increase compared to 2013–2014 (18%), but a decrease compared to 2015–2016 (22%). Figure 35. Proportion of backstopping missions by organizational level 2013–2018 (%) Headquarters Regional office Subregional office (where applicable) Joint visit by HQ and regional office (and/or subregional office) 01/03/2019 Mission trend 1/1 10 20 30 40 50 60 2013-2014 2015-2016 2017-2018 18 19 22 13 10 8 49 57 52 20 14 19 For WHO country offices in all six regions, the majority of technical backstopping comes from the respective regional office (70% in the Region of the Americas, 60% in the Eastern Mediterranean Region, 79% in the European Region, 54% in the South-East Asia Region and 46% in the Western Pacific Region). In the African Region, while a large proportion of backstopping comes from the regional office (39%), subregional offices play the largest role in terms of missions compared to other subregional offices in other regions. The African Region also receives the greatest amount of support from joint missions compared to other regions. The relatively high number of backstopping missions to countries in the European Region is in accordance with a region-specific model by which regional staff members provide technical assistance to countries rather than having an expert in each technical area in each country office. Communicable diseases accounted for the highest proportion (33%) of backstopping missions overall. Health systems/UHC comprised the highest proportion (25%) of backstopping missions in the Eastern Mediterranean Region, and the second highest overall reason for conducting a country mission (21%). The number of backstopping missions pertaining to health emergencies has increased in every region except for the Western Pacific Region since the 2017 country presence report, with a 54% increase reported in the African Region. While the 2019 country presence report covers a slightly shorter survey period, an increased number of backstopping missions have been reported by WHO country offices in the Region of the Americas and South-East Asia Region. Categories of WHO’s backstopping missions to countries: already working towards the three Strategic Priorities of the GPW 13 Universal health coverage Strengthening health systems to move towards UHC, ensuring equitable access to affordable health services.Working to increase and sustain access to prevention, treatment and care for HIV, tuberculosis, malaria and neglected tropical diseases and to reduce vaccine-preventable diseases. Better protection from health emergencies Helping countries prepare for and respond to health emergencies including extreme weather events and disease outbreaks. Better health and well-being Supporting countries to prevent and treat noncommunicable diseases and look beyond the health sector for solutions. Addressing environmental risks and social determinants of health, as well as gender, equity and human rights. 46 Ι WHO presence in countries, territories and areas Figure 36. Number of backstopping missions received by WHO country offices in the six regions from different levels of the Organization Figure 37. Distribution of backstopping missions to WHO country offices by region and area of work 3. How we do it Ι 47 3.2 Funding WHO’s work at the country level WHO requires predictable, flexible funding to provide high-quality technical assistance to Member States and to achieve results for people at the country level. This subsection provides details on the funds available to support WHO programmes in countries, territories and areas as well as the sources, distribution and status of expenditure during the report period. 3.2.1 Availability of financial resources at the country level As of 31 December 2018, US$ 2.48 billion was available for WHO country-level work under the WHO programme budget, representing 79% of the total planned costs for the 2018–2019 biennium, and an increase of 20% from the 2016– 2017 biennium. Of this amount, 58% (US$ 1.44 billion) was allocated for polio, outbreak and crisis response and special programmes, and 42% (US$ 1.036 billion) for base programmes. Key terms Assessed contributions Funds from Member States and Associate Member States used to finance the programme budget. They are calculated based on each country’s population and wealth. Core voluntary contributions Fully flexible funds at the level of the programme budget, or highly flexible at category level. Voluntary contributions Contributions made by Member States (and other partners) in addition to the assessed contribution. Earmarked funding is the biggest portion of the budget. Base segment Budget segment where WHO has exclusive strategic and operational control over undertaking the associated activities. Planned costs Amount allocated in the budget. The African Region and Eastern Mediterranean Region received 75% of total funds (US$ 1.86 billion) and 88% of funds allocated for polio, outbreak and crisis response and special programmes. The Eastern Mediterranean Region received 57% of funds for polio, outbreak and crisis response and special programmes as this Region contains two polio-endemic countries and seven priority countries1 facing Grade 2 and 3 emergencies. Since 2017 the number of polio-endemic countries has decreased from three to two, with polio funding being instrumental in providing support towards the eradication of polio. The South-East Asia Region received 10% of the total programme budget, while the European Region and Western Pacific Region both received 7% and the Region of the Americas 2%. Figure 38. Proportion of available funding allocated by segment (%) Base Polio, outbreak and crisis response and special programmes AFR AMR EMR EUR SEAR WPR In terms of the total base programme allocation, country offices in the African Region received the highest share of funds (37%), followed by the Eastern Mediterranean Region (20%), South-East Asia Region (17%), Western Pacific Region (14%), European Region (8%) and the Region of the Americas (4%). Higher funding for the African Region is consistent with the previous biennium and reflects organizational commitment to address the higher burden of disease and challenges of fragile health systems in that region. 1 Iraq, Libya, occupied Palestinian territory, Somalia, Sudan, Syrian Arab Republic and Yemen. 48 Ι WHO presence in countries, territories and areas 3.2.2 Distribution of base funds by programmatic priorities and operations The largest share of base funds distributed by programmatic priorities and operations to country offices was for communicable diseases excluding polio (34%) followed by cooperate services and enabling functions (19%), health systems (16%), health emergencies (14%), promoting health through the life-course (10%) and noncommunicable diseases (8%). This is consistent with data on backstopping missions which show that communicable diseases and health systems are the most frequent categories of missions received by country offices. The share of funding distributed to country offices for communicable diseases increased from 29% to 34% and for health emergencies from 10% to 14% in comparison to the 2016–2017 biennium. 3.2.3 Sources of funding for WHO country- level work WHO’s programme budget is funded through a mix of assessed and voluntary contributions. Assessed contributions are dues Member States pay to be a member of WHO. Member States (and other partners) may make voluntary contributions in addition to the assessed contribution. These are fully flexible at the level of the programme budget or highly flexible at the category level. Specified voluntary contributions account for the greatest proportion of funding allocated for the work of WHO country offices (82%), including 37% from Member States (other than their assessed contribution), 11% from United Nations organizations, 10% from philanthropic foundations, 7% from partnerships, 6% from Figure 39. Comparison of the distribution of base programme funds by category (%) Communicable diseases Corporate services and enabling functions Health Emergencies Programme Health systems Noncommunicable diseases Promoting health through the life-course 2016-2017 2018-20192018–20192016–2017 3. How we do it Ι 49 nongovernmental organizations and 10% from other sources. Assessed contributions made up 14% of overall funds allocated for country activities, with the distribution between voluntary and assessed contributions as sources of funding for WHO having remained consistent over the last four bienniums. Programme support costs accounted for the other 4% of distributed funds at the mid-biennial point. The institutions which are reported by WHO Region Most frequent donor Second most frequent donor Third most frequent donor African Region Government of the United States (17) Gavi (14) Government of the United Kingdom (12) Region of the Americas Government of Canada (7) Government of the United Kingdom (6) European Union (5) Eastern Mediterranean Region Government of the United States (9) European Union (8) Gavi (3) Government of Japan (3) European Region European Union (9) Government of the United States (5) Gavi (4) Global Fund (4) Government of Japan (4) South-East Asia Region Gavi (6) Government of the United States (5) Global Fund (4) Western Pacific Region Government of the United States (9) Government of the Republic of Korea (7) Government of Australia (6) Table 10. Donors reported in the ‘top three’ by WHO country offices; (x) denotes number of WHO country offices in each region receiving funds from the donor country offices to be among the top three donors that provided financial support to WHO country offices in 2017–2018 are detailed in Table 10. The Government of the United States was reported to be the most frequently mentioned donor – and among the top three donors to WHO country offices overall and in the African Region, Eastern Mediterranean Region and The Government of the United States of America is reported to be among the top three donors to 49 out of 149 WHO country offices. The European Union is reported to be among the top three donors to 35 out of 149 WHO country offices. It is the most frequent donor in the European Region, the second most frequent in the Eastern Mediterranean Region, and the third most frequent in the Region of the Americas. Gavi, The Vaccine Alliance, is reported to be among the most frequent donors to 33 WHO country offices. It is the most frequent donor to country offices in the South-East Asia Region, the second most frequent in the African Region, and the third most frequent in the Region of the Americas and the European Region. The Government of the United Kingdom is reported to be among the top three donors to 25 WHO country offices, reportedly the second most frequent donor in the Region of the Americas and the third most frequent in the African Region. The Government of Japan is reported to be among the top three donors to 18 WHO country offices, being the third most frequent donor in Eastern Mediterranean Region and European Region. Figure 40. The top five institutions funding WHO’s work in countries globally 50 Ι WHO presence in countries, territories and areas Western Pacific Region. The United States is followed by the European Union which was reported to be among the top three donors to 35 WHO country offices and the most frequently reported top donor in the European Region and also among the top donors in all regions except the Western Pacific Region. Gavi, the Government of the United States, specifically USAID, and the Government of the United Kingdom, specifically the Department for International Development (DFID), were reported to be among the top three donors by at least one WHO country office in every region. 3.2.4 Distribution and spending of planned funds at the country level Considering the distribution of funds against the planned budget among regions at the mid-biennium point, the European Region had received 88%, the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region had received 80–85% of the planned budget and the African Region and the Region of the Americas had received 70–75%. This represents a slight decrease compared to the same point in the 2016–2017 biennium for the African Region, Eastern Mediterranean Region and European Region, an increase of 2–5 percentage points for the South-East Asia Figure 41. Planned, distributed and spent funding by region at mid-biennium point of 31 December 2018 (US$ billion) AFR AMR EMR EUR SEAR WPR Planned costs Distributed funds Expenditure 3. How we do it Ι 51 Region and Western Pacific Region, and an increase of 30 percentage points for the Region of the Americas. As of 31 December 2018, the mid-point of the 2018–2019 biennium, fifty-five per cent of funds distributed for the 2018–2019 biennium had been spent at the country level, in line with the previous biennium. 3.2.5 Mobilization of funds for Human Resource support In 2017–2018, eighty-one per cent of WHO country offices reported mobilizing financial resources for supporting human resource/ programmatic activities. The amount of mobilized resources reported by WHO country offices to support their human resources or programmatic activities Figure 42. Number and proportion of WHO country offices reporting mobilization of resources for human resource support 83% 89% 100% 100%48% 93% 52 Ι WHO presence in countries, territories and areas Figure 43. Number of WHO country offices which reported mobilizing varying amounts of resources Less than US$ 1 million Between US$ 1–5 million Between US$ 6–10 million Above US$ 10 million between January 2017 and 31 December 2018 was most frequently between US$ 1–5 million (33%), followed by less than US$ 1 million (28%). Variations between regions are evident, with a third of WHO country offices in the Eastern Mediterranean Region reporting mobilizing over US$ 10 million. WHO country offices in the South-East Asia Region reported mobilizing a varied amount of resources. Four WHO country offices reported mobilizing between US$ 1 and 5 million, while four others reported mobilizing over US$ 10 million, namely Bangladesh, India, Indonesia and Myanmar. 3. How we do it Ι 53

Who we work with 4. As outlined in the GPW 13 strategic shifts, WHO is promoting the vital role of health by fostering partnerships at all levels of government, within the United Nations system, and with a range of non-State actors, including civil society “If we are serious about serving humanity, we need collaboration and partnership.” dr tedros a. ghebreyesus who director-general 4. Who we work with and communities at country level. WHO recognizes that engaging with partners from all sectors is crucial for driving health impact in each country. Specifically, at the country level, the Global Action Plan for Healthy Lives and Well-Being for All1 provides an additional opportunity for WHO to work with different partners – including bilateral and multilateral agencies – the United Nations System, funds and foundations, nongovernmental organizations and civil society organizations with a view to leveraging available expertise and providing coherent support to the implementation of the 2030 Agenda. 1 The Global Action Plan for Healthy Lives and Well-Being for All is an initiative of 12 global health organizations, led by WHO to support countries to take action on the health-related SDGs. It will be launched in September 2019 at the UN General Assembly. https:// www.who.int/sdg/global-action-plan 56 Ι WHO presence in countries, territories and areas This partnership approach of WHO at the country level can be categorized into: • engagement with government; • engagement with the United Nations System; • engagement with non-State actors and global health initiatives; • engagement with bilateral agencies; and • South–South and triangular cooperation. WHO country offices also work and collaborate on health issues with other intergovernmental organizations and subregional partners. 4.1 Collaboration with the United Nations system WHO collaboration with the United Nations System has been further strengthened, especially in the context of the Sustainable Development Goals and the reform of the United Nations development system. Through various United Nations coordinating mechanisms across the three levels of the Organization, WHO continues to support its Member States in achieving national health priorities and promoting better health outcomes. This collaborative approach also reflects WHO’s efforts to increase coherence, effectiveness and efficiency in delivering results. In the GPW 13, WHO has clearly stated its commitment to supporting the United Nations Secretary- General’s proposal to work as “One UN” to improve the efficiency and effectiveness of operational activities at the country level to support countries towards achievement of the Sustainable Development Goals. Work at the country level is key to progress towards addressing priorities, and platforms such as UNDAF, One United Nations Programme and health clusters in emergencies provide avenues to position health as well as catalyse multisectoral approaches for improved health outcomes. Reforms in the United Nations development system The 2030 Agenda for Sustainable Development set new, ambitious goals for all people around the world and reshaped the way the UN will work together to deliver on a global blueprint of such unprecedented scale. WHO is committed to contributing to the success of this UN reform process as stated in the GPW 13 and considers it an opportunity to position health at the centre of the UN system’s work at country level for achieving the SDGs. To effectively engage in this reform process and deliver on its promise, WHO will strengthen mutual accountability among UNCT members and hold its HWOs and Resident Coordinators accountable for increased priority and a multisectoral, integrated approach to achieving the health-related SDGs in the UNDAFs. WHO support to its Member States, including through country presence, remains subject to the direct request of the host country. WHO country presence is determined on the basis of bilateral discussions with the host government and corresponds to agreed health priorities and an allocated budget, in accordance with discussions in the Governing Bodies and the Global Policy Group. It is believed that a stronger WHO role at country level will depend on focused and mutually supportive engagement across several areas. In terms of promoting the centrality of health to the development process and strengthening WHO’s contribution to improved health outcomes, United Nations Resident Coordinators can advance WHO’s work by advocating for multisectoral action in response to cross-cutting issues across the SDG agenda; by maximizing entry points for WHO in sectors that influence health outcomes; and by increasing UN coherence and accountability on health-related SDGs within the context of UNDAF. A repositioned UNDAF is expected to serve multiple purposes and help support effective implementation of the SDGs and realize national health goals. WHO is supportive of increasing efficiencies, reducing costs and partnering with other UN agencies where this makes sense financially. WHO already participates in some common services in most of its country offices. Key elements of WHO’s collaboration with the United Nations System include: • positioning health in the debates and decisions of United Nations intergovernmental bodies; • contributing to a coherent and effective United Nations System at the global, regional and country levels; • providing leadership in health-related humanitarian efforts, including as the health cluster lead; and • promoting alliances and interagency approaches to address health issues. 4. Who we work with Ι 57 4.1.1 Supporting the United Nations Resident Coordinators As a UN specialized agency, WHO is committed to working as part of the United Nations country team (UNCT) within the Resident Coordinator system in support of the implementation of the 2030 Agenda for Sustainable Development. The Resident Coordinator system aims to bring together the different UN agencies to improve the efficiency and effectiveness of operational activities at the country level. Resident Coordinators lead and strategically position the United Nations country team in support of national priorities, development strategies and plans, and that role is pivotal to the success of the United Nations in driving the 2030 Agenda for Sustainable Development in each of the countries it serves. WHO is engaged with Resident Coordinators to strengthen the health capacity of the United Nations country teams, while recognizing WHO’s constitutional mandate to act as the directing and coordinating authority on international health work. WHO country offices reported the presence of a Resident Coordinator in 85% of countries, territories and areas where the WHO is physically present. During the period from October 2016 to 31 October 2018, HWOs served as acting Resident Coordinators in 88 of the 149 countries, territories and areas where WHO is physically present, as reported by WHO country offices. In 86% (76) of these countries, that role was assumed for a period of less than three months, while it lasted for more than six months in 5% of the countries, showing an increase in both cases from the 2017 country presence report. In 26% of countries (24) with a Resident Coordinator, the WHO country offices reported contributing financially to the functioning of the Resident Coordinator office. Figure 44. Proportion of WHO country offices per region reporting that the HWO acted as the Resident Coordinator at some point during the survey period, and the average duration of the assignment 58 Ι WHO presence in countries, territories and areas 4.2 Engaging within the United Nations Country Teams WHO’s efforts count most when it works in countries as part of the United Nations system. Through its country offices, WHO actively participates in United Nations joint activities towards achievement of the SDGs within the context of national priorities. The United Nations country team is the platform through which WHO: • strengthens dialogue among UN funds, programmes and specialized agencies; • fosters a multisectoral response to health challenges; • mobilizes additional resources to achieve national health goals. There is a UNCT in 91% (135 of the 149) of countries, territories and areas where WHO is physically present. There is a UNCT in all countries, territories and areas in the African Region, Eastern Mediterranean Region and the South-East Asia Region, 93% of countries, territories and areas in the Region of the Americas, 74% in the European Region and 73% of countries, territories and areas in the Western Pacific Region. WHO is the only United Nations agency present in one country in the Region of the Americas and in eight countries in the European Region. 4.2.1 WHO participation in Joint National/ United Nations Steering Committees Joint National/United Nations Steering Committees are a mechanism for effective collaboration between the government and United Nations agencies towards the achievement of national development goals. These committees are established in 76 (51%) countries, territories and areas where WHO is physically present. WHO country offices in 68 countries, territories and areas reported participating in the Joint Steering Committee. 4.2.2 United Nations Development Assistance Framework The UNDAF is the planning and implementation instrument for United Nations development activities in each country, in support of the implementation of the 2030 Agenda for Sustainable Development. It describes the collective and coherent response of the United Nations to national development priorities. The UNDAF is sometimes referred to as a United Nations Development Plan or a One United Nations Plan. WHO actively engages in developing, implementing and monitoring the UNDAF, shapes its health dimension, and aligns its country cooperation strategy with UNDAF. The UNDAF or equivalent document is reported in 130 (87%) of the 149 countries, territories and areas where WHO is physically present, and in over 90% of countries, territories and areas in the African Region, Region of the Americas, South- East Asia Region and Western Pacific Region. Figure 45. Proportion of WHO country offices reporting the presence of and participation in different activities of UNCTs (%) United Nations country team Operations Management Team United Nations Resident Coordinator Thematic working groups/results groups UNDAF or equivalent Joint United Nations communications programme Joint resource mobilization Joint programmes Political/peacekeeping mission 01/03/2019 Q23 1/1 AMR 0 50 100 96 93 93 93 89 63 63 44 19 AFR 0 50 100 100 98 98 94 91 79 70 62 23 EMR 0 50 100 100 100 100 94 83 78 78 44 44 EUR 0 50 100 74 61 61 58 58 48 35 32 10 SEAR 0 50 100 100 100 100 100 100 73 73 36 9 WPR 0 50 100 87 87 73 73 67 67 47 33 4. Who we work with Ι 59 WHO country offices in 128 countries (98% of countries with an UNDAF) reported to have participated in the development of the UNDAF and to be contributing to its monitoring and evaluation. By aligning the WHO country cooperation strategy, biennial collaborative agreements and helping to shape the health dimension of the UNDAF, WHO aims to ensure a more coordinated and integrated support to countries in achieving the health-related goals of the 2030 Agenda for Sustainable Development. To respond in an integrated and coherent manner to national development priorities in a country, the United Nations country team identifies strategic priorities (sometimes called results, areas, pillars or clusters) in the UNDAF. These pillars, framed by the 2030 Agenda for Sustainable Development, reflect the country situation, and are in line with national priorities and needs. In some countries, the UNDAF has specific health pillars. To ensure better health outcomes in countries, the country cooperation strategy and the health dimension of UNDAF have been harmonized and are mutually reinforcing. Of the 130 countries, territories and areas with an UNDAF, 31 (24%) corresponding WHO country offices reported that it reflects all the priorities in the country cooperation strategy and 93 (72%) reported that it reflects some of the priorities. The UNDAF reflects some or all of the country cooperation strategy priorities in 100% of countries, territories and areas with the UNDAF in the Region of the Americas, Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region, 93% in the African Region and 83% in the European Region. WHO country offices reported that health is incorporated into the UNDAF at outcome level (107 countries) and output level (103 countries). Incorporation of health in UNDAF has increased in comparison to the 2017 country presence report at all four levels, with a 7% increase in incorporation at outcome level and a 22% increase in incorporation at output level. Overall, universal health coverage is the most frequently included health priority in UNDAF Figure 46. Total number of UNDAFs per region where the WHO country office was involved in its development, monitoring and evaluation and degree of alignment to CCS UNDAF reflects some CCS priorities UNDAF reflects all CCS priorities UNDAF does not include any CCS priority AFR AMR EMR EUR SEAR WPR 60 Ι WHO presence in countries, territories and areas (87%). From the regional perspective, universal health coverage was the most frequently included health priority in UNDAFs in the Region of the Americas, Eastern Mediterranean Region, European Region and Western Pacific Region. “Promoting health through the life course” is reflected in 82% of UNDAFs. Noncommunicable d i seases (NCDs) and communicable diseases were each included in UNDAFs in 78% of countries, territories and areas, 80% of which included both areas, highlighting the many settings facing a double burden of communicable and noncommunicable diseases. Inclusion of antimicrobial resistance as a health issue increased from 15% of UNDAFs in the 2017 country presence report to 24% in this reporting period. 4.2.3 WHO participation in the thematic groups of United Nations country teams To promote an integrated approach, the United Nations country teams establish thematic or results groups in which WHO actively participates. These groups function as a coordination mechanism at the operational level that contributes to the achievement of UNDAF outcomes and covers a variety of areas from health to human rights and the environment. WHO participates and assumes leadership roles across multiple thematic and results groups. The highest level of involvement reported by WHO country offices is in the health thematic group (91% of countries with a United Nations country team) followed by disaster risk reduction, gender, and Sustainable Development Goals implementation (79%) and monitoring and evaluation and nutrition/food safety (74%). Between 55% and 60% of WHO country offices in countries with a United Nations country team reported being involved in thematic groups dealing with access to social services/social protection, environment, human rights and water and sanitation. In 77% of countries, territories and areas, the health thematic group is reportedly chaired or co-chaired by WHO, an increase of 11 percentage points from the 2017 country presence report. Figure 47. The number of WHO country offices reporting inclusion of health at different levels in the UNDAF Joint work plan Outcome level Output level Results group 4. Who we work with Ι 61 Additionally, WHO chaired or co-chaired an increasing number of health-related thematic groups between the 2017 and 2019 country presence reports as reported by WHO country offices. Overall participation in five of the thematic or results groups has increased over this time frame, with the largest increases evident in the monitoring and evaluation group (+12 percentage points) and the Sustainable Development Goals implementation group (+10 percentage points). 4.2.4 WHO participation in United Nations common business operations and activities WHO country offices in 81% of countries, territories and areas reported participating in at least one of the United Nations common business operations and activities, an increase from 70% in the 2017 country presence report. This is most commonly security services (79% with 46% of WHO country offices contributing in-kind), followed by local procurement (39%), travel Table 11. Number of WHO country offices reporting participation in UN common business operations and activities Region Nu m be r o f W HO co un tr y of fic es Se cu rit y se rv ice s Lo ca l pr oc ur em en t Tr av el Ad m in ist ra tiv e se rv ice s In fo rm at io n te ch no lo gy Lo gi st ics an d tr an sp or t IC T Ba nk HR No ne Ot he r AFR 47 39 27 19 19 18 18 16 13 14 3 8 AMR 27 10 6 9 2 6 1 3 4 1 10 1 EMR 18 17 8 7 10 7 10 8 6 7 1 1 EUR 31 17 10 3 5 5 6 6 7 1 3 5 SEAR 11 9 3 3 3 1 0 2 1 1 1 1 WPR 15 9 4 3 4 2 3 2 1 3 2 0 Nutrition Disaster Risk Reduction  Monitoring and Evaluation Gender Access to services and social protection Water and sanitation Environment  Human RightsHealth SDG implementation Figure 48. Thematic/results groups of the United Nations country team in which WHO country offices reported participation 62 Ι WHO presence in countries, territories and areas (30%) and administrative services (29%). Eight WHO country offices (five in the African Region, two in the Eastern Mediterranean Region and one in the Western Pacific Region) reported partaking in at least nine of the ten activities. 4.2.5 WHO participation in joint activities of the United Nations resident coordinator office WHO’s commitment to work as “One UN” as part of the resident coordinator system, is also demonstrated by its participation in joint activities organized by the resident coordinator office in countries. A total of 132 WHO country offices reported participating in or contributing in-kind to joint activities organized by the United Nations resident coordinator office. This includes all countries, territories and areas in the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region, 98% in the African Region, 70% in the Region of the Americas 4. Who we work with Ι 63 Figure 49. Percentage of WHO country offices by region reporting participation in, and in-kind contribution to joint activities of the UN resident coordinator office Participating (%) Providing in-kind contribution (%) AFR SEAR WPR Common business operations UN Security UN Dispensary Committee Joint Resource mobilization strategy Joint Communication group Joint Assessments Functioning Resident Coordinator office (e.g. RC premises) and 74% in the European Region. Over 60% of WHO country offices reported participating in joint assessments, and joint communication groups. A participation level of over 75% was reported for joint communication groups and joint assessments in both the African Region and Eastern Mediterranean Region. Joint resource mobilization activities between the United Nations and WHO generate additional resources to fulfil United Nations commitments reflected in the UNDAF. Various mechanisms are in place to jointly mobilize resources at the country level. Joint resource mobilization is reported by WHO country offices in 46% of countries, territories and areas where WHO has a presence. Eleven WHO country off ices reported participating in all seven activities highlighted in Figure 49, with the highest proportion participating in security services (79%) or joint communication group (66%). 4.3 UN Multi-Partner Trust Funds The Multi-partner or Multi-Donor Trust Funds (MDTFs) are partnerships by which the United Nations system, national authorities and funding partners establish a joint fund that uses the “pass-through fund management” model. These funds can be established in a variety of ways and can have a thematic or geographic focus. These pooled funds have common guiding strategies:2 • involves a broad range of stakeholders in the decision-making process; • builds on existing structures (rather than creating parallel ones); • strengthens aid effectiveness through coordinated and harmonized interventions; • full transparency and accountability in funding, management and implementation; • focuses on effective and efficient delivery of results. 2 Drawn from the Multi-Partner Trust Fund Office Gateway (www.mptf. undp.org) MDTFs are generally established to support a country and/or global strategic priorities that are defined in national or strategic plans of the UNDAF, Delivering as One (DaO) and similar strategic frameworks. WHO, as a UN agency, participates in the development of UNDAFs at the country level and can apply for funds as relevant, where MDTFs exist in country programmes. WHO country offices in 24 countries, territories and areas received funds from United Nations Multi- Partner Trust Funds, such as the One Fund/MDTF and the Sustainable Development Goals fund. Figure 50. Number of WHO country offices reporting receiving funds from United Nations Multi-Partner Trust Funds AFR AMR EMR EUR SEAR WPR In May 2018, the International Labour Organization (ILO), the Organization for Economic Co-operation and Development (OECD) and WHO signed a memorandum of understanding operationalizing the Working for Health Multi-Partner Trust Fund (MPTF). The MPTF will enable partners to pool resources and drive implementation of the Working for Health five-year action plan, a collaborative partnership between ILO, OECD and WHO to support countries to invest in the health and social service workforce required to achieve universal health coverage and the Sustainable Development Goals. 64 Ι WHO presence in countries, territories and areas 4.4 WHO country-level engagement with global health initiatives Development partners play an increasingly important role in promoting and protecting the health of the population in a country. Global health initiatives are humanitarian initiatives that raise and disburse additional funds for infectious diseases such as AIDS, tuberculosis and malaria; for immunization; and for strengthening health systems in low and middle-income countries. WHO recognizes the significance of these contributors to health and development in a country and gives priority to closely collaborating with them. One objective of this collaboration is to support the health ministry and health sector in general, to raise adequate financial resources for health programmes. The existence of a donor coordination mechanism was reported by 89 (60%) WHO country offices overall, and between 39% and 77% of WHO country offices within each region. These coordination platforms include bilateral development partners, multilateral agencies, funds and philanthropic foundations, nongovernmental organizations and civil society, the private sector and academic institutions. WHO plays a leadership role as either chair, co-chair or rotational chair in 62 (70%) of the countries, territories and areas with a donor coordination mechanism for health, while it acts as the Secretariat in 31 (35%) and as a participant in a further 22 (25%) countries. 4.4.1 WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is one of the leading funders of the prevention and control of HIV, TB and malaria. WHO is the only technical partner of the Global Fund that has expertise in HIV, TB, malaria, health systems strengthening, reproductive, maternal and newborn, child and adolescent health. WHO has an office in every country with a Global Fund grant, this global reach being essential for making an impact in the prevention and control of the three diseases targeted by the Global Fund, as well as strengthening the systems needed to deliver critical services and reach vulnerable populations. Recognizing the critical role of funding from the Global Fund Figure 51. Proportion of WHO country offices reporting the existence of a donor coordination mechanism and number of WHO country offices playing various roles in the coordination mechanism Chair or rotational chair Secretariat for the coordination mechanism Co-chair with other partners Participant but no leadership or coordination role Other 4. Who we work with Ι 65 in preventing and controlling diseases and strengthening systems, WHO country offices work in close partnership and collaboration with governments and partners to avail and use Global Fund financial resources. Countries consider WHO as their first port of call for information and technical support. In 113 countries, territories and areas with a WHO office and eligibility for Global Fund grants, WHO has provided technical support and/or capacity building for accessing, implementing and reporting on Global Fund grants. WHO country offices are most frequently engaged in being active members of the Country Coordination Mechanism (89%) and in updating disease control strategic plans (88%), with over 80% also facilitating comprehensive Strategic Framework for Collaboration between WHO and the Global Fund WHO and the Global Fund share a common commitment to universal health coverage and the SDGs. In 2018, to further strengthen and optimize the partnership between the two organizations, a Strategic Framework for Collaboration was signed. The Framework is designed to improve collaboration and communication between WHO and the Global Fund on a wide spectrum of policy, technical and programmatic areas to combat HIV, TB and malaria and efforts to support countries in building health systems, improving reproductive, maternal, newborn, child and adolescent health and addressing wider determinants of health. The agreed principles for this partnership have been defined and include country focus and partnership; gender and human rights; respect for each other’s mandate; evidence-based implementation; alignment between and within agencies; transparency and accountability. While the heads of both organizations are expected to meet annually, a joint steering committee and working groups will be meeting periodically to review progress and support implementation. Figure 52. Percentage of Global Fund-eligible countries where WHO has an office and supports the government to access and implement grants Active Member of the Country Coordination Mechanism Updating disease control strategic plans Facilitating comprehensive country dialogue across HIV, tuberculosis, malaria and health systems strengthening to determine cross-cutting elements in the Global Fund allocation envelope Funding request Concept note or proposal development Updating disease epidemiology and key intervention coverage trends Reporting on monitoring and evaluation of grant progress and performance Grant negotiation and implementation for service delivery Procurement of medical and public health supplies and equipment Managing WHO technical staff funded by Global Fund Implementing activities funded by the Global Fund for WHO country offices 66 Ι WHO presence in countries, territories and areas country dialogue across HIV, tuberculosis, malaria and health system strengthening (HSS) to determine cross-cutting elements in the Global Fund allocation envelope. WHO also supports the development of funding proposals and updating of epidemiological data and intervention coverage trends. Fifteen WHO country offices reported being engaged in all 10 roles highlighted in Figure 52. WHO country offices across 52 countries, territories and areas reported acting as subrecipients of at least one Global Fund grant with 29 of these receiving a grant for more than one programme. Tuberculosis is the primary programme through which the WHO country offices act as subrecipients (63%) followed by HIV/AIDS (60%), malaria (42%), health systems strengthening (23%) and RMNCH (6%). The proportion of WHO country offices in each region acting as subrecipients of Global Fund grants was 80% in the Western Pacific Region, 64% in the South-East Asia Region, 44% in the Eastern Mediterranean Region, 26% in the African Region and European Region, and 19% in the Region of the Americas. WHO and the Global Fund have developed a long-term, sustainable partnership to promote prevention and control to end the epidemics of HIV, tuberculosis and malaria. Under this partnership, significant financial resources have been mobilized and spent to strengthen countries’ ability to develop strategic, results-oriented grant proposals and effectively implement the approved grants. This collaboration is executed through the following key elements: • in-country technical assistance; • building the capacity of technical assistance providers through regional offices; and • assuring the quality of the technical assistance provided. WHO staff members at the country, regional and headquarters levels provide invaluable support to help attract critical financial resources from the Global Fund for government and civil society organizations. More than 400 WHO staff members directly and indirectly contribute meaningfully Figure 53. Global and regional distribution of Global Fund programmes for which the WHO country office has received a sub-grant 4. Who we work with Ι 67 to Global Fund processes and support health ministries in effectively implementing grants. 4.4.2 WHO and Gavi, the Vaccine Alliance Gavi, the Vaccine Alliance (Gavi), is an international alliance that was created in 2000 to improve access to new and underused vaccines for children living in the world’s poorest countries. WHO is a key policy influencer and implementing partner of Gavi. Vaccines contribute to healthier populations and universal health coverage through the life course, and WHO has developed a strategic approach to immunization to be aligned with GPW 13, with one focus area devoted to driving immunization impact in countries. The ultimate goal is to fully align the WHO GPW 13 implementation with the bottom-up approach of the Gavi Partners’ Engagement Framework. Gavi aims to focus its support on the world’s poorest countries, with national incomes determining eligibility. WHO country offices in 73 (49%) countries, territories and areas reported contributing to accessing and implementing Gavi grants, the same number as in the 2017 country presence report. Over 90% of these WHO country offices were engaged in supporting programming, planning and implementation or supporting reporting and monitoring. The majority (84%) of WHO country offices involved in supporting Gavi grants reported being engaged in at least five of the roles highlighted in Figure 54. In the field, Gavi relies significantly on collaboration with WHO’s six regional offices and country offices in countries that receive Gavi support. This support is provided through: • regional working groups that coordinate support for country programmes working through a core group of partners usually led by WHO and UNICEF; • WHO country offices working closely with national health authorities and their partner organizations in identifying national health priorities, formulating policy and supporting immunization and health system development; and Figure 54. WHO country offices which reported providing support to Member States in accessing and implementing Gavi grants, showing (a) % of country offices in each region participating, and (b) % of country offices which reported providing different types of support Support for programming, planning and implementation Reporting and monitoring Application for new vaccine introduction Member of the Inter-Agency Coordinating Committee (ICC) and/or Health Sector Coordination Committee (HSCC) or equivalent Preparation and reporting of Joint Appraisals Proposal Development Support for transitioning out of Gavi support Channelling funding for cash grants Other 68 Ι WHO presence in countries, territories and areas • WHO offices also assisting country health authorities in drafting applications for Gavi support and drawing up a plan of action for introducing vaccines. In addition, WHO staff members provide technical support for implementing immunization programmes, including storage and logistics, and monitoring and evaluating vaccines and equipment after they are introduced. 4.4.3 South-South and triangular cooperation The 2030 Agenda reaffirms the need to enhance South-South and t r iangular (SSTC) as well as regional and international cooperation on access to science, technology and innovation for the achievement of the Sustainable Development Goals. South-South and triangular cooperation is also recognized as one of the means to strengthen international support for implementing capacity-building in developing countries to support national plans to implement all the Sustainable Development Goals. The Thirteenth General Programme of Work emphasizes that WHO will help develop and scale up innovative solutions using such approaches as South−South cooperation. Globally, half of the WHO offices in countries, territories and areas in the six regions reported supporting a total of 241 South-South and/or triangular cooperation initiatives. The highest proportion of country office support for SSTC initiatives was reported in the Region of the Americas (78%), followed by the South-East Asia Region (64%), the Western Pacific Region (60%), the African Region (55%), the Eastern Mediterranean Region (28%) and the European Region (19%). Figure 55. Number of WHO country offices in each region which reported supporting SSTC initiatives AFR AMR EMR EUR SEAR WPR WHO country offices not involved in supporting SSTC Figure 56. Proportion of WHO country offices which reported support of SSTC initiatives and number of initiatives per region AFR AMR EMR EUR SEAR WPR 4. Who we work with Ι 69 Of the countries, territories and areas that supported SSTC initiatives, 50 WHO country offices (68%) reported supporting initiatives related to communicable diseases, followed by health systems strengthening and universal health coverage by 35 WHO country offices (47%). Health emergencies and International Health Regulations (IHR) initiatives were supported by 28 country offices (38%), followed by noncommunicable disease in 23 countries (31%), and promoting health through the life- course in 22 countries (30%). Timor-Leste, Sri Lanka: Strengthening immunization programme management The health system in Timor-Leste is relatively underdeveloped due to several years of conflict. A wide geographical spread of demographics poses a challenge to implementing a responsive immunization programme. Coupled with constrained capacity of the health system and an understaffed immunization (EPI) unit, transitioning from Gavi support at the end of 2019 is considered a big challenge. To cushion the transition from Gavi support, there was an urgent need to develop capacities within the EPI unit and the Ministry of Health. Sri Lanka, which had also suffered the impact of internal conflict, transitioned out from Gavi support in 2016 and took control of its own EPI with full government funding. In June 2017, at the sidelines of the WHO SEAR ITAG Meeting, Gavi, WHO, Sri Lanka and Timor-Leste officials met and had a preliminary discussion on how the two nations could build a partnership to strengthen the immunization programmes in both countries. South-South collaboration became the proposed solution. WHO, UNICEF and Gavi are supporting both nations in their twinning partnership. Under this programme, Timor-Leste’s health professionals are learning directly from their peers from Sri Lanka. For Sri Lanka, this programme provided an opportunity to showcase the strengths of its immunization programme both globally and regionally. It also enhanced its capacities in EPI mentoring and coaching with the potential for future twinning arrangements with other countries. Through this mutual partnership, both nations are on the fast track to achieving good health and well-being for women and children. Timor- Leste is now the third country to eliminate rubella and measles in South Asia. Upon completion of this twinning programme, a horizontal collaboration especially between South-South nations will be recognized as an effective solution for other countries challenged by capacity building and health systems development. Figure 57. Number of WHO country offices by region supporting SSTC initiatives in various technical areas Communicable diseases Health Emergencies and International Health Regulations (2005) Health systems and universal health coverage Noncommunicable diseases Promoting health through the life course Other Global Global Global 70 Ι WHO presence in countries, territories and areas The major focus of the initiatives varies among regions. Countries in the Region of the Americas were most likely to have reported supporting initiatives which were related to health systems and universal health coverage along with communicable diseases. The African Region also reported that the most common type of initiative supported by countries pertained to communicable diseases along with health emergencies/IHR. The top focus on initiatives in the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region was also on communicable diseases, while it shifted to noncommunicable diseases in the European Region. Over three quarters of WHO country offices reported the existence of SSTC initiatives including support through technical backstopping, while 74% provided support through training and capacity building, 47% by establishing information sharing platforms and networks, 32% provided financial and equipment support and 18% provided other services. South-South and triangular cooperation has been mainstreamed into the policies and programmes of the Organization and has become a means of implementation for achieving the health-related Sustainable Development Goals. However, keeping in mind the significance and contribution of SSTC to the protection and promotion of health in developing countries, this form of cooperation must be further strengthened and WHO country offices enabled to promote it. Figure 58. Number of WHO country offices supporting SSTC initiatives by type of support provided 11/03/2019 Q18c 1/1 AFR 10 6 6 19 18 21 AMR 12 8 3 18 17 6 EMR 3 3 3 4 13 EUR 4 3 4 4 25 SEAR 4 2 1 7 5 4 WPR 2 2 1 5 7 6 35 24 13 56 55 Global Training and capacity building Technical support Other types of support Financial and equipment support Establishment of information sharing platforms and networks 4. Who we work with Ι 71

Our work and its results 5. 5. Our work and its results Reflecting the overarching objective set out in WHO’s Constitution1 of enjoyment by all peoples of “the highest attainable standard of health”, GPW 13 places countries at the centre of WHO’s work. The foundation of WHO’s work is Sustainable Development Goal 3: ensuring healthy lives and promoting well-being for all at all ages. To ensure its achievement, GPW 13 has set the ambitious ‘triple billion’ goal on: • Universal health coverage – 1 billion more people benefitting from universal health coverage; • Health emergencies – 1 billion more people better protected from health emergencies; • Healthier populations – 1 billion more people enjoying better health and well-being. Placing the focus on the most vulnerable people, the GPW 13 also strives to ‘leave no one behind’. To deliver on the ambitious GPW 13, WHO is undergoing a number of strategic shifts to become more focused and effective in driving progress/impact in its country-based operations, working closely with partners, engaging in policy dialogue, providing strategic support and technical assistance, 1 WHO constitution, entered into force 7 April 1946, available at https:// www.who.int/governance/eb/who_constitution_en.pdf (accessed 2.7.2019). and coordinating service delivery, depending on the country context. Across 149 offices in countries, territories and areas, WHO staff, backed by six regional offices and headquarters, provide ministries of health with policy advice and technical assistance in many areas, including scaling up essential prevention, treatment and care services to achieve better health outcomes for populations. To showcase the result of the work of WHO offices in countries, territories and areas, more than 200 country experiences and success stories on the role of WHO teams in the field were compiled from its field offices. These stories highlight progress in a range of SDGs such as those relating to: communicable diseases, noncommunicable diseases, promoting health through the life-course (including sexual and reproductive, maternal, newborn, child and adolescent health; social determinants of health; and health and environment), health systems and universal health coverage, health emergencies and the International Health Regulations (all country stories will soon be made available on the country presence portal). For illustrative purposes, selected country stories from across all WHO regions covering the three strategic priorities of the GPW 13 are included below. Figure 59. GPW 13 strategic priority outcomes – promoting health, keeping the world safe, serving the vulnerable PROTECTION FROM HEALTH EMERGENCIES • Countries prepared for health emergencies • Epidemics and pandemics prevented • Health emergencies rapidly detected and responded to BETTER HEALTH AND WELL-BEING • Determinants of health addressed • Risk factors reduced through multisectoral action • Healthy settings and Health-in-All- Policies promoted UNIVERSAL HEALTH COVERAGE • Improved access to quality essential health services • Reduced number of people suffering financial hardship • Improved access to essential medicines, vaccines, diagnostics and devices for primary health care 74 Ι WHO presence in countries, territories and areas Fi gu re 60 . E xa m pl es of W HO co un tr y o ffi ce ac tiv iti es w or ld w id e 5. Our work and its results Ι 75 The essence of universal health coverage is a strong and resilient people-centred health system with primary care as its foundation. WHO provides support to countries to progress towards universal health coverage and the goal of ensuring that all people and communities Expanding universal health coverage have access to, and can use the promotive, preventive, curative, rehabil itative and palliative health services that are appropriate to their needs, and that are of sufficient quality to be effective, while not exposing the user to financial hardship. SERVICE ACCESS AND QUALITY HEALTH WORKFORCE ACCESS TO MEDICINES, VACCINE AND HEALTH PRODUCTS GOVERNANCE AND FINANCE HEALTH INFORMATION SYSTEMS POLICY DIALOGUE 76 Ι WHO presence in countries, territories and areas SOLOMON ISLANDS Western Pacific Region The Ministry of Health & Medical Services (MHMS) established the National Health Strategic Plan 2016-2020 (NHSP) and the Solomon Islands Government (SIG) have since identified that the Role Delineation Policy (RDP) is the key implementation mechanism to operationalize the NHSP and move towards universal health coverage. Traditionally, service delivery has not been integrated, especially as 80% of the population lives in rural and remote areas. RDP promotes integrated and patient centered care through service delivery packages provided in each of six levels of service and facilities, with referral pathways as well. Packages include considerations of staffing, equipment, essential medicines, guidelines, clinical support services at each level. WHO responded to country needs and helped in building strong partnerships in health and mobilizing and coordinating all available resources. The WHO country office has a program of ongoing support for the MHMS as it embarks on the implementation of RDP in the years ahead. After consultations conducted by the RDP national and provincial health planners, local staff and communities now have a common reference to identify what range and quality of services they can expect and deliver. RDP provides a roadmap for the realization of universal health coverage for the country. Challenge: implementing the NHSP to move towards universal health coverage Action: promote decentralized service delivery packages Outcome: common reference on range and quality of health services SERVICE ACCESS AND QUALITY 5. Our work and its results Ι 77 ARGENTINA Region of the Americas The Argentine Public Health Virtual Campus of the Pan American Health Organization/World Health Organization (PAHO/WHO) plays a strategic role for professionals and health workers. With a total of 79 296 persons enrolled, the platform offers a wide range of courses, resources, services and educational activities, as well as information and knowledge management in health. This Virtual Campus is comprised of a network of committed people, institutions and organizations that collaborate with a shared objective of strengthening capacity in public health. It is an important tool resulting from the joint effort of the Ministry of Health and Social Development (MOHSD) and PAHO/WHO to train public health professionals. The MOHSD’s National Observatory on Human Resources for Health supports the management of the Virtual Campus and designs and promotes courses according to its needs in coordination with PAHO/WHO. As a result, in 2017 alone, more than 30 courses were provided through the Argentine node of the PAHO/WHO virtual campus including courses on primary care management, establishing electronic health records, environmental health practice, surveillance of non-communicable diseases, vaccines in medical practices and key aspects of essential medicines. In 2017, more than 19 000 people participated in courses through self-learning or with tutoring in the country. Most of these courses were developed with contributions from the government. As a result, the PAHO/WHO Virtual Campus has evolved into a key resource for learning and collaboration in Argentina and has served to strengthen the steering and governance role of the national health authorities. Challenge: providing a platform for training public health professionals Action: creation of Virtual Campus to deliver courses Outcome: strengthening the human resources for health HEALTH WORKFORCE 78 Ι WHO presence in countries, territories and areas INDIA South-East Asia Region In India, an estimated 40 million people are infected with hepatitis B and approximately 6 million people are infected with hepatitis C with 184 000 deaths annually due to complications, twice the number of HIV and malaria deaths combined. In 2017, the Government of India responded to this public health crisis by providing free nation-wide treatment for hepatitis C using generic direct acting antiviral (DAA) drugs. This decision was made based on the results of a hepatitis C treatment programme that was piloted in Punjab state and from two economic analyses that were conducted with WHO’s technical support, including a cost-effectiveness analysis of DAA treatment and a treatment cost analysis of the whole course of drugs based on the pilot project. The results showed that a 12-week course using DAAs would cost $300 and that this plan would continue to be cost-effective over time. From June 2016 to September 2018, over 50 000 hepatitis C patients started the free treatment in Punjab and there was a cure rate of more than 92%. Generic drugs are now being manufactured in India making them affordable by bringing the cost down from $300 to $70 for a 12-week course. The generic drug programme used a decentralized service delivery model called ECHO in which doctors in tertiary hospitals provide oversight and monitoring via WhatsApp to doctors in district hospitals. Patients are monitored and those with viral suppression are given a certificate to prove they are disease free. Challenge: hepatitis B and C are a public health crisis Action: providing evidence on cost-effectiveness of pilot Outcome: piloting the project in Punjab with a 92% cure rate ACCESS TO MEDICINES, VACCINE AND HEALTH PRODUCTS 5. Our work and its results Ι 79 RWANDA African Region Over 80% of the population in Rwanda had financial barriers in accessing health care. Rwanda introduced community-based health insurance (CBHI) to address this issue, but faced some challenges along the way. Collecting premiums, attaining optimal recovery levels, a regressive flat fee premium, and significant financial deficit in covering reimbursement costs to CBHI providers were all challenges. WHO worked with partners to support and develop national health financing and CBHI policy documents and laws, to promote institutional capacity building, and to categorize people and health financing systems by socio-economic health financing system reviews. The WHO country office also advocated for equitable health care access, financial protection, policy support to move CBHI from the Ministry of Health/Districts to Rwanda Social Security Board (RSSB), and resource mobilization through the United Nations Development Assistance Plan. Since CBHI transferred to RSSB, coverage increased from 76% to 81% and utilization rose from 0.9 to 1.72 visits per person per year. The financial risk protection situation has improved, with a decrease of households who faced catastrophic health expenditure by more than 1.5% and a decrease in inequities between poorer and wealthier and/or urban and rural households. Challenge: financial barriers to accessing healthcare Action: supporting the development of a community based health insurance Outcome: improvements in coverage, visit rates, and financial protection GOVERNANCE AND FINANCE 80 Ι WHO presence in countries, territories and areas TAJIKISTAN European Region Recognizing that the collection of accurate and up-to-date data is crucial for evidence-based policy-making to achieve universal health coverage, WHO provided support to the Agency for Statistics under the President of the Republic of Tajikistan to gather reliable data on key areas such as health services utilization, unmet need and financial burden. The work was focused on updating a health module of the Household Budget Survey (HBS) and providing in-depth training for over 100 survey interviewers from the Agency for Statistics. The training series was in July 2018 and focused on building the capacity of interviewers, at both national and regional levels, to collect data on health services utilization and household expenditures within the scope of the routinely conducted HBS. During the training, interviewers were given guidance on processing data from the questionnaires and on fieldwork using the computer-assisted personal interviewing (CAPI) application. Including the revised health module questionnaire with the regular HBS makes it possible to link utilization and health expenditure data to detailed information on household consumption, including costs associated with disability. This data helped in strengthening analysis on equity and poverty dimensions, and the relevant financial protection aspects per household. It has also allowed for the calculation of the burden of health-care expenditures and the estimation of the impact of catastrophic health expenditures. Challenge: improving evidence-based policy making Action: training 100 employees of the Agency of Statistics in health services data collection Outcome: building capacity to investigate equity and poverty dimensions in health HEALTH INFORMATION SYSTEMS 5. Our work and its results Ι 81 TUNISIA Eastern Mediterranean Region Absence of coherent health sector vision has been an important challenge to the achievement of universal health coverage in Tunisia. One of the aims of the Tunisian Jasmine Revolution was to create better conditions of life, including better access to quality public services, more accountability, and a more open society where people influence policymaking more directly. The WHO country office has been helping establish an innovative citizen participation mechanism called “Dialogue Sociétal en santé” to define a common vision in policy making for universal health coverage and will monitor implementation mid-2018. Seven thematic strategic documents had been developed through Dialogue which cover the following themes: people centered-care, health determinants and multisectoral action, health financing, drugs and medical devices, digital health, health research and health sector governance. Debates around these strategic documents have been organized with support from the WHO country office. The participatory process of the Dialogue Sociétal and its ownership by the different stakeholders, including civil society, is an example of health democracy that can inspire other countries. Tunisia is also rapidly moving towards having a technically sound and coherent vision as well as policy documents which will guide the health sector for many years to come. Challenge: enhancing participative policy making towards universal health coverage Action: helping to establish a citizen participation mechanism Outcome: producing strategic documents leading to a coherent vision POLICY DIALOGUE 82 Ι WHO presence in countries, territories and areas The threat of epidemics and emergencies is universal, and every country is vulnerable to one or more types of health emergencies. WHO works with Member States and partners using an ‘all-hazards’ approach to health emergency preparedness, prevention, detection and risk management, response and recovery. This is done through the implementation of the International Health Regulations (IHR 2005) and the Sendai Framework for Disaster Risk Reduction. In responding to emergencies, WHO plays a central role at the country level as the Addressing health emergencies humanitarian health cluster lead. Meanwhile, WHO’s work in the area of emergencies also intersects with the other two strategic priorities of the GPW 13. For instance, under the health and well-being strategic priority, mitigating and addressing climate change and climate sensitive diseases are essential in preventing emergencies. Similarly, in fragile and conflict- affected countries, WHO focuses on preventing health system collapse, maintaining critical services and rebuilding health systems after crises. ACCESS TO LIFE- SAVING TREATMENTS IN HUMANITARIAN CRISES MITIGATE RISKS FROM INFECTIOUS HAZARDS ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 5. Our work and its results Ι 83 YEMEN Eastern Mediterranean Region Nearly 16.4 million people lack access to basic healthcare in Yemen. To respond to this massive need, WHO, Health Cluster partners and other health sector actors are delivering health services despite the critical security situation, logistical difficulties and the collapsing health system. WHO and Health Cluster partners have scaled-up their presence to meet rising health needs, reaching 9.5 million beneficiaries out of the targeted 10.4 million people. This has been done through preventive and curative interventions in 1708 health facilities and with 239 emergency medical mobile teams (EMMTs). WHO and other health partners scaled up the overall operational response to infectious disease outbreaks. At the peak of the cholera outbreak, there were 229 Diarrhoea Treatment Centres (DTCs) with in-patient capacities, and 1095 Oral Rehydration Corners (ORCs) for early detection, treatment and referral of severe cholera cases. Rapid response teams (RRTs) were established across all 333 districts in Yemen. WHO supported the technical and operational work of the response to contain outbreaks and build local capacity at governorate and district level health facilities and at community levels. Despite all challenges such as accessibility to the conflict affected areas, with WHO support, it was possible to save or improve the lives of at least 9.5 million people in 2017. Challenge: health needs amid a humanitarian crisis Action: coordinating and supporting the Health Cluster Outcome: containing outbreaks and delivering essential services, reaching 9.5 million people in need ACCESS TO LIFE-SAVING TREATMENTS IN HUMANITARIAN CRISES 84 Ι WHO presence in countries, territories and areas UGANDA African Region Uganda faced outbreaks of newly emerging or re-emerging diseases that constitutes public health threats, such as Marburg virus disease, yellow fever, meningitis, hepatitis B, E and cholera. These outbreaks are due to poor disease detection, drug stock outs, non-adherence to treatments, inadequate training, lack of necessary equipment, weak health system functionality and poor service delivery. The WHO country office helped address these problems by building core capacities to prevent, detect, report, assess and respond to public health emergencies. The Ministry of Health has increased emergency preparedness and integrated disease surveillance. There is now an Emergency Operation Center and improved laboratory infrastructure. However, despite these improvements, a joint external evaluation (JEE) showed that Uganda had a demonstrated capacity of 20%, a developed capacity of 40% and limited capacity of 30% of JEE core indicators. This strengthened system capacity allowed for the quick detection and response to the Marburg virus disease, which was contained in 42 days. Cholera guidelines also prevented outbreak. Health system strengthening in Uganda has also helped to contain Congo Crimean haemorrhagic-fever (CCHF) with no deaths. All these measures have strengthened the health system, decreased morbidity, and reduced associated mortality. Challenge: containing re-emerging outbreaks Action: building capacity to monitor and respond to outbreaks Outcome: faster containments with fewer or no deaths MITIGATE RISKS FROM INFRECTIOUS HAZARDS 5. Our work and its results Ι 85 ROMANIA European Region The ongoing measles outbreak in Romania started in January 2016. Since then, WHO, in close collaboration with UNICEF, has been providing extensive support to the country to interrupt the outbreak that represents a serious public health threat not only for the country but also to the region. Technical assistance has been provided by WHO, in close collaboration with Regional Office and Headquarters in developing the communication plan to ensure protection among the individuals identified as being most susceptible, including those at the highest risk of infection. As part of the outbreak response, a survey was conducted to identify the main reasons for parents not vaccinating their children. WHO and UNICEF assisted the Ministry of Health in preparing supplemental immunization activities in the country to interrupt the measles outbreak. With WHO’s support and as part of preparation for the measles campaign, a communication plan was developed using the survey data. Through training activities, more nationals are now able to strengthen their risk communication response capacity during outbreaks. The draft outbreak response plan was developed in collaboration with the European Centre for Disease Control and applied WHO’s After Action Review (AAR) methodology. The vaccine supply shortage review was performed, and areas for improvement were identified aiming at strengthening the Ministry of Health’s vaccine procurement capacity. The Immunization Law provision was reviewed before the planned public debate. Challenge: responding to measles outbreak Action: providing technical assistance to develop communication plan Outcome: risk communication response capacity strengthened RESPONDING TO DISEASE OUTBREAK 86 Ι WHO presence in countries, territories and areas MYANMAR South-East Asia Region In Myanmar, the WHO country office was notified of 13 H1N1 cases by the Ministry of Health and Sports (MoHS) on 24 July 2017. WHO provided significant support to the MoHS in the form of influenza A(H1N1) pdm09 response activities. By 5 January 2018, MoHS reported 406 H1N1 lab confirmed cases, including 60 deaths, 38 of which were likely due to Influenza and 22 due to influenza with co-morbidities. The WHO country office supported national authorities in overcoming the H1N1 outbreak by providing influenza event management and clinical case management technical experts from SEARO, the WHO country office, and the National University of Singapore. WHO’s technical support was essential for the coordination of influenza immunizations, viral characterization, data management and coordination with partners to ensure a comprehensive response. WHO also provided essential preventive and diagnostic tools, such as influenza vaccines, laboratory reagents and personal protective equipment. Risk communication capacity building for public health professionals was implemented in close collaboration with MoHS. The collaboration between MoHS, WHO, and development partners resulted in a significant decrease in laboratory confirmed Influenza A (H1N1) pdm09 cases and deaths since mid-August 2017. This decreasing trend in diagnoses show that Myanmar has successfully controlled the situation within a short duration of time. Challenge: responding to H1N1 influenza outbreak Action: providing management expertise, technical support and essential tools Outcome: situation under control within a short time duration RESPONDING TO DISEASE OUTBREAK 5. Our work and its results Ι 87 BAHAMAS Region of the Americas The WHO country office collaborates with the national health authorities and National Emergency Management Agency in both The Bahamas (BHS) and Turks and Caicos Islands (TCA) to prepare for and respond to disasters and emergencies. Technical assistance has been provided to both countries to prepare All Hazards Emergency preparedness and response plans. Both BHS and TCA are highly vulnerable to weather related disasters because of their geographical location, small land masses, low elevations and vulnerable coastal areas. The islands were adversely impacted by hurricanes Irma and Maria in 2017, which caused damage to infrastructure and economic losses. The WHO country office provided water purification and vector control supplies post-hurricanes and donated funds for construction materials to repair a health clinic on Ragged Island in The Bahamas. Human resources were provided to support Emergency Operating Centres (EOCs) in both countries and for evaluating damage to health facilities. Training was provided for emergency responders and coordinators on “Psychological first aid” and “Incident Command Management Systems” in TCA. Equipment was procured to improve communication and EOC operational capacities in both countries. In BHS consultants were assigned to assist with health risk assessment and air pollution testing equipment was donated to the Ministry of the Environment in response to another emergency caused by a fire at the landfill in New Providence in 2017. Challenge: improve preparedness for extreme weather events Action: providing human, in-kind and monetary resources Outcome: improved infrastructure and human capital to respond to emergencies ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 88 Ι WHO presence in countries, territories and areas VANUATU Western Pacific Region Malaria used to be a main cause of morbidity and mortality in Vanuatu. The WHO Vanuatu country office is the major long term technical partner for malaria control and the office helps in resource mobilization, strategic planning, field assessments such as vector surveillance and case finding; monitoring and evaluation; supervision; and bed-net distribution. As a result, malaria incidence has decreased by 95% in the last 10 years. A major milestone was that TAFEA province was declared malaria free in 2017. Several other provinces are on track, but the main challenge is the decreasing availability of funding. Vanuatu is ranked by the UN as the country most at risk of being severely impacted by natural disasters. The WHO country office, as co-chair of the health cluster has helped with the health sector’s responses to the many disasters in Vanuatu, including Tropical Cyclone Pam in 2015, Cyclone Donna in 2017, earthquakes, and, most recently, a serious volcanic eruption that required the removal of 10 000 people from the affected island. Among other activities, the WHO country office assisted in the completion of impact assessments and nutritional surveys and helped with training health workers and setting up syndromic surveillance for detection of outbreaks among affected and displaced populations. Other support consisted of health cluster coordination, creating emergency medical teams, and data management. WHO country office support significantly strengthened the health sector’s response to these emergencies. Challenge: malaria control and emergency response Action: technical partner for malaria and co-chairing health cluster Outcome: 95% decrease in malaria incidence over the last 10 years and health sector emergency response strengthened ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 5. Our work and its results Ι 89 WHO will contribute to better health and well- being for people through five interconnected platforms (left). Each of them presents considerable 21st Century challenges to people’s health and calls for multisectoral action to address health determinants. Using Promoting better health and well-being an integrated approach across technical units and levels of the Organization, WHO has a unique comparative advantage to work with governments and partners to address these five areas. ACCELERATING ACTION ON PREVENTING NONCOMMUNICABLE DISEASES AND PROMOTING MENTAL HEALTH IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE HEALTH EFFECTS OF CLIMATE CHANGE ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES TACKLING ANTIMICROBIAL RESISTANCE 90 Ι WHO presence in countries, territories and areas BURUNDI African Region Cervical cancer is the leading cause of cancer deaths among women in Burundi. Cancer screening services are still very poor, and the detection and treatment of pre-cancerous lesions is quasi inexistent. Cancer registries are yet to be institutionalized. The human papillomavirus (HPV) vaccine has proven to be effective in preventing cervical cancer. In 2016, WHO Burundi advocated and successfully mobilized US$ 161 882 through the GAVI Alliance to conduct a demonstration project to introduce the vaccine in two pilot districts. This step was very useful to generate evidence on feasibility of vaccine introduction, to galvanize political support and mobilize additional resources to scale up the intervention nationwide. WHO conducted high level advocacy, leading to the engagement of the Burundi’s First Lady in the introduction of the HPV vaccine in 2016. The preparation and technical organization of this activity was entrusted to the EPI Program. WHO provided technical support for planning, implementation, monitoring and evaluation, documentation of the results of the campaign and facilitated resource disbursement. A total of 91% of girls aged between 9 and 13 years throughout schools and surrounding communities were protected after receiving the first and second doses in 2016 and 2017. Following this successful intervention, national authorities are now engaged and GAVI has expressed willingness to consider an application from Burundi to apply for funding to extend HPV vaccination to the entire country as from 2019. Challenge: reducing cervical cancer deaths Action: advocacy, resource mobilization and technical support Outcome: 91% of girls aged 9–13 received the two rounds HPV vaccination IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE 5. Our work and its results Ι 91 PARAGUAY Region of the Americas Paraguay faces high levels of maternal and newborn mortality and aims to reduce the number of women who die during childbirth each year. The current registered maternal mortality ratio (MMR) in Paraguay is 81.8 per hundred thousand live births (as measured in 2016). Paraguay promoted the “National Mobilization for the reduction of maternal and newborn mortality 2014-2018”. Within this framework, PAHO’s technical cooperation focused on improving components such as strengthening the integrated health services network; maternal and neonatal health surveillance; development of human resources competencies and capacities in the mother-child area of the three levels of care; and strengthening of the strategic information system in health. This program has resulted in important advances, such as the strengthening of Family Health Units with basic equipment, supplies and materials, improving the mortality information system and reinforced analysis capabilities. The program also strengthened capacity of human resources for comprehensive health care, which made technical and financial cooperation possible in hospitals and primary care units in hard to reach communities. A total of 6663 health professionals and technicians have been trained to date. As a result, there has been a 10% reduction in the number of maternal deaths recorded during the last three years, showing that the national mobilization for the reduction of maternal and newborn mortality 2014– 2018 has been effective in saving the lives of women and newborns in Paraguay. Challenge: reducing maternal mortality Action: strengthening surveillance and capacity and integrating services Outcome: 10% reduction in the number maternal deaths over the last three years IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE 92 Ι WHO presence in countries, territories and areas LITHUANIA European Region Lithuania has a high rate of alcohol consumption, binge-drinking patterns and high levels of alcohol-attributable mortality and burden of disease. In the latest comparative risk assessments, Lithuania ranked highest among all European Union countries, and sixth among all the WHO European Region countries in alcohol-attributable mortality, and highest in alcohol-attributable disability-adjusted life years. “Best buys” are a WHO created concept describing evidence-based, highly cost- effective and feasible interventions to reduce the impact of NCD risk factors. Currently, Lithuania is implementing all three best buy alcohol related policy options, namely increased taxation, restricting availability and banning marketing and advertising along with other policy changes with major changes being implemented between 2016 and 2018. The WHO country office in Lithuania contributed to this process by continuously prioritising the topic of alcohol consumption and related harm within the biennium cooperation agreements and providing on-going policy advice and technical support in raising awareness and sharing evidence and good practices. In 2017/2018, with new political leadership in the country and renewed commitment for introducing relevant alcohol control measures, WHO used this window of opportunity to support the Government and the Parliament in introducing alcohol control policies. With technical and political support from regional and headquarter levels, the WHO country office has actively engaged in policy dialogue and strategic communication with national stakeholders. It has clarified WHO’s approach on alcohol consumption estimates and highlighted the harm and burden of high alcohol use on health, despite opposition from the alcohol industry and related groups. It was considered key to monitor and evaluate the alcohol control policy situation and its impact on healthy. Currently the WHO country office is supporting the set-up of a study to rigorously evaluate these policies. Challenge: reducing alcohol abuse Action: advocacy, policy dialogue and evaluation on policies on alcohol-attributable health issues Outcome: the government prioritized alcohol control policies ACCELERATING ACTION ON PREVENTING NONCOMMUNICABLE DISEASES AND PROMOTING MENTAL HEALTH 5. Our work and its results Ι 93 SAMOA Western Pacific Region World Health Assembly Resolution 50.29 called on Member States to eliminate lymphatic filariasis as a public health problem. In response, WHO launched its Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000 with the aims of eliminating transmission and alleviating the suffering caused by lymphatic filariasis by 2020. In 1999, PacELF baseline surveys in Samoa revealed an antigenemia prevalence rate of 4.52%. The mass drug administration (MDA) strategy for the interruption of lymphatic filariasis transmission is 5-6 annual rounds of large-scale treatment of all eligible people in areas where infection is present. In efforts to accelerate elimination of lymphatic filariasis in Samoa, the Ministry of Health adopted the new treatment strategy recommended by the WHO in 2017 to implement MDA with triple drug therapy nationwide from 14 to 26 August 2018. WHO provided technical advice and financial assistance at each stage of the MDA campaign in Samoa. The rationale and purpose of WHO assistance is three-fold: stop transmission of lymphatic filariasis and prevent new infections by 2020; ensure the provision of basic care for people living with disability due to lymphatic filariasis; enhance Post-Mass Drug Administration Surveillance towards validation by 2024. The preliminary results based on Savaii Island demonstrate a high coverage of more than 90% of the entire eligible population. The results for Upolu Island and Apia are expected to be within a similar range. The MDA will be repeated in 2019 and if the rounds of MDA in 2018 and 2019 are successful then Samoa will be declared free of lymphatic filariasis by WHO. Challenge: eliminating lymphatic filariasis Action: providing technical and financial assistance Outcome: provision of basic care reached 90% of the eligible population ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES 94 Ι WHO presence in countries, territories and areas DJIBOUTI Eastern Mediterranean Region In 2017, Djibouti experienced a malaria epidemic, as confirmed by the WHO country office. The WHO country office supported the malaria control program to reduce the incidence of malaria by assisting in training 170 health workers regarding malaria diagnosis, case management, and community mobilization. To bolster malaria prevention, a total of 203 000 long lasting insecticide treated bed nets were distributed in the most affected areas. The malaria caseload reduced to below the epidemic threshold because of this WHO country office intervention. Of all confirmed malaria cases in Djibouti, 87% received the first line of treatment and 20 000 cases were effectively treated. A total of 91 788 rapid tests were provided and used. Additionally, WHO country office involvement led to strengthening of the national vector control capacity for malaria in terms of necessary equipment and support for the workforce. Challenge: responding to malaria epidemic Action: assisting in training and provision of bed nets Outcome: reduction of caseload to below epidemic threshold ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES 5. Our work and its results Ι 95 MALDIVES South-East Asia Region As part of the Joint UN program on Low Emission Climate Resilient Development (LeCRED), the WHO country office has collaborated with six other UN agencies to address issues related to climate change and health. Waste management and vector control activities were among some of the most challenging areas where opportunities to build on each agency’s comparative advantages were evident. Following the mapping of activities, the WHO country office prioritized focus on developing health care waste management activities which remained a neglected area in overall waste management approach. After agreeing to implement vector control activities with agency partners, the WHO country office provided technical assistance to develop health care waste management technology. As the work progressed it was noted that country did not have a Health Care Waste Management Policy, Strategic Plan and Operational Plan, subsequently the WR led development discussions at the highest level with the Health Minister. The WHO country office team then mobilized high quality technical assistance from the regional office which supported identification of a suitable expert to further the plan’s development and established sites for appropriate health care waste management with an autoclave at the regional hospital and a desktop autoclave in each of 11 island health centres as an example of policy implementation. Utilizing the opportunity, the WHO country office brought different agencies together to participate in elements of the campaign such as communication activities, facilitating participation of the women groups from islands and mobilizing local councils while the WHO country office mobilized the hospital and health centre staff for participation in the campaign which was launched by Health Minister, State Minister of Environment and Energy and attended by local council chief, members of atoll and island councils and several community representatives. Given the limited staff numbers at the WHO country office, the joint working with UN agencies made it possible to mobilize different partners, stakeholders and importantly ensured engagement of the community as well. Challenge: developing resilience to climate change Action: mobilizing high quality technical assistance and bringing other UN agencies to work together Outcome: achieving both community and high level engagement HEALTH EFFECTS OF CLIMATE CHANGE 96 Ι WHO presence in countries, territories and areas Annexes Annex 1 List of WHO Member States and Associate Member States Puerto Rico Tokelau A S S O C I AT E M E M B E R S TAT E S Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo (the) Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Democratic People’s Republic of Korea Democratic Republic of the Congo Denmark M E M B E R S TAT E S Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Republic of North Macedonia Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syrian Arab Republic Tajikistan Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe 98 Ι WHO presence in countries, territories and areas Annex 2 WHO offices and suboffices in countries, territories and areas A F R I C A N R E G I O N Country, territory, area Location Country, territory, area Location Algeria Algiers Lesotho Maseru Angola Luanda Liberia Monrovia Benin Cotonou Madagascar Antananarivo Botswana Gaborone Malawi Lilongwe Burkina Faso Ouagadougou Mali Bamako Burundi Bujumbura Mauritania Nouakchott Cabo Verde Praia Mauritius Port Louis Cameroon Yaoundé Mozambique Maputo Central African Republic Bangui Namibia Windhoek Chad N’Djamena Niger Niamey Comoros Moroni Nigeria Abuja Congo (the) Brazzaville Rwanda Kigali Côte d’Ivoire Abidjan São Tomé and Príncipe São Tomé Democratic Republic of the Congo Kinshasa Senegal Dakar Equatorial Guinea Malabo Seychelles Victoria, Mahé Eritrea Asmara Sierra Leone Freetown Eswatini Mbabane South Africa Pretoria Ethiopia Addis-Ababa South Sudan Juba Gabon Libreville Togo Lomé Gambia Banjul Uganda Kampala Ghana Accra United Republic of Tanzania (the) Dar es Salaam Guinea Conakry Zambia Lusaka Guinea-Bissau Bissau Zimbabwe Harare Kenya Nairobi W H O O F F I C E S Annexes Ι 99 Annex 2, continued R E G I O N O F T H E A M E R I C A S Country, territory, area Location Argentina Buenos Aires Bahamas Nassau, New Providence Barbados Bridgetown Belize Belize City Bolivia (Plurinational State of) La Paz Brazil Brasilia Chile Santiago Colombia Bogotá Costa Rica San Jose Cuba Havana Dominican Republic Santo Domingo Ecuador Quito El Salvador San Salvador Guatemala Guatemala City Guyana Georgetown Haiti Port-au-Prince Honduras Tegucigalpa Jamaica Kingston Mexico Mexico City Nicaragua Managua Panama Panama City Paraguay Asunción Peru Lima Suriname Paramaribo Trinidad and Tobago Port-of-Spain Uruguay Montevideo Venezuela (Bolivarian Republic of) Caracas E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Location Afghanistan Kabul Djibouti Djibouti Egypt Cairo Iran (Islamic Republic of) Tehran Iraq Baghdad Jordan Amman Lebanon Beirut Libya Tripoli Morocco Rabat Oman Muscat Pakistan Islamabad Saudi Arabia Riyadh Somalia Mogadishu Sudan Khartoum Syrian Arab Republic Damascus Tunisia Tunis West Bank & Gaza Strip Jerusalem Yemen Sana’a W H O O F F I C E S 100 Ι WHO presence in countries, territories and areas Annex 2, continued E U R O P E A N R E G I O N Country, territory, area Location Albania Tirana Armenia Yerevan Azerbaijan Baku Belarus Minsk Bosnia and Herzegovina Sarajevo Bulgaria Sofia Croatia Zagreb Czech Republic Prague Estonia Tallinn Georgia Tbilisi Greece Athens Hungary Budapest Kazakhstan Astana Kyrgyzstan Bishkek Latvia Riga Lithuania Vilnius Montenegro Podgorica Poland Warsaw Pristina Pristina Republic of Moldova Chisinau Republic of North Macedonia Skopje Romania Bucharest Russian Federation Moscow Serbia Belgrade Slovakia Bratislava Slovenia Ljubljana Tajikistan Dushanbe Turkey Ankara Turkmenistan Ashgabat Ukraine Kyiv Uzbekistan Tashkent S O U T H - E A S T A S I A R E G I O N Country, territory, area Location Bangladesh Dhaka Bhutan Thimphu Democratic People’s Republic of Korea Pyongyang India New Delhi Indonesia Jakarta Maldives Male Myanmar Yangon Nepal Kathmandu Sri Lanka Colombo Thailand Nonthaburi Timor-Leste Dili W E S T E R N PA C I F I C R E G I O N Country, territory, area Location Cambodia Phnom Penh China Beijing Kiribati Tarawa Lao People’s Democratic Republic (the) Vientiane Malaysia Kuala Lumpur Micronesia (Federated States of) Palikir Mongolia Ulaanbaatar Papua New Guinea Port Moresby Philippines Manila Samoa Apia Solomon Islands Honiara South Pacific Suva Tonga Nuku’alofa Vanuatu Port Villa Viet Nam Hanoi W H O O F F I C E S Annexes Ι 101 Annex 2, continued A F R I C A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Angola Luanda 0 Angola does not have suboffices, but does have an office in each of the 18 provinces, located within each of the provincial health directorates. The offices have all required equipment to function, including a vehicle, a driver, and technical staff with an epidemiological/surveillance background Central African Republic Bangui 3 Bambari, Kagabandoro and Bouar Chad N’Djamena 6 Abeche, Sarh, Moundou, Mongo, Mao and N’Djamena Democratic Republic of the Congo Kinshasa 11 Kinshaha, Matadi, Bandundu ville, Kananga, Mbuji Mayi, Lubumbashi, Bukavu, Goma, Kindu, Kinsagani and Mbandaka Ethiopia Addis-Ababa 1 Somali Region Ghana Accra 1 Tamale Guinea Conakry 2 Nzérékoré and Guéckédou Kenya Nairobi 4 Garissa (serving the North Eastern Province), Embu, Eldoret, Nakuru Nigeria Abuja 37 In each of the 37 states, including the Federal Capital Territory in Abuja South Sudan Juba 10 In all the capitals of the 10 States that constitute the country Uganda Kampala 1 Moroto United Republic of Tanzania (the) Dar es Salaam 5 Zanzibar, Tanga, Dodoma, Mwanza and Iringa W H O S U B O F F I C E S R E G I O N O F T H E A M E R I C A S Country, territory, area Location Number of suboffices Location of WHO suboffices Barbados Bridgetown 7 Anguilla, Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia and Saint Vincent Guatemala Guatemala City 1 San Marcos Mexico Mexico City 1 Tuxtla Gutiérrez Chiapas Paraguay Asunción 1 Boqueron, Filadelfia in El Chaco Paraguayo 102 Ι WHO presence in countries, territories and areas Annex 2, continued E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Afghanistan Kabul 8 Jalalabad, Gardez, Herat, Kandahar, Bamyan, Kunduz, Balkh and Badakhshan Iraq Baghdad 5 Erbil, Dohuk, Sulaimaniyah, Basrah and Baghdad (within the Ministry of Health) Jordan Amman 0 EMRO Regional Centre for Environmental Action (CEHA) EMRO Regional Centre for Polio Eradication and Emergency Libya Tripoli 2 Benghazi , Sabah Pakistan Islamabad 4 Lahore, Karachi, Peshawar and Quetta Somalia Mogadishu 4 Nairobi (Liaison Office), Hargeisa (serving Somaliland), Garowe (serving Puntland), and Baidoa (serving southwestern State) Sudan Khartoum 6 El-Fasher, Nyala, Geneina, Kassala, Kadugli and Damazine Syrian Arab Republic Damascus 4 Qamishly, Aleppo, Homs and Latakia West Bank & Gaza Strip Jerusalem 2 Ramallah, Gaza Yemen Sana’a 4 Aden, Al Hodeida, Ibb (serving Ibb and Taiz) and Sadaa W H O S U B O F F I C E S E U R O P E A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Bosnia and Herzegovina Sarajevo 1 Banja Luka Turkey Ankara 1 Gaziantep Ukraine Kyiv 4 Donetsk, Kramatorsk, Luhansk and Severodonetsk S O U T H - E A S T A S I A R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices India New Delhi 7 In all seven regional hubs in the country Indonesia Jakarta 2 Jakarta W E S T E R N PA C I F I C R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Philippines Manila 1 Davao City Viet Nam Hanoi 1 Ho Chi Minh City Annexes Ι 103 Annex 3 Number and categories of staff members working in WHO offices in countries, territories and areas A F R I C A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Algeria 15 2 7 6 Angola 53 12 15 26 Benin 25 1 9 15 Botswana 15 1 7 7 Burkina Faso 32 3 9 20 Burundi 25 3 7 15 Cameroon 28 1 11 16 Cabo Verde 8 1 3 4 Central African Republic 36 8 10 18 Chad 58 13 10 35 Comoros 16 0 5 11 Congo (the) 23 0 9 14 Côte d’Ivoire 34 3 11 20 Democratic Republic of the Congo 90 12 35 43 Equatorial Guinea 8 0 3 5 Eritrea 19 1 6 12 Eswatini 16 1 5 10 Ethiopia 131 15 59 57 Gabon 17 1 5 11 Gambia 16 1 5 10 Ghana 29 1 10 18 Guinea 34 3 9 22 Guinea-Bissau 11 2 2 7 Kenya 47 5 20 22 Lesotho 14 2 4 8 Liberia 32 5 5 22 Madagascar 27 3 9 15 Malawi 24 0 12 12 Mali 26 4 8 14 Mauritania 22 3 8 11 Mauritius 9 1 2 6 Mozambique 29 3 13 13 Namibia 18 3 4 11 Niger 40 4 15 21 Nigeria 403 34 144 225 Rwanda 21 2 10 9 São Tomé and Príncipe 7 0 3 4 Senegal 16 1 6 9 104 Ι WHO presence in countries, territories and areas Annex 3, continued R E G I O N O F T H E A M E R I C A S Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Argentina 11 4 2 5 Bahamas 3 2 1 0 Barbados 24 17 1 6 Belize 3 1 1 1 Bolivia (Plurinational State of) 14 7 1 6 Brazil 63 24 24 15 Chile 7 1 2 4 Colombia 15 6 3 6 Costa Rica 6 3 1 2 Cuba 1 1 — — Dominican Republic 11 7 1 3 Ecuador 14 5 4 5 El Salvador 12 8 0 4 Guatemala 15 7 1 7 Guyana 10 3 4 3 Haiti 17 10 0 7 Honduras 16 8 3 5 Jamaica 10 6 1 3 Mexico 15 9 2 4 Nicaragua 11 3 3 5 Panama 11 8 1 2 Paraguay 12 8 1 3 Peru 22 14 2 6 Suriname 5 3 1 1 Trinidad and Tobago 10 7 0 3 Uruguay 12 6 3 3 Venezuela (Bolivarian Republic of) 13 5 2 6 Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Seychelles 6 1 2 3 Sierra Leone 56 18 14 24 South Africa 36 7 9 20 South Sudan 73 23 19 31 Togo 17 2 3 12 Uganda 46 3 20 23 United Republic of Tanzania (the) 42 4 17 21 Zambia 32 2 16 14 Zimbabwe 40 2 12 26 A F R I C A N R E G I O N Annexes Ι 105 E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Afghanistan 105 23 19 63 Djibouti 10 3 0 9 Egypt 17 1 7 9 Iran (Islamic Republic of) 18 1 4 13 Iraq 66 21 16 29 Jordan 16 4 3 9 Lebanon 9 1 2 6 Libya 23 11 4 8 Morocco 10 1 3 6 Oman 9 1 0 8 Pakistan 127 38 31 58 Saudi Arabia 8 3 1 4 Somalia 56 25 13 18 Sudan 57 7 11 39 Syrian Arab Republic 61 5 22 34 Tunisia 14 2 1 11 West Bank & Gaza Strip 25 4 8 13 Yemen 123 29 29 65 Annex 3, continued 106 Ι WHO presence in countries, territories and areas E U R O P E A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Albania 6 1 3 2 Armenia 8 1 3 4 Azerbaijan 6 1 2 3 Belarus 5 1 2 2 Bosnia and Herzegovina 7 2 1 4 Bulgaria 3 1 1 1 Croatia 2 0 1 1 Czech Republic 2 1 0 1 Estonia 2 0 1 1 Georgia 9 1 5 3 Greece 1 1 0 0 Hungary 3 1 1 1 Kazakhstan 5 1 2 2 Kyrgyzstan 17 2 9 6 Latvia 1 0 1 0 Lithuania 2 0 1 1 Montenegro 2 0 1 1 Poland 3 1 0 2 Pristina 0 1 3 4 Republic of Moldova 7 0 5 2 Republic of North Macedonia 6 1 2 3 Romania 3 1 1 1 Russian Federation 9 1 4 4 Serbia 9 2 3 4 Slovakia 2 1 0 1 Slovenia 3 1 0 2 Tajikistan 17 2 8 7 Turkey 37 13 11 13 Turkmenistan 7 1 2 4 Ukraine 35 10 14 11 Uzbekistan 18 2 9 7 Annex 3, continued Annexes Ι 107 S O U T H - E A S T A S I A R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Bangladesh 63 13 19 31 Bhutan 15 2 3 10 Democratic People’s Republic of Korea 7 7 0 0 India 88 10 48 30 Indonesia 52 10 16 26 Maldives 21 3 4 14 Myanmar 54 12 8 34 Nepal 50 7 15 28 Sri Lanka 28 3 8 17 Thailand 28 7 5 16 Timor-Leste 22 7 4 11 Annex 3, continued W E S T E R N PA C I F I C R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Cambodia 46 13 11 22 China 31 5 14 12 Kiribati 2 0 0 2 Lao People’s Democratic Republic (the) 51 12 17 22 Malaysia 7 1 1 5 Micronesia (Federated States of) 2 1 0 1 Mongolia 16 1 6 9 Papua New Guinea 37 14 4 19 Philippines 28 7 8 13 Samoa 9 1 2 6 Solomon Islands 12 6 0 6 South Pacific 44 14 9 21 Tonga 4 1 0 3 Vanuatu 11 5 1 5 Viet Nam 45 9 13 23 108 Ι WHO presence in countries, territories and areas Annex 4 Global fund grants of which WHO is a subrecipient Region Country HIV/AIDS TB Malaria RMNCH Health systems strengthening African Region Democratic Republic of the Congo Madagascar Malawi Nigeria Senegal South Sudan Eastern Mediterranean Region Afghanistan Iran (Islamic Republic of) Iraq Lebanon Somalia Sudan Syrian Arab Republic Tunisia European Region Ukraine South-East Asia Region Bangladesh Democratic People's Republic of Korea India Indonesia Nepal Myanmar Sri Lanka Thailand Timor-Leste Western Pacific Region Cambodia Kiribati Lao People's Democratic Republic Micronesia (Federated States of) Mongolia Papua New Guinea Solomon Islands South Pacific (Fiji) Tonga Viet Nam Annexes Ι 109 Annex 5 Countries (with WHO presence) eligible for Gavi new vaccines support in 2018 Region Country African Region Benin Burkina Faso Burundi Cameroon Central African Republic Chad Comoros Côte d'Ivoire Democratic Republic of the Congo Eritrea Ethiopia Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mozambique Niger Rwanda São Tomé and Príncipe (grace year) Senegal Sierra Leone South Sudan Togo Uganda United Republic of Tanzania Zambia Zimbabwe Region Country Region of the Americas Haiti Eastern Mediterranean Region Afghanistan Djibouti Pakistan Somalia Sudan Yemen European Region Kyrgyzstan Tajikistan South-East Asia Region Bangladesh Democratic People’s Republic of Korea Myanmar Nepal Western Pacific Region Cambodia 110 Ι WHO presence in countries, territories and areas Annex 6 Planned costs and available funds for WHO work in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Algeria 3 354 850 2 979 382 89 Angola 24 299 010 17 693 432 73 Benin 8 200 207 5 351 466 65 Botswana 3 445 319 3 037 354 88 Burkina Faso 11 273 270 8 124 304 72 Burundi 6 660 682 5 587 156 84 Cameroon 17 577 558 13 326 433 76 Cabo Verde 4 730 065 3 448 769 73 Central African Republic 18 572 844 15 069 549 81 Chad 30 803 324 21 304 288 69 Comoros 3 414 705 2 176 013 64 Congo (the) 26 769 904 5 693 820 21 Côte d’Ivoire 12 252 284 7 286 136 59 Democratic Republic of the Congo 181 951 333 143 081 603 79 Equatorial Guinea 4 484 128 3 454 689 77 Eritrea 7 355 205 4 484 026 61 Eswatini 4 780 486 3 561 213 74 Ethiopia 53 761 403 43 172 305 80 Gabon 4 692 818 4 085 179 87 Gambia 3 751 184 2 170 860 58 Ghana 12 116 486 8 969 669 74 Guinea 16 349 029 10 726 905 66 Guinea-Bissau 5 535 346 4 182 410 76 Kenya 32 290 476 21 948 090 68 Lesotho 3 734 509 2 811 489 75 Liberia 14 428 682 11 661 850 81 Madagascar 16 366 539 14 370 110 88 Malawi 8 916 737 6 177 910 69 Mali 14 870 265 11 481 693 77 Mauritania 8 798 427 6 406 695 73 Mauritius 2 283 500 2 216 480 97 Mozambique 21 562 163 21 558 333 100 Namibia 9 235 202 4 011 953 43 Niger 24 563 396 16 650 933 68 Nigeria 274 225 293 230 135 696 84 Rwanda 8 145 971 6 429 951 79 Reunion 137 635 — — A F R I C A N R E G I O N Annexes Ι 111 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Saint Helena 27 000 — — São Tomé and Príncipe 2 538 691 1 950 664 77 Senegal 9 342 428 4 497 119 92 Seychelles 1 897 998 1 453 667 77 Sierra Leone 24 530 437 22 524 940 92 South Africa 11 132 639 9 286 472 83 South Sudan 53 479 013 41 280 367 77 Togo 5 774 562 4 302 253 75 Uganda 32 264 856 17 162 892 53 United Republic of Tanzania (the) 24 230 131 11 608 319 48 Zambia 14 482 869 11 815 824 82 Zimbabwe 18 242 013 14 258 706 78 Annex 6, continued A F R I C A N R E G I O N 112 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Antigua and Barbuda 11 033 129 090 1170 Argentina 1 366 845 1 124 521 82 Bahamas 522 520 320 000 61 Barbados — — — Belize 552 109 268 000 49 Bolivia (Plurinational State of) 4 206 424 2 148 605 51 Brazil 7 222 510 5 304 093 73 Chile 1 814 720 883 100 49 Colombia 5 469 985 3 676 606 67 Costa Rica 528 520 638 200 121 Cuba 1 680 281 1 274 856 76 Dominica 180 555 292 533 162 Dominican Republic 4 240 384 2 705 569 162 Ecuador 4 099 095 2 368 657 58 El Salvador 1 159 984 532 800 46 Guatemala 5 013 879 3 148 302 63 Guyana 1 699 937 946 642 56 Haiti 10 699 476 6 478 422 61 Honduras 3 181 013 2 149 729 68 Jamaica 1 953 417 1 162 255 59 Mexico 3 419 410 2 375 101 69 Nicaragua 1 995 827 1 080 370 54 Panama 521 229 579 600 111 Paraguay 820 959 924 635 113 Peru 3 001 846 2 349 296 78 Saint Kitts and Nevis — 112 600 — Saint Lucia 22 288 115 050 516 Saint Vincent and the Grenadines 121 622 72 900 60 Suriname 1 256 805 584 385 46 Trinidad and Tobago 819 424 811 100 99 Uruguay 169 640 276 000 163 Venezuela (Bolivarian Republic of) 5 925 824 7 340 856 124 R E G I O N O F T H E A M E R I C A S Annex 6, continued Annexes Ι 113 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Afghanistan 157 135 700 119 155 728 76 Bahrain 155 200 81 819 53 Djibouti 6 392 200 3 651 229 57 Egypt 11 798 300 8 509 450 72 Iran (Islamic Republic of) 7 988 500 3 867 272 48 Iraq 110 262 700 94 300 408 86 Jordan 10 154 800 5 713 004 56 Kuwait 172 000 60 331 35 Lebanon 21 098 700 14 236 270 67 Libya 26 599 700 19 313 886 73 Morocco 5 176 085 4 287 802 83 Oman 2 836 700 2 147 231 76 Pakistan 257 405 000 191 394 534 74 Qatar 432 800 321 881 74 Saudi Arabia 4 298 800 3 047 146 71 Somalia 62 832 300 42 188 661 67 Sudan 62 733 100 43 565 790 69 Syrian Arab Republic 105 299 661 76 488 688 73 Tunisia 4 123 500 2 706 712 66 United Arab Emirates 326 900 174 838 53 West Bank & Gaza Strip 27 218 000 22 310 493 82 Yemen 373 507 300 369 137 766 99 Annex 6, continued E A S T E R N M E D I T E R R A N E A N R E G I O N 114 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Albania 1 831 260 1 457 596 80 Armenia 3 145 420 2 320 690 74 Azerbaijan 1 207 745 887 159 73 Belarus 3 199 699 2 569 017 80 Bosnia and Herzegovina 3 416 290 2 609 555 76 Bulgaria 1 043 872 824 894 79 Croatia 968 792 675 620 70 Czech Republic 972 651 691 455 71 Estonia 784 164 434 453 55 Georgia 3 964 069 3 070 140 77 Greece 2 373 327 2 138 895 90 Hungary 1 148 856 939 293 82 Kazakhstan 3 752 448 2 591 150 69 Kyrgyzstan 9 416 911 8 125 086 86 Latvia 552 689 332 185 60 Lithuania 1 423 195 1 114 997 78 Malta 70 894 60 108 85 Montenegro 864 005 460 531 53 Poland 844 397 651 686 77 Portugal 67619 — — Pristina 3 143 169 2 357 184 75 Republic of Moldova 6 276 964 4 756 292 76 Republic of North Macedonia 1 701 757 1 326 068 78 Romania 2 519 260 1 624 509 64 Russian Federation 5 970 404 4 597 918 77 Serbia 5 901 876 4 806 787 81 Slovakia 960 705 795 682 83 Slovenia 1 046 199 606 170 58 Tajikistan 7 676 342 5 559 447 72 Turkey 83 390 473 85 718 788 103 Turkmenistan 3 890 947 2 664 082 68 Ukraine 19 590 756 13 983 726 71 Uzbekistan 6 389 891 6 602 945 103 E U R O P E A N R E G I O N Annex 6, continued Annexes Ι 115 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Bangladesh 49 640 875 43 834 788 88 Bhutan 4 861 688 4 016 623 83 Democratic People’s Republic of Korea 17 377 145 15 462 803 89 India 93 858 328 81 296 126 87 Indonesia 28 943 767 25 001 023 86 Maldives 4 553 397 4 179 797 92 Myanmar 30 521 648 23 331 055 76 Nepal 19 131 618 13 459 360 70 Sri Lanka 7 662 773 6 776 800 88 Thailand 12 136 200 9 861 971 81 Timor-Leste 10 900 823 9 625 720 88 Annex 6, continued S O U T H - E A S T A S I A R E G I O N 116 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) American Samoa 69 000 69 000 100 Brunei Darussalam 36 000 36 000 100 Cambodia 18 823 279 13 752 325 73 China 20 350 734 15 822 108 78 Commonwealth of the Northern Mariana Islands 37 000 37 000 100 Cook Islands 363 660 413 994 114 Fiji 4 714 772 4 232 239 90 French Polynesia 53 628 36 000 67 Guam 36 000 36 000 100 Kiribati 1261 550 965 027 76 Lao People’s Democratic Republic (the) 17 868 331 14 625 881 82 Malaysia 1 964 802 1 935 218 98 Marshall Islands 348 925 282 951 81 Micronesia (Federated States of) 2 026 031 1 949 584 96 Mongolia 6 385 632 5 224 683 82 Nauru 126 000 101 000 80 Niue 94 000 94 080 100 Pacific Island Countries 19 260 182 17 580 263 91 Palau 181 000 124 000 69 Papua New Guinea 35 398 591 34 000 257 96 Philippines 14 608 471 12 730 708 87 Samoa 3 385 657 3 321 791 98 Singapore 37 000 37 000 100 Solomon Islands 11 685 543 12 021 731 103 Tokelau 92 941 95 973 103 Tonga 1 000 414 1 167 082 117 Tuvalu 125 976 107 360 85 Vanuatu 4 470 244 4 279 321 96 Viet Nam 22 382 432 17 256 130 77 W E S T E R N PA C I F I C R E G I O N Annex 6, continued Annexes Ι 117 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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Contact World Health Organization Department of Country Cooperation and Collaboration with the United Nations System Avenue Appia 20 1211 Geneva 27 Switzerland Tel: +41 22 791 21 11 Fax: +41 22 791 31 11 http://www.who.int 2019 Report WHO presence in countries, territories and areas W H O P R E S E N C E IN C O U N T R IE S , T E R R IT O R IE S A N D A R E A S Ι 2019 R E P O R T

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Photos and figures: WHO Design and layout: L’IV Com Sàrl, Switzerland Printed in France Contents FOREWORD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Methodology for data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Limitations of the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1. WHO WE ARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.1 World Health Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.1.1 Governance and Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.1.2 Regional Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1.3 WHO country offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.1.4 WHO country offices covering more than one country, territory or area . . . . . . . . . . . . . . . . . . . . . 10 1.1.5 Countries and areas covered by WHO regional offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.1.6 Suboffices in countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.2 People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.1 WHO country office leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.2 Status of acting HWOs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1.2.3 Gender distribution of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.2.4 Region of origin of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 1.2.5 Age and retirement of HWOs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.2.6 HWOs’ length of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.2.7 WHO workforce in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2.8 WHO country-level staffing situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.2.9 Gender distribution of WHO staff at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.2.10 Diversity of WHO staff capacity at the country office level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.3 Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.3.1 Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.3.2 Corporate communication capacity at country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 1.3.3 Information sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 1.3.4 Access to breastfeeding facilities in WHO country offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. WHAT WE DO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 2.1 Contributing to national health policies, strategies and plans to roll out UHC, ensure healthy lives and respond to health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.2 Country Cooperation Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.3 Joint WHO and government monitoring mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 2.4 Supporting implementation of the Sustainable Development Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 2.5 WHO support in health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 2.6 Supporting health sector coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 3. HOW WE DO IT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 3.1 Technical backstopping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3.2 Funding WHO’s work at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.1 Availability of financial resources at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.2.2 Distribution of base funds by programmatic priorities and operations . . . . . . . . . . . . . . . . . . . . . . . 49 3.2.3 Sources of funding for WHO country-level work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 3.2.4 Distribution and spending of planned funds at the country level . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 3.2.5 Mobilization of funds for Human Resource support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 iii 4. WHO WE WORK WITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 4.1 Collaboration with the United Nations system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.1.1 Supporting the United Nations Resident Coordinators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.2 Engaging within the United Nations Country Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.2.1 WHO participation in Joint National/United Nations Steering Committees . . . . . . . . . . . . . . . . . . . . 59 4.2.2 United Nations Development Assistance Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.2.3 WHO participation in the thematic groups of United Nations country teams . . . . . . . . . . . . . . . . . . 61 4.2.4 WHO participation in United Nations common business operations and activities . . . . . . . . . . . . . . 62 4.2.5 WHO participation in joint activities of the United Nations resident coordinator office . . . . . . . . . . . . 63 4.3 UN Multi-Partner Trust Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4.4 WHO country-level engagement with global health initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4.1 WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4.2 WHO and Gavi, the Vaccine Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 4.4.3 South-South and triangular cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5. OUR WORK AND ITS RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Expanding universal health coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Addressing health emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Promoting better health and well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 ANNEXES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annex 1: List of WHO Member States and Associate Member States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Annex 2: WHO offices and suboffices in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Annex 3: Number and categories of staff members working in WHO offices in countries, territories and areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Annex 4: Global Fund grants of which WHO is a subrecipient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Annex 5: Countries eligible for Gavi new vaccines support in 2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Annex 6: Planned costs and available funds for WHO work in countries, territories and areas . . . . . . . . . . . . 111 iv Ι WHO presence in countries, territories and areas Foreword T he ultimate measure of WHO’s success is not the number of reports we publish or the meetings we hold, but the difference we make to the health of the world’s people. That’s why delivering impact in countries is the essence of both WHO’s 13th General Programme of Work (GPW13) and the Sustainable Development Goals (SDGs). The “triple billion” targets of GPW13 are designed to make us focus on delivering results for the people we serve, and value for money for our donors. To support those efforts, WHO is now embarking on a comprehensive transformation, to make sure we empower and enable the entire organization – and especially our country offices – to make a measurable difference at country level. It’s impossible to adequately summarise the extraordinary work that WHO does all over the world every day, but the 2019 country presence report is an excellent snapshot of the Organization’s work in 149 countries, territories and areas across six regions. This year’s report attempts for the first time to provide additional information on the role of WHO country offices in supporting governments and partners to achieve the SDGs and provide support for South-South and triangular cooperation initiatives. It also features several country stories highlighting achievements relating to each of the “triple billion” targets. While we have achieved significant results, we cannot be content. The world remains dangerously off-course for the SDGs, and we have a lot of work to do to support countries to get on track and stay on track. One of the principles of both the SDGs and GPW13 is that they are for all countries, rich and poor. No health system is perfect, and WHO has something to offer every country. Our new policy dialogue process is designed to give us a robust mechanism, based on solid data and projections, for identifying weaknesses in health systems and recommending policy solutions. We are also improving the way we develop “global goods” including norms and standards, to ensure we develop the highest-quality products that address the needs of countries. WHO’s new aligned structure will help to ensure we work more seamlessly across all three levels of the organization to deliver results. But delivering results in countries is not a job for WHO alone. Partnership is key. The Global Action Plan for Healthy Lives and Well-Being for All, which was launched last year and will be presented at the United Nations General Assembly in September 2019, is a vital platform for ensuring enhanced collaboration in the global health community. WHO is pleased to be leading the development of this ground-breaking instrument, in which 12 global health and development agencies have committed to align their operating practices, identify ways to accelerate progress, and develop shared milestones to keep ourselves accountable. The challenge now is to turn good intentions, bold promises and ambitious documents into concrete changes that make a difference. I am optimistic that future editions of this report will highlight even greater results in pursuit of our mission to promote health, keep the world safe and serve the vulnerable. Dr Tedros Adhanom Ghebreyesus Director-General World Health Organization Foreword Ι v Executive summary WHO as an intergovernmental organization has a governance system that comprises the World Health Assembly, the Executive Board and Regional Committees. The WHO Secretariat is headed by the Director-General and comprises country and regional offices, headquarters and associated offices. The six regional offices are headed by regional directors. WHO has one of the largest field presences within the UN system. Working with 194 Member States across six regions and from 149 offices in countries, territories and areas, WHO through its large network of staff, provides support to countries through policy dialogue, technical assistance in strategic areas as well as operational support, depending on the country context. WHO has placed countries squarely at the centre of its work. Through its transformation programme, WHO is stepping up efforts to continue strengthening its country office leadership, ensure a fit-for-purpose staffing structure, and provide optimal tools and processes for enhanced effectiveness and efficiency. In addition, other levels of the Organization have been supporting country offices to strengthen their capacity to achieve greater impact in each country. WHO’s engagement with Member States and partners ensures that a robust technical platform is in place and that the Organization acts as an impartial convenor and coordinator of health in support of national authorities. To highlight WHO’s work in countries as envisioned by the Director-General, the 2019 country presence report provides information on: who we are as WHO, what the Organization does, with whom it works and with what resources. Compared to the 2017 country presence report, this year’s report provides additional information on: the role of the WHO country office in supporting governments and partners in implementing the SDGs; support for South-South and/or triangular cooperation initiatives; WHO`s collaboration with the United Nations system; and selected country stories categorized by the strategic priorities of GPW 13 from countries where WHO teams are contributing in making a difference in systems and in the lives of people. The information contained in this report was obtained through an online country presence survey administered to all 149 Heads of WHO offices (HWOs) in 2018, the WHO Global Management System and other internal and external information systems and sources. As of January 2019, WHO opened a new country office in Greece and eight subnational offices in different countries to strengthen its field presence. The Organization is represented across the six regions by 123 Heads of WHO offices in countries, territories and areas and by 26 acting HWOs, indicating the continuing need to improve succession planning. Gender and geographic diversity is increasing among WHO leadership. In 2017, the Director-General announced a new management team at HQ with 60% women leaders. At country level, a similar growing trend is being observed as the proportion of women HWOs has increased to 39% from the 33% The 2030 Agenda for Sustainable Development views health as vital for the future of our world. With a commitment to achieving Goal 3, which calls on all stakeholders to “ensure healthy lives and promote well-being for all at all ages”, the World Health Organization (WHO), as a specialized agency of the UN system, leads and coordinates global health, and supports countries in reaching all health-related SDG targets. vi Ι WHO presence in countries, territories and areas reported in the 2017 country presence report. In five of the six regions there has been an increase in the proportion of HWOs serving outside their region of origin. The proportion of HWOs serving outside their region of nationality has increased from 18% in 2010 to 28% in 2019 – which falls just short of the 30% target. Over 60% of HWOs in WHO are aged 56 years and above. From 2019 until 2025 an average of nine HWOs are expected to retire each year. With the increasing focus on country impact, the WHO workforce is also increasing, including professional and support staff as well as others recruited on non-staff contracts. As of 31 December 2018, WHO had a total of 3956 staff members working at country level across the six regions. This figure represents a 9% increase on that of the 2015 country presence report. Of the country level workforce, 20% are professional and higher graded staff (1% higher compared to the 2017 report), 30% are national professional officers (a 2% increase compared to the 2017 Report) and 50% are general service staff members (3% less than in the 2017 report), continuing a trend towards a higher proportion of professional staff. Sixty-nine per cent of WHO office premises across the world are made available to the Organization at no cost to it. There are 28 country offices in common UN premises (19%), with 10% of country offices being independently owned or rented by WHO. WHO corporate communication capacity is gradually being enhanced with the proportion of full-time communication staff increasing from 41% to 44% between the 2010 country presence report and the 2019 report. WHO is also increasingly using digital media to extend its outreach to stakeholders as 89% of WHO country offices reported having a country-specific website and 49% reported using the social media platform, Facebook. WHO delivers its technical cooperation based on biennial workplans developed through country cooperation strategies and biennial collaborative agreements (European Region only) – country support plans have been developed for the Programme budget 2020–2021. Currently, there are 83 valid country cooperation strategies and 26 valid biennial collaborative agreements in place, while a further 24 countries, territories and areas are in the process of developing or updating one, in line with the GPW 13 strategic priorities. Joint WHO and government mechanisms are used to enhance implementation, monitoring and reporting on WHO technical cooperation, and are reported to be present by 89% of WHO country offices, an increase from 83% in the 2017 country presence report. WHO country offices are supporting governments and partners in implementing the Sustainable Development Goals by contributing to national SDG coordination platforms, advocacy, resource mobilization, coordinating the setting of national targets and monitoring and evaluation. A high proportion of WHO country offices reported being engaged in providing technical support for the mainstreaming of SDGs into national plans, policies and programmes (89%). Such support is in line with WHO’s engagement strategy to promote health in the 2030 Agenda for Sustainable Development. During the reporting period, WHO was able to successfully respond to public health and humanitarian emergencies and support countries in enhancing their national capacity for preparedness, which is key to mounting effective responses. In 2017–2018, a total of 901 new health emergency events occurring in 162 countries, territories and areas were reported to WHO. All WHO country offices reported having provided at least one form of support to national authorities and partner organizations for emergency preparedness, prevention, detection and response during this period. Following events that occurred over this period such as Hurricane Irma in the Caribbean and Cyclone Donna in the Pacific as well as the Ebola outbreak in the DRC, WHO country offices in the Bahamas, Cuba, Vanuatu, Nigeria and the DRC among others, reported providing multifaceted support for the emergency response and preventing disease outbreaks. Since 2010, all 196 States Parties to the international Health Regulations (IHR 2005) have reported at Executive summary Ι vii least once to the Secretariat using the State Party Annual Reporting (SPAR) questionnaire. Globally, progress has been reported across the 13 core capacities, particularly in respect of surveillance, laboratory and IHR coordination, but the overall average scores suggest that further and sustained efforts are urgently needed in the areas of chemical events, capacities at points of entry and radiation emergencies. Throughout 2016-2018, joint external evaluations of IHR (2005) core capacities were completed in a total of 91 Countries (AFRO–39; AMRO/PAHO–4; EMRO–16; EURO–13; SEARO–8; WPRO–11). To augment WHO country office capacity for effective and responsive technical cooperation, WHO regional offices and HQ have been increasingly providing technical backstopping to its country offices to better support Member States towards the implementation of their national health policies, strategies and plans. With the focus on putting countries at the centre of WHO’s work, the demand for technical support is also growing. A total of 5870 missions were reported between January 2017 and 31 July 2018 to support WHO country offices in all six regions. A total of 68% of these missions were initiated by WHO country offices, which indicates an increasing trend of demand-driven backstopping. Between the 2015 and 2019 country presence reports, a 17% increase was observed in backstopping missions initiated by country offices. Communicable diseases and health systems/universal health coverage were the most frequently mentioned focus areas of such backstopping missions, covering 54% of all missions. In accordance with the vision of the Director General as expressed in GPW 13 regarding the transfer of more resources to countries, resources allocated to countries are also gradually increasing. A total of US$ 2.48 billion was made available for WHO country-level work under the WHO programme budget, representing 79% of the total planned costs for the 2018-2019 biennium, which indicated some gaps between the planned budget and actual funds made available to countries. However, almost 60% of these funds were allocated for polio, outbreak and crisis response and special programmes, leaving 42% (US$ 1.036 billion) for technical cooperation executed through base programmes. As of 31 December 2018, fifty-five per cent of the funds distributed for the 2018–2019 biennium had been spent at country level; it should be noted that this date marks the midpoint of the biennium. The Government of the United States of America, the European Union, Gavi, the Vaccine Alliance, the Government of the United Kingdom (DFID) and the Government of Japan are among the key donors of WHO at country level. As part of the UN Country Team, WHO has been proactively engaged in the UN reform at country level to enhance the effectiveness of UN presence in countries in support of their efforts to achieve the SDGs. With the global plan of action on SDG 3, WHO will be more involved in coordinating health, especially among UN agencies at country level. WHO’s engagement as part of UNCT within the UN Resident Coordinator system includes: participating in initiatives such as joint national/United Nations steering committees; joint thematic/ results groups; the Business Innovations group; development, implementation and evaluation of the United Nations Development Assistance Framework (UNDAF) within the purview of the SDGs. One hundred and twenty-eight (128) WHO country offices reported having participated in the development of UNDAF in their country of assignment. Most of the priorities of the country cooperation strategies are reflected in the UNDAF, which echoes the synergies between these two strategic frameworks and the work of WHO and the UN. However, 24% of WHO offices in the field reported that the UNDAF of their respective countries reflected all the priorities identified in the CCS. Compared to the 2017 country presence report, an increase of 11% percentage points was observed (70% in the 2017 and 81% in 2019) in the WHO offices in the field reporting participating in at least one of the United Nations common business operations and services. WHO country offices are increasingly involved in the health thematic/results group, with an viii Ι WHO presence in countries, territories and areas increase of 11 percentage points compared to the 2017 report, of WHO office staff who chair or co-chair this group, indicating an increasing level of cooperation. Integration and cooperation in the field have become of paramount importance in the SDGs era and WHO continues to lead or co-lead donor coordination mechanisms with governments. WHO country offices reported increasingly playing a leadership role in 70% of the countries, territories and areas in such mechanisms. These coordination platforms provide a hub for dialogue among multilateral, bilateral and nongovernmental agencies. United Nations Multi- Partner Trust Funds, such as One Fund/MDTF and the Sustainable Development Goals Fund are partnerships whereby the United Nations system, national authorities and funding partners establish a joint fund that uses the “pass-through fund management model”. WHO country offices in 24 countries, territories and areas receive financial support from such funds. In 2018, WHO and the Global Fund signed a new strategic framework for collaboration to strengthen the coordination and effectiveness of joint support to countries. WHO country offices in all 113 countries, territories and areas which are eligible for Global Fund grants have been active in at least one significant aspect relating to the grant process. Fifty-two (52) country offices reported acting as subrecipients of Global Fund grants to strengthen national programmes and systems to address HIV, TB, Malaria and relevant areas of work. The level of involvement in providing technical support and capacity building for accessing, implementing and reporting Global Fund grants has generally risen among WHO country offices, particularly the number of countries which are active members of the country coordination mechanism. WHO and Gavi, the Vaccine Alliance, are partners in improving access to new and underused vaccines for children. Between the 2017 and 2019 country presence reports, the number of WHO country offices reporting contributing to accessing and implementing Gavi grants has remained stable at 73 (49%). Engagement in certain elements of the funding process has generally remained the same. However, an almost 50% increase in WHO country offices channelling funding for cash grants was observed. The 2030 Agenda reaffirms the need to enhance South-South and triangular cooperation (SSTC) as well as regional and international cooperation on access to science, technology and innovation for the achievement of the Sustainable Development Goals. Globally, half of the WHO offices in countries, territories and areas in the six regions reported supporting a total of 241 South- South and/or triangular cooperation initiatives. GPW 13 focuses on driving impact in countries – while its implementation started in January 2019, an effort was made to collect country experiences, stories and achievements to highlight WHO’s contribution in terms of protecting and promoting health and serving the vulnerable. Over 200 stories of achievements and progress made by WHO country offices and interagency collaboration with other UN agencies were shared by these offices as part of the data collection exercise for the 2019 country presence report. Among the WHO country success stories collected in 2018, over a third referred to contributions made to the expansion of universal health coverage and the strengthening of health systems at country level, demonstrating the level of the work being carried out, which is key to meeting the triple billion goal of having 1 billion more people benefitting from universal health coverage, 1 billion more people protected from health emergencies and 1 billion more people enjoying better health and well-being under GPW 13. Over 60% of stories of interagency collaboration and partnership were related to promotion of health through the life-course. This reflects the fact that efforts outside the health sector are required to ensure effective implementation of the third billion, which is to improve the health of populations to achieve the goal of 1 billion more people enjoying better health and well-being. Executive summary Ι ix

Introduction Introduction Overview The country presence report is a biennial document produced by the Department of Country Cooperation and Collaboration with the United Nations System. The Report is a joint effort of the Country Support Unit Network – a network of focal points based in all six regional offices – heads of WHO offices in countries, territories and areas (HWOs) and relevant departments at WHO Headquarters. The 2019 country presence report aims to capture a wide range of relevant information to give a snapshot of the work of WHO in the field. It provides information on: 1 Who we are: WHO, people and places – infrastructure, leadership, capabilities and resources at the country level; 2 What we do: WHO at country level through the country cooperation strategy, implementation of the Sustainable Development Goals, and preparation for and response to health emergencies among other areas; 3 How we do it: technical back- stopping provided by the regional, subregional and headquarters levels and financial details including budgeting, funding and expenditure by the country offices; 4 Who we work with: collaboration with United Nations and non-United Nations partner organizations, c o u n t r y - l e v e l c o o r d i n a t i o n , contribution to implementation of global health initiatives and promotion of South-South and triangular cooperation; and 5 Work and results achieved by the WHO country offices: in relation to strategic priorities such as expanding universal health coverage, addressing health emergencies and promoting better health and well-being. In addition to the information provided in the 2017 report, it highlights country presence and performance information through the lens of the Thirteenth General Programme of Work (GPW 13), keeping in mind that 2019 is a year of transition for its implementation. It analyses more in-depth information on WHO country office human resource capacity, WHO’s contribution to the Sustainable Development Goals and WHO’s engagement in South-South and triangular cooperation. Methodology for data collection The information contained in this report was obtained through: • an online presence survey administered to all 149 HWOs in 2018; • WHO’s Global Management System (information on human resources and finance) and the database of the Department of Country Cooperation and United Nations Collaboration on the HWOs; • information obtained from the relevant departments, e.g. WHE and HTM Cluster. The data was collected through a cross- sectional quantitative and qualitative global survey administered to all WHO offices in countries, territories and areas. The survey was also translated into French and Spanish, enabling HWOs to provide the information in their preferred language. The survey was administered to all 149 HWOs in the six regions, with a 100% response rate. 2 Ι WHO presence in countries, territories and areas Limitations of the report The data and draft of this report were shared with the regions and different WHO departments at headquarters for review and validation. While due diligence has been undertaken to ensure the quality and consistency of data, the data collection, analysis and writing process had a few limitations. The respective HWOs self-reported the survey responses with no alternative mechanism to verify the accuracy of reported data. In certain instances, this may have led to minor discrepancies in data analysis or interpretation which could not be fully explained. It is also pertinent to mention that, though the survey instrument was administered with a set of detailed instructions and a glossary of terms, there is a possibility that the survey questions may not have been interpreted consistently or uniformly. To overcome these challenges, regular contacts were maintained with all six regional offices through the Country Support Unit Network, which made it possible to clarify any questions during the submission of the online survey. In instances where no responses were provided to some questions, direct contacts were made, where necessary, with the relevant WHO country offices. Introduction Ι 3

Who we are 1. “Health is a human right. No one should get sick or die just because they are poor, or because they cannot access the services they need.” dr tedros a. ghebreyesus who director-general 1. Who we are 1.1 World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations and acts as the directing and coordinating authority on international health. It was established in 1948 and is headquartered in Geneva, Switzerland. WHO’s Constitution1 entered into force on 7 April 1948 – a date now celebrated around the globe every year as World Health Day. 1 The Constitution of the World Health Organization entered into force on 7 April 1948. Available at http://apps.who.int/gb/bd/PDF/bd48/ basic-documents-48th-edition-en.pdf#page=7 (accessed 7 February 2019). Figure 1. Thirteen General Programme of Work framework 6 Ι WHO presence in countries, territories and areas WHO fulfils its role in public health through a set of six core functions which are grounded in the WHO Constitution and were first articulated in the Eleventh General Programme of Work. They remain relevant today and are reiterated in the Thirteenth General Programme of Work, 2019–2023 (GPW 13). They are: 1 providing leadership on matters critical to health and engaging in partnerships in which joint action is needed; 2 shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3 setting norms and standards and promoting and monitoring their implementation; 4 articulating ethical and evidence-informed policy options; 5 providing technical support, catalysing change and building sustainable institutional capacity; and 6 monitoring the health situation and assessing health trends. GPW 13 sets out WHO’s vision and strategic direction for 2019–2023, outlining how the Organization will proceed with its implementation and providing a framework to measure progress in this effort. GPW 13 is structured around three interconnected strategic priorities to ensure healthy lives and well-being for all at all ages: achieving universal health coverage, addressing health emergencies and promoting healthier populations. These strategic priorities are supported by three strategic shifts which are further supported by five organizational shifts as presented in Figure 1. 1.1.1 Governance and Structure The WHO Secretariat, headed by the Director- General, mainly comprises 149 offices in countries, territories and areas, as well as six regional offices and headquarters (see Fig. 2). It is governed by its 194 Member States and two Associate Member States (Puerto Rico and Tokelau). Annex 1 lists WHO Member States and Associate Member States. The World Health Assembly is WHO’s supreme decision-making body. Its main function is to determine the policies of the Organization. The World Health Assembly appoints the Director- General, supervises the financial policies of the Organization and reviews and approves the proposed programme budget. It similarly considers reports of the Executive Board,2 which it instructs on matters that may require further action, study, investigation or reporting. The Executive Board implements the decisions and policies of the World Health Assembly, advises it and generally facilitates its work. WHO’s Regional Committees meet each year to set policies and approve budgets and programmes of work for each of the six WHO regions. Each session addresses the specific public health needs and challenges of the area represented by the region. 2 The Executive Board comprises of 34 health experts at any time who are nominated by Member States. 1. Who we are Ι 7 3 There are also several subregional and geographically dispersed offices. Figure 2. The three levels of organization in WHO3 WHO Headquarters HQ outpost offices Global Service Centre in Kuala Lumpur, Malaysia, houses the administrative services of the Secretariat WHO office at the United Nations, in New York, represents the interests of WHO at the UN These are located in Addis Ababa, Ethiopia; Bangkok, Thailand; and Brussels, Belgium and managed, respectively, by the WHO Regional Office for Africa, WHO Regional Office for South-East Asia and WHO WHO Regional Offices 149 WHO offices in countries, territories and areas Outpost offices managed by regional offices 2 field offices in territories and areas 147 WHO country offices WHO country offices covering more than one country, territory or area WHO Centre for Health Development in Kobe, Japan, conducts research on the consequences of social, economic and environmental change and their implications for health policies Regional Office for the Europe. Some sub-regional offices related to WHO Region Office for the Eastern Mediterranean are located in Amman, Jordan. Further sub-regional offices in the African Region are located in Harare, Libreville and Ouagadougou. Geneva, Switzerland WHO suboffices in countries Figure 3. Map of WHO’s presence in countries, territories and areas WHO headquarters WHO HQ outpost office WHO regional office (*) includes 1 WHO field office in a territory or area Country, territory or area with a WHO office WHO headquarters WHO HQ outpost office WHO regional office Country, territory or area with a WHO office 8 Ι WHO presence in countries, territories and areas 1.1.2 Regional Offices WHO Member States are grouped into six regions, each having a regional office. 1.1.3 WHO country offices WHO as a specialized agency of the United Nations (UN) system, leads and coordinates global health and supports countries in reaching all health-related SDG targets under the 2030 Agenda for Sustainable Development. With its 149 offices in countries, territories and areas, WHO has one of the largest global footprints. To effectively support Member States, WHO has developed one of the largest in- country networks of offices compared to other UN Agencies. These offices, equipped with infrastructure and human and financial resources, are the foundation of WHO’s support to its Member States; providing a platform for effective cooperation to advance the global health agenda and contribute to national health policies, strategies and plans. Table 1. WHO regional offices, location and Member States covered Region Regional office Location Number of Member States covered African Region Regional Office for Africa Brazzaville, Congo 47 Region of the Americas Regional Office for the Americas Washington DC, USA 35 Eastern Mediterranean Region Regional Office for the Eastern Mediterranean Cairo, Egypt 21 European Region Regional Office for Europe Copenhagen, Denmark 53 South-East Asia Region Regional Office for South-East Asia New Delhi, India 11 Western Pacific Region Regional Office for the Western Pacific Manila, Philippines 27 Total 194 WHO’s newest country office opens in 2018 in Athens, Greece In June 2018, WHO and the Greek Ministry of Health inaugurated the new WHO Country Office in Athens. WHO Director-General, Dr Tedros Adhanom Ghebreyesus, and the WHO Regional Director for Europe, Dr Zsuzsanna Jakab joined the Minister of Health for Greece, Dr Andreas Xanthos for the official opening. Considering past achievements, the new office represents a deepening of bilateral cooperation between WHO and Greece. 1. Who we are Ι 9 1.1.4 WHO country offices covering more than one country, territory or area Some WHO country offices provide support for WHO’s activities in locations outside the boundaries of the countries in which they are located. The following table shows the WHO offices that provide support to more than one country, territory or area. 4 The Director of the Division of Pacific Technical Support/WHO Representative in the South Pacific coordinates WHO’s intercountry programmes in the Pacific with WHO representatives based in Samoa and Solomon Islands and with the WHO country liaison officers in Kiribati, Northern Micronesia, Tonga and Vanuatu. Table 2. WHO country offices covering more than one country, territory or area Region WHO office Additional countries, territories and areas covered African Region Madagascar (based in Antananarivo) Réunion Island (French Overseas Department) Region of the Americas Bahamas (based in Nassau, New Providence) Turks and Caicos Islands PAHO/WHO Office of the Eastern Caribbean Coordination (based in Bridgetown, Barbados) Antigua and Barbuda, Anguilla, British Virgin Islands, Dominica, Montserrat, Grenada, Saint Lucia, Saint Vincent and the Grenadines, Saint Kitts and Nevis and the French departments in the Caribbean (Guadeloupe, Martinique, French Guiana and French Saint Martin) Jamaica (Kingston, Jamaica) Bermuda and Cayman Islands Trinidad and Tobago Aruba, Curaçao and Sint Maarten and the special municipalities of the Kingdom of the Netherlands in the Caribbean (Bonaire, Saba and St Eustatius) Western Pacific Region Malaysia, Brunei Darussalam and Singapore (based in Kuala Lumpur) Brunei Darussalam, Malaysia and Singapore American Samoa, Cook Islands, Niue and Tokelau (based in Apia) Samoa, American Samoa (United States of America), Cook Islands, Niue and Tokelau (New Zealand) Division of Pacific Technical Support/ WHO Representative Office in the South Pacific (Suva, Fiji)4 Fiji, French Polynesia (France), Commonwealth of the Northern Mariana Islands (United States of America), New Caledonia (France), New Zealand, Nauru, Palau, Solomon Islands, Tuvalu, Wallis and Futuna (France) and Pitcairn Islands (United Kingdom) The Director of the Division of Pacific Technical Support/WHO Representative in the South Pacific coordinates WHO's intercountry programmes in the Pacific with WHO representatives based in Samoa and Solomon Islands and the WHO country liaison officers in Kiribati, Northern Micronesia, Tonga and Vanuatu Northern Micronesia (Country Liaison Office based in Palikir, Pohnpei, Federated States of Micronesia) Federated States of Micronesia, Marshall Islands and Palau In the Eastern Mediterranean Region, on account of ongoing emergencies in several Member States, WHO offices in some countries provide logistic and operational support to neighbouring or nearby countries. For example, the WHO Country Office in Afghanistan has a liaison office in Pakistan (Islamabad); the WHO Country Office in Somalia has one liaison office in Kenya (Nairobi); and the WHO Country Office in Yemen has a liaison office in Djibouti (Djibouti) and another in Jordan (Amman). 10 Ι WHO presence in countries, territories and areas 1.1.5 Countries and areas covered by WHO regional offices WHO does not have a physical presence in all 196 of its Member and Associate Member States and areas. In 36 of these, WHO provides technical and normative support from its respective regional offices and headquarters. Table 3. WHO Member and Associate Member States and areas without WHO offices Region Member States, Associate Member States and areas Region of the Americas Canada, United States of America and Puerto Rico (Associate Member State) Eastern Mediterranean Region Bahrain, Kuwait, Qatar and United Arab Emirates European Region Andorra, Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland and United Kingdom Western Pacific Region Australia, Guam (United States of America), Hong Kong Special Administrative Region (China), Japan, Macao Special Administrative Region (China) and Republic of Korea 1.1.6 Suboffices in countries In some countries, suboffices are established as subsidiaries of a country office to provide support for implementing field activities to a programme or to facilitate effective coverage of WHO activities in geographically large countries as well as in countries facing complex emergencies or countries affected by polio outbreaks. A suboffice is normally located at the subnational level and led by a senior staff member who reports to the Head of WHO Office (HWO). HWOs usually delegate authority to these officers to effectively execute their responsibilities in accordance with the WHO mandate and under the rules and regulations of the Organization. WHO has a total of 147 suboffices, distributed throughout 32 countries. That number includes 81 suboffices in the African Region, 10 in the Region of the Americas, 39 in the Eastern Mediterranean Region, six in the European Region, nine in the South-East Asia Region and two in the Western Pacific Region. Since the 2017 country presence report, nine suboffices have been opened and one closed. Four new suboffices have been opened in the African 1. Who we are Ι 11 Table 4. Number and location of WHO suboffices in countries by WHO region Region Country, territory or area Number of subofffices Location of suboffices African Region Nigeria 37 In each of the 37 States, including the Federal Capital Territory in Abuja Democratic Republic of the Congo 11 Kinshasa, Matadi, Bandundu ville, Kananga, Mbuji Mayi, Lubumbashi, Bukavu, Goma, Kindu, Kinsagani and Mbandaka South Sudan 10 In all the capitals of the 10 States that constitute the country Chad 6 Abeche, Sarh, Moundou, Mongo, Mao and Ndjamena United Republic of Tanzania 5 Zanzibar, Tanga, Dodoma, Mwanza and Iringa Kenya 4 Garissa (serving the North Eastern Province), Embu, Eldoret, Nakuru Central African Republic 3 Bambari, Kagabandoro and Bouar Guinea 2 Nzérékoré and Guéckédou Ethiopia 1 Somali Region Ghana 1 Tamale Uganda 1 Moroto Region of the Americas Barbados 7 Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia, Saint Vincent and the Grenadines, and Anguilla Guatemala 1 San Marcos Mexico 1 Tuxtla Gutiérrez Chiapas Paraguay 1 Boqueron, Filadelfia in El Chaco Paraguayo Eastern Mediterranean Region Afghanistan 8 Jalalabad, Gardez, Herat, Kandahar, Bamyan, Kunduz, Balkh and Badakhshan Sudan 6 El-Fasher, Nyala, Geneina, Kassala, Kadugli and Damazine Iraq 5 Erbil, Dohuk, Sulaimaniyah, Basrah and Baghdad (within the Ministry of Health) Pakistan 4 Lahore, Karachi, Peshawar and Quetta Somalia 4 Nairobi (Liaison Office), Hargeisa (serving Somaliland), Garowe (serving Puntland), and Baidoa (serving southwestern state) Syrian Arab Republic 4 Qamishly, Aleppo, Homs and Latakia Yemen 4 Aden, Al Hodeida, Ibb (serving Ibb and Taiz) and Sadaa Libya 2 Benghazi , Sabah West Bank & Gaza Strip 2 Ramallah, Gaza European Region Ukraine 4 Donetsk, Kramatorsk, Luhansk and Severodonetsk Bosnia and Herzegovina 1 Banja Luka Turkey 1 Gaziantep South-East Asia Region India 7 In all seven regional hubs in the country Indonesia 2 Jakarta Western Pacific Region Philippines 1 Davao City Viet Nam 1 Ho Chi Minh City Region (three in Kenya and one in Ethiopia), one in the Region of the Americas (Paraguay), three in the Eastern Mediterranean Region (two in Libya and one in Somalia) and one in the European Region (Ukraine). In Uganda, one of the two suboffices was closed (Table 4 shows the distribution of these suboffices by WHO region). 12 Ι WHO presence in countries, territories and areas 1.2 People 1.2.1 WHO country office leadership A WHO office in a country, territory or area is usually headed by a Head of WHO Office (HWO). The designations included in this report under the term HWO include: WHO representative (WR); PAHO/WHO representative (PWR); liaison officer, and country liaison officer. While different regions use different titles in some cases, the roles and functions of the position have been standardized across the Organization. Profile of an HWO As the designated representative of the Director-General and under the guidance of the Regional Director, the HWO is the most senior WHO staff member at the country level. She/ he is responsible for leading, managing, implementing and coordinating WHO’s strategic and operational functions in the country of assignment towards the realization of health outcomes in line with national priorities, regional and global commitments, the WHO General Programme of Work and the SDGs. The HWO serves as a credible, trusted, neutral broker, an effective, influential and accountable leader in health at the country level, working across different sectors and at all levels of government, as well as with the UNCT, other partners, non-State actors, civil society and communities. Supported by all levels of the Secretariat, the HWO delivers excellence in her/his various policy, technical, political, diplomatic, managerial and advocacy roles. 5 The desk officers for Bahrain, Kuwait, Qatar and the United Arab Emirates are not considered HWOs. 6 Country Liaison Officers are internationally recruited staff members. An HWO represents the Director-General and the respective Regional Director in the country of assignment and is the responsible officer for all aspects of the collaborative activities of WHO. The generic roles and functions of an HWO (detailed terms of reference that have been revised to reflect the SDGs, GPW 13 and UN reform are available on request) include: • convening, representation, partnership and advocacy; • technical cooperation, policy advice and dialogue; and • administration and management. As of January 2019, WHO was represented across the six regions by 123 appointed and 26 acting HWOs, as represented in Table 5. 1.2.2 Status of acting HWOs Across all regions, between 2015 and 2019 the number of acting HWOs increased from 18 to 26, highlighting the need for timely recruitment of HWOs and better succession planning to ensure uninterrupted presence of a full time HWO in each country office. As shown below, the greatest increase in acting HWOs was observed in the African Region. Table 5. HWOs in countries, territories and areas by WHO region (excluding acting HWOs) Region WHO Representative PAHO/WHO Representative WHO Representative or Head of Country Office Other Comments Total African Region 31 31 Region of the Americas 24 24 Eastern Mediterranean Region5 14 1 “Other” refers to the head of the WHO Office in the West Bank and Gaza Strip 15 European Region 13 16 29 South-East Asia Region 11 11 Western Pacific Region 11 2 “Other” refers to the Country Liaison Officers in Northern Micronesia and Vanuatu6 13 Total 80 24 16 3 123 1. Who we are Ι 13 1.2.3 Gender distribution of HWOs WHO is committed to advancing gender equality in its workforce. However, progress AFR AMR EMR EUR SEAR WPR Figure 4. Number of acting HWOs by WHO region 2015–2019 0 2 4 6 8 10 12 14 16 2015 2017 2019 8 7 16 2 1 3 4 4 3 1 4 2 1 1 0 2 2 2 towards this aim has been slow, and the proportion of women appointed as HWOs has remained below 40% from 2010 to 2019. Figure 5. Proportion of women HWOs, 2010–2019 (excluding acting HWOs) (%) 30 32 34 36 38 40 2010 2012 2015 2017 2019 31 39 34 3333 14 Ι WHO presence in countries, territories and areas The European Region is the only region currently where more than 50% of HWOs are women (59%), though 48% of HWOs in the Region of the Americas are women due to a six-percentage point increase since the 2017 country presence report. The proportion of women HWOs in the African Region increased from 23% to 32% during this time. While the number of women HWOs in the Eastern Mediterranean Region doubled between the 2017 and 2019 country presence reports from three to six, there remains only one female HWO in the South-East Asia Region and three in the Western Pacific Region. Women Men Figure 6. The proportion of men and women HWOs globally and by region (%) 01/03/2019 Total 1/1 Global 61% 39% AFR 68% 32% AMR 52%48% EMR 60% 40% EUR 41% 59% SEAR 91% 9% WPR 77% 23% 1.2.4 Region of origin of HWOs In 2012, the Director-General, in consultation with the WHO Global Policy Group (GPG), decided that at least 30% of HWOs should come from outside their WHO region of origin, to promote regional diversity. The proportion of HWOs serving outside their region of nationality has increased globally from 18% in 2010 to 28% in 2019. There is a high level of regional variance, with 67% of HWOs serving in the Eastern Mediterranean Region and Western Pacific Region originating from outside of these regions compared to 10% in the African Region and 7% in the European Region. Table 6. Number of HWOs serving outside of their WHO region of origin (excluding acting HWOs) Region Number of WHO country offices Number of HWOs serving outside their WHO region of origin (nationality) African Region 47 3 Region of the Americas 27 7 Eastern Mediterranean Region 18 10 European Region 31 2 South-East Asia Region 11 4 Western Pacific Region 15 8 1. Who we are Ι 15 1.2.5 Age and retirement of HWOs Over 60% of HWOs are aged 56 years or over. The 56–60 age bracket represented either the highest or shared highest proportion of HWOs across all six regions. As of 1 January 2019, WHO has extended the mandatory age of retirement to 65 for all staff members. All staff members who reached their retirement age of 60 or 62 in 2017 and 2018 separated from WHO on retirement except in exceptional circumstances. As a result, between 2019 and 2025, it is anticipated that nine HWOs, on average, will retire every year. By region, this represents 33% of the current HWOs in the European Region, over 50% of HWOS in the Regions of the Americas, Eastern Mediterranean, South-East Asia and Western Pacific; and 66% of the current HWOS in the African Region. AFR AMR EMR EUR SEAR WPR Figure 7. Age distribution of HWOs by WHO region (excluding acting HWOs) 0 2 4 6 8 10 12 14 16 36-40 41-45 46-50 51-55 56-60 61-62 63-65 1.2.6 HWOs’ length of service HWOs are selected through a roster-based competitive process. They are normally senior staff members who have worked for WHO for some time and should have a minimum of 10 years of professional experience at the national and international levels. Over three quarters of HWOs have over 11 years of service as WHO staff members, while three HWOs have served for more than 26 years. The most frequent length of service is between 11 to 15 years as a staff member. Over 60% of HWOs have served in their role for five years or less. Seven HWOs have been WHO representatives for over 10 years and seven HWOs have been in service for 16–20 years in several duty stations. 16 Ι WHO presence in countries, territories and areas AFR AMR EMR EUR SEAR WPR Figure 8. Number of HWOs by years of service as WHO staff members (fig. left) and years of service as HWOs (fig. right) 2/22/2019 HWOs service-length-1 1/1 <5 6-10 11-15 16-20 21-25 26 and above 2 4 25 10 3 3 3 9 4 3 3 2 11 3 2 7 12 9 2 2 3 3 4 7 3 2/22/2019 HWOs tenure-1 1/1 <5 6-10 11-15 16-20 29 13 20 38 10 11 10 8 9 12 3 1.2.7 WHO workforce in countries, territories and areas As shown in Figure 9 below, WHO has four categories of personnel at the country level: (1) internationally recruited professional officers, (2) locally recruited national professional officers, (3) locally recruited general service staff, and (4) non-staff contractors. Figure 9. Categories of WHO workforce 1.2.8 WHO country-level staffing situation As of 31 December 2018, WHO had a total of 3957 staff members working at country level across the six regions. This represents a 9% increase from the 3641 WHO staff members at the country level in 2015. There were also 5738 non-staff contractors working at the country level. Almost half of these staff are based in the African Region (46%); 19% are based in the Eastern Mediterranean Region; 11% in the South- East Asia Region; 9% in both the Region of the Americas and the Western Pacific Region and 6% in the European Region. Of the country-level workforce, 20% are professional and higher graded staff, 30% are national professional officers and 50% are general service staff members, maintaining the trend towards a higher proportion of professional staff at the country level (this staff category rose from 11% in 2010 to 47% in the 2017 country presence report). The proportion of professional and higher graded staff varies from 12% in the African Region up to 50% in the Region of the Americas and stands at 26% in the Western Pacific Region, 24% in the Eastern Mediterranean Region, 21% in the European Region, and 19% in the South-East Asia Region. The ratio of professional to general service staff is often lower in countries where WHO has significantly large operational activities. International professional officers • Recruited internationally in accordance with WHO Staff Rules and may be assigned to any official station outside their home country. • Perform functions of a professional nature requiring global knowledge, expertise and experience of an international dimension. National professional officers • Nationals of the country in which they are to serve, are recruited locally and are not subject to assignment to any official station outside the home country. • Perform functions of a professional nature requiring local knowledge, expertise and experience of a national dimension. General service staff • Perform clerical, custodial and subprofessional tasks in accordance with Staff Rule 1310. • All positions in the general service category are subject to local recruitment and must be filled, as far as possible, by people recruited in the local commuting area of each office. Non-staff contractor support • WHO country offices hire non-staff contractors to implement programme-specific and time- limited activities such as polio eradication and emergencies. • The status of non-staff contractors differs from that of international civil servants or national professionals. 1. Who we are Ι 17 Figure 10. Breakdown of WHO workforce across the six regions by job category and gender Female Male General service staff National professional officer Professional and higher graded staff AFR AMR EMR EUR SEAR WPR Professional and higher graded staff National professional officer General service staff Distribution of WHO country staff by category Gender distribution of WHO country staff by category 1.2.9 Gender distribution of WHO staff at the country level Of the total 3956 staff at country level, 62% are male and 38% are female, a shift from 64% and 36% respectively in the 2017 country presence report. Within the regions, up to 70% of country office staff are male as seen in the African Region and Eastern Mediterranean Region. In every region the proportion of male staff increases when considering professional staff to overall staff members, with the exception of a 1% fall in the Eastern Mediterranean Region. This is even more pronounced when the category of professional and higher graded staff is considered in isolation, with the difference being over 20% in the European Region. However, slight increases in the proportion of professional female staff between 2017 and 2019 have been observed in the African Region, Eastern Mediterranean Region and Western Pacific Region. 1.2.10 Diversity of WHO staff capacity at the country office level GPW 13 guides WHO’s priorities and work overall; however, the specific focus of and approach to the Secretariat’s engagement with each individual country will be flexible in order to take into account country context and country capacity, thus ensuring that support is relevant and effective. In some settings such engagement will be more upstream – policy- related, strategic and normative − and in others more downstream with a focus on technical assistance and strengthening service delivery. In many countries engagement will involve a mixture of approaches, and the focus of WHO support will evolve over time. The WHO country team capacity must be fit for purpose to carry out the core functions of WHO and support the Member State to address its national priorities. With a renewed focus on WHO’s impact in countries, a range of initiatives are underway to reprofile and build the capacities of WHO’s country offices. WHO’s country cooperation strategies and country support plans for instance, are the strategic and operational tools used by WHO at the country level to define priorities and identify WHO’s comparative advantage as well as any gaps in capacity. Country office functional reviews and the current transformation agenda provide further opportunities to rationalize and hone the expertise in country offices. This section highlights the current picture in terms of country capacity as it relates to specific programme areas. A total of 140 (94%) of 149 WHO country offices reported having human resource capacity to 18 Ι WHO presence in countries, territories and areas address programmatic/technical issues in at least one of the highlighted programme areas in Figure 11, while 56 WHO country offices (38%) reported having capacity for all seven areas of work. Human resource capacity for addressing issues related to health systems/universal health coverage and communicable diseases was reported in over 84% of WHO country offices, with the Region of the Americas and South-East Asia Region reporting 100% capacity. All WHO country offices in the Region of the Americas also reported having human resource capacity for health emergencies with many countries in that Region, particularly the Caribbean Islands, being vulnerable to extreme weather events. Within the African Region, WHO country offices reported having the highest level of human resource capacity in the technical area of communicable diseases, in line with the high burden of disease caused by communicable diseases across the Region. Health systems/ universal health coverage was the technical area with the highest reported level of human resource capacity in the Eastern Mediterranean Region, following protracted efforts for health system strengthening and the achievement of health equity in the Region. Figure 11. Proportion of WHO country offices reporting the availability of human resources to address programmatic/technical issues in various programme areas (%) AFR EMR SEAR WPR AMR EUR 1. Who we are Ι 19 Among WHO country offices in the European Region, 58% reported having capacity in health emergencies and noncommunicable diseases, with noncommunicable diseases a priority area for action in many countries, and others strengthening their response to the arrival of increased numbers of refugees/migrants. Communicable diseases, noncommunicable diseases and health systems/universal health coverage were reported in 87% of countries in the Western Pacific Region. As with the different technical areas, depth of capacity and competency in the functional processes which enable WHO office teams to carry out the core functions of the Organization at country level are equally important. The majority of WHO country offices have available capacity in policy dialogue/policy analysis, the Health in All Policies (HiAP) approach, including all WHO country offices in the Region of the Americas and South-East Asia Region. Over 85% of WHO country offices overall also have capacity in procurement and logistics, and project/programme management. Within the regions, between 61% and 96% of WHO country offices have capacity for multi-stakeholder collaboration for SDG implementation; the figure stands at 80% or above in the Region of the Americas, South-East Asia Region and Western Pacific Region. One hundred and twenty WHO country offices (81%) have capacity in at least five of the functional competencies, while 44 WHO country offices (30%) have capacity in at least nine of the 10 highlighted roles. 1.3 Facilities 1.3.1 Place Across the 149 countries, territories and areas where WHO is physically present, there are diverse housing arrangements for WHO offices. These offices include the categories of dedicated country offices, sub and field offices. The majority of premises (69%) across the world are made available to WHO at no charge; such offices are usually located within, or near Figure 12. Proportion of WHO country offices reporting availability of capacity in functional competencies (%) Community engagement Data/ Information processing/ Health statistics Monitoring and evaluation Multi-stakeholder collaboration for SDGs implementation Policy dialogue/ Policy analysis/ Health in All Policies (HiAP) approach Procurement and logistics Project/ programme Management Resource mobilisation and proposal drafting AFR EMR EUR SEAR WPRAMR Gender, equity and human rights Region Country offices In territories UN shared premises African Region 47 12 Region of the Americas 27 1 Eastern Mediterranean Region 17 1 (West Bank and Gaza Strip) 3 (Includes Tripoli) European Region 30 1 (Pristina) 8 South-East Asia Region 11 2 Western Pacific Region 15 2 Total 147 2 28 Table 7. Number of WHO offices in countries and areas housed in UN shared premises 20 Ι WHO presence in countries, territories and areas the premises of the health ministry. There are 28 country offices in common UN premises (19%), with 10% of country offices being independently owned by WHO. 1.3.2 Corporate communication capacity at country level WHO recognizes that effective, integrated and coordinated communication is integral to the achievement of its goal of building a better, healthier future for people all over the world. Two thirds of WHO country offices (66%) reported having dedicated communication staff, two thirds of whom are full-time; a further 24% are part-time and the remaining 10% are outsourced. Over 80% of WHO country offices in the African Region, Region of the Americas and South-East Asia Region have dedicated communication staff, with the proportion of full-time staff across regions varying from 13% to 62%. The proportion of full-time communication staff has increased overall from 41% to 44% since the 2010 country presence report and has doubled in the Eastern Mediterranean Region and Western Pacific Region, with increases also Region Sub and field offices UN shared premises African Region 60 9 Region of the Americas 0 0 Eastern Mediterranean Region 33 9 European Region 7 4 South-East Asia Region 489 2 Western Pacific Region 3 1 Total 592 25 Table 8. Number of WHO sub and field offices housed in UN shared premises Figure 13. Proportion of WHO country offices reporting having communication staff (%) Full-time Part-time Outsourced None 11/03/2019 Fig 13 1/1 0% 20% 40% 60% 80% 100% AFR AMR EMR EUR SEAR WPR 61% 55% 33% 13% 45% 40% 15% 15% 44% 74% 18% 40% 9% 15% 9% 7% 15% 15% 22% 13% 27% 13% 1. Who we are Ι 21 reported in the Region of the Americas and the European Region. 1.3.3 Information sharing WHO country offices in 133 countries, territories and areas (89%) reported the existence of a country-specific website in order to provide information to stakeholders. At least 83% of WHO country offices in each region reported having a country-specific website, with this figure as high as 100% in the Eastern Mediterranean Region. Engaging with social media allows WHO country offices to drive traffic to websites where more detailed and trusted content can be found. New social media platforms emerge and current platforms also constantly evolve to take advantage of novel film, broadcast, and other new technologies that enhance the ability for their subscribers to engage in conversations. WHO aims to constantly keep abreast of changes and identify areas for improvement. WHO country offices in 91 countries, territories and areas (61%) reported having at least one official account on social media, with 23 WHO country offices (15%) having three or more. WHO country offices are most likely to have reported the existence of a Facebook or Twitter account (48% and 42% of WHO country offices respectively) and at least 10% also reported using YouTube and Instagram/Flickr. At least 39% of WHO country offices in each region have at least one social media account with the highest levels of engagement reported in the Region of the Americas (85%) and the Eastern Mediterranean Region (72%). 1.3.4 Access to breastfeeding facilities in WHO country offices Breastfeeding gives children the healthiest start to life. Just under half of WHO country offices reported having an appropriate facility for breastfeeding for staff (49%); within regions this figure is between 58% and 67% in the Region of the Americas, Eastern Mediterranean Region, European Region, South-East Asia Region and Western Pacific Region, and 21% in the African Region. Figure 14. Proportion of WHO country offices reporting having a country-specific website or official accounts on social media (%) 06/03/2019 Fig 14 1/1 Website Facebook Twitter YouTube Instagram/Flickr Other local social media Google+/Google Play 89 48 42 11 10 5 1 22 Ι WHO presence in countries, territories and areas 05/03/2019 Q4 1/1 AFR AMR EMR EUR SEAR WPR 21 67 61 58 64 60 Overall 49 Figure 15. Proportion of WHO country offices reporting having an appropriate facility for breastfeeding for staff (%) 1. Who we are Ι 23

What we do 2. 2. What we do To drive impact in every country, WHO engages in policy dialogue and provides strategic support, technical assistance and operational support to Members States as required. WHO is a trusted partner to ministries of health and strives to build sustainable institutional capacity to protect health, keep people safe and serve the vulnerable in each country. WHO engagement with the health ministry is primarily delivered through its contribution to national health policies, strategies and plans for UHC and for ensuring financial protection; its role in convening and managing health sector coordination for better impact at country level; its participation in joint annual health sector reviews; its provision of policy advice and technical support for attainment of the three GPW 13 priorities; and mobilization of resources for health. Besides ministries of health, WHO collaborates with a range of other ministries and government entities beyond the health sector, including parliamentarians and Heads of State to advocate for multisectoral action to reduce risk factors and improve health as a cornerstone of the entire 2030 Agenda for Sustainable Development. Working with non-health ministries is increasingly being recognized and promoted as a significant vehicle for improving health outcomes related to non-health sector risk factors and influences. WHO’s collaboration with a wide range of partners is the key to leveraging the greatest gains for global public health. At the country level, WHO works with UN agencies, bilateral and mult i lateral agencies, funds and foundations, nongovernmental organizations and communities in planning, implementing and monitoring programmes to improve health. WHO country office roles and functions Articulating policy options • Lead health policy dialogue and provide policy advice to national counterparts and partners • Promote the engagement of countries in setting regional and global policies and strategies Providing leadership • Advocate for Health in All Policies and promote dialogue for intersectoral and multistakeholder collaboration • Lead WHO’s United Nations interagency work in integrating national health priorities into the development agenda and the United Nations Development Assistance Framework (UNDAF) • Lead the convening and coordination of the health response in emergencies • Lead in strengthening country capacity in health diplomacy for better engagement in national and international processes and global health governance Providing technical support and building capacity • Lead the development of a country cooperation strategy and its implementation • Lead and manage the provision and brokering of technical cooperation • Lead in implementing and monitoring international commitments, conventions and legal instruments • Lead emergency response and action during crises and emergencies Monitoring health trends • Lead WHO’s work in monitoring and evaluating national policies and programmes Setting norms and standards • Support countries in adapting and implementing guidelines, tools and methods • Contribute to setting global norms and standards by providing evidence from countries Shaping the research agenda • Promote research and strengthen research capacity in countries • Support and, when appropriate, conduct operational research and ensure the use of results • Contribute to the body of knowledge on best practices 26 Ι WHO presence in countries, territories and areas 2.1 Contributing to national health policies, strategies and plans to roll out UHC, ensure healthy lives and respond to health emergencies National Health Policies, Strategies and Plans (NHPSPs) play an essential role in outlining a country’s population health needs, vision, policy directions and investments to improve health and realize the SDGs. During the reporting period, a valid NHPSP was in place in 124 (83%) countries, territories and areas where WHO has an office. All countries in the South-East Asia Region had an up-to-date national health policy, strategy or plan at this time as well as over 80% of countries in the African Region, Region of the Americas, European Region and Western Pacific Region. WHO country offices in 147 countries, territories and areas have reported playing a role in the initiation, development, implementation and/ or monitoring of the national health policy, strategy or plan either at present or previously. Depending on the country context, WHO plays various roles in support of NHPSPs, with building national capacity for implementation being the most frequently reported activity by WHO country offices (89% of countries, territories and areas). Other roles are shown in Figure 16 below. In 105 (70%) country offices, WHO was engaged in at least five of the six active roles. Active participation (e.g. Co-Chair with Ministry of Health or other leadership session leading to formulation of NHPSP Actively engaged in the implementation of NHPSP Building national capacity for effective policy analysis, formulation, monitoring and review Building national capacity for implementation of NHPSP Improving national health governance through sustained and inclusive effective health sector policy dialogue Main technical partner in undertaking situation analyses Not involved One of the partner agencies attending the NHPSP development meetings (but not providing active support) 05/03/2019 Q7 1/1 100% SEAR 89% AMR 90% EUR 50% EMR 93% WPR 81% AFR AFR 18% 17% 17%16% 15% 14% 3% EMR 17% 17% 16%16% 15% 14% 3% EUR 20% 17% 17% 17% 13% 13% 2% 1% SEAR 17% 17% 16%16% 16% 12% 7% WPR 18% 16% 16%16% 15% 14% 4% AMR 17% 17% 17%16% 14% 13% 3% 1% Proportion of countries, territories and areas where the WHO is physically present with a valid national health policy, strategy or plan Figure 16. Proportion of WHO country offices in each region reporting engagement in supportive roles relating to the national health policy, strategy or plan (%) 2. What we do Ι 27 Figure 17. WHO country office support for the implementation of the Framework Convention on Tobacco Control The Framework Convention on Tobacco Control (FCTC) and the Protocol to Elimincate Illicit Trade in Tobacco Products Actions in Member States that are Parties Providing multi-level assistance to facilitate policy dialogue and to ensure full implementation of the Convention; collecting contributions from the Parties and encouraging them to join the Protocol to Eliminate Illicit Trade in Tobacco Products. Supporting the preparation of progress reports on treaty implementation. Actions in Member States that are Parties WHO country offices Actions in relation to the Convention's Secretariat Facilitating the communication with Parties' governments; working to integrate the Convention in the UN system at country level (UN funds, UN RC System, UNDAF), supporting need assessment missions and meeting with experts. Actions in Member States that are not Parties Providing support and advocacy to encourage the country to join the Convention. Countries with a WHO country office which have ratified the FCTC Countries without a WHO country office which have ratified the FCTC The FCTC has been ratified in 91% of the 149 countries, territories and areas where the WHO is physically present. WHO country offices play active roles to ensure ratification and implementation. A high level of ratification across a wide geographical spread is evident, with over 80% of countries, territories and areas within each region having ratified the FCTC, including 100% in the Western Pacific Region. An additional 37 countries, territories and areas where the WHO is physically present have ratified the Protocol to Eliminate Illicit Trade in Tobacco Products as of October 2018. WHO country offices in action: FCTC implementation Multiple WHO country offices have been actively engaged in numerous aspects of FCTC implementation. These efforts range from assisting with an economic study on tobacco and taxation in support of FCTC ratification in Morocco, to deploying international technical expertise for effective FCTC 2030 project implementation in Jordan. Having a lasting impact is key, and this aspect was addressed by the WHO country office in the Russian Federation through advocacy and the provision of evidence to ensure that tobacco control remains a high-level government priority with assured funding. The WHO country office in Slovenia engaged in situational analysis, promoting stakeholder policy dialogue, monitoring violations and evaluating impact. The WHO country office in Georgia was heavily involved in the endorsement and enforcement of a modern tobacco-control law. Assisting NGOs in organizing a study tour and initiating collaboration with members of parliament from different countries afforded decision-makers the opportunity to gain experience. WHO worked with partners to lead a strong communication campaign, critically contributing to robust public support for tobacco control measures. Continued WHO support and multisectoral collaboration seek to increase impact and prevent interference from the tobacco industry. A report on investing in FCTC implementation from WHO and partners played a significant role in the endorsement of the tobacco-control law in Georgia and in strengthening intersectoral collaboration at national level. 28 Ι WHO presence in countries, territories and areas WHO country offices have played a key role in supporting the implementation of WHO treaties such as the Framework Convention on Tobacco Control (FCTC), the first WHO treaty adopted under article 19 of the WHO Constitution. The types of action taken by WHO country offices to facilitate implementation of the FCTC are detailed in Figure 17. 2.2 Country Cooperation Strategy A Country Cooperation Strategy (CCS) is WHO’s country-level medium-term strategic vision to guide the Organization’s work in and with a country. It imprints the General Programme of Work at the country level and responds to the national health and development agenda.1 Based on evidence of health needs and strategic dialogue with Member States and partners working at the country level, the CCS identifies a set of jointly agreed priorities that will underpin collaboration with WHO over a four- to five-year period, covering areas in which WHO has a comparative advantage to drive public health impact. In line with WHO’s strategic shift towards impact in every country, the CCS also includes a GPW 13-aligned country impact framework covering the jointly identified priorities. Therefore, the CCS plays a unique and important role as the public expression of WHO’s results chain at the country level. It is also a critical input to support WHO’s biennial operational planning including country support plans (CSP) and programme budgets (PB). The role of the CCS is to strategically respond to a country’s specific priorities and institutional resources needed to achieve its national health policies, strategies and plans and the action needed to achieve its national health-related targets under the Sustainable Development Goals. 1 The term ‘national health and development agenda’ is used here to describe the totality of the country’s health-related priorities typically set out in government strategies, policies, plans and vision documents. These often include national health policies and plans, sustainable development plans, other sector policies and plans that influence health, the UN Development Assistance Framework (or equivalent), and government ‘vision’ documents. CCS: A snapshot of Global Analysis 2017 The WHO Country Cooperation Strategies – Global Analysis (2017), a review that is done every three years, reported that UHC through strengthening of health systems has been at the heart of WHO’s work at country level and has been recognized as a leading target within the recently adopted 2030 Agenda for Sustainable Development. Actions towards UHC are evident in 84% of the 64 CCSs reviewed. Emergency risk and crisis management (78%), IHR 2005 (69%) and alert and response capacities (61%) are the top strategic priorities/focus areas in the CCSs reviewed in 2017, followed by disease surveillance and early warning systems (52%) (in the context of emergencies). As recommended by the previous WHO global analysis, most CCSs now include a strategic priority on emergency risk assessment, preparedness, alert and response to epidemics and emergencies, as well as full support for the implementation of the IHR at national level. Twelve (19%) CCSs among the 64 that were reviewed in the 2017 Global Analysis have prioritized strategies addressing cross-cutting interventions. Thirty-five (95%) out of the 64 CCSs analyzed, addressed social determinants of health, 89% addressed equity, 86% gender and 65% addressed human rights issues. Following the introduction of the SDGs in 2016, CCSs have been oriented or reoriented to provide strategic direction for implementation of the SDGs at country level, while they have equally promoted the multisectorality of health, a critical pillar of the SDGs and GPW 13. The CCS is also used to define technical cooperation and provides a platform for integrating health and non-health issues. High-income countries, some of which are donors and supporters of health and development in many developing countries, have increasingly started using CCSs, leading to better structured partnership with WHO. A summary of the features of the country cooperation strategy and how it ties in with the WHO General Programme of Work is given in Figures 18 and 19. In the European Region, WHO uses an alternative tool called a Biennial Collaborative Agreement (BCA) for collaboration with countries. However, with the onset of the current mandate, the Regional Office for Europe has taken steps to align with other WHO regional offices and started to roll out country cooperation strategies at the request of Member States. 2. What we do Ι 29 Figure 18. Functions and features of the WHO country cooperation strategy It is tailored to the country's CAPACITY and CONTEXT Provides a FLEXIBLE time frame, adaptive to changing CIRCUMSTANCES It is a tool for TRANSPARENCY: CCS evaluation focuses on how the country and WHO collaborated to achieve local targets It is the basis for bottom-up PLANNING, guides BUDGET DECISIONS and directs RESOURCES to programmes and Member States ALIGNS country priorities to GPW 13 and WHO leadership priorities Identifies health NEEDS and PRIORITIES in line with the country's development agenda Promotes country OWNERSHIP in achieving the SDGs Creates opportunities for COLLABORATION with non-state stakeholders Country Cooperation Strategy What is it for ? Promotes health issues in the UNDAF, harmonizing it with other UN Agencies and the SDGs Links to the COUNTRY SUPPORT PLAN, using it as the results chain to measure CCS IMPACT and WHO's CONTRIBUTION Figure 19. The Thirteenth General Programme of Work planning process and linkages to the country cooperation strategy 30 Ι WHO presence in countries, territories and areas As of 31 October 2018, a total of 133 (72%) countries, territories and areas where WHO is physically present had a valid country cooperation strategy or biennial collaborative agreement or were in the process of developing or updating one. Of these, there are currently 83 valid country cooperation strategies, an increase from 62 in the 2017 country presence survey period during which many countries were renewing strategies to align them with the Sustainable Development Goals. Countries, territories and areas with a valid country cooperation strategy constitute 77% (36) of WHO country offices in the African Region, 63% (17) in the Region of the Americas, 22% (four) in the Eastern Mediterranean Region, one in the European Region, 91% (10) in the South-East Asia Region and all in the Western Pacific Region.2 2 The country cooperation strategy for Viet Nam is an internal document within UN ONE. The proportion of countries, territories and areas with valid country cooperation strategies has increased by over 50% in the African Region and Region of the Americas since the 2017 country presence report. An increasing number of countries in the European Region have a CCS, including six high-income countries (Belgium, Cyprus, Italy, Malta, Portugal and Switzerland) and one upper-middle income country where WHO is physically present (Russian Federation). Additionally, 26 countries in the European Region have valid BCAs. Of the 83 countries, territories and areas with a valid country cooperation strategy and for which further data is available, 94% of WHO country offices reported utilizing the document for the purposes of advocating for health issues and aligning financial and human resources to country priorities, and 93% for helping to Figure 20. Coverage of valid country cooperation strategies and biennial collaborative agreements across Member States with a WHO country office 2. What we do Ι 31 align WHO country office work with partners. Within each region, utilization of the CCS for these three purposes is over 85%, and 100% for all three in the Eastern Mediterranean Region, European Region and South-East Asia Region. Among WHO country offices with a valid country cooperation strategy, 87% reported using it for resource mobilization, while in 85% it is utilized for providing information on the WHO country office priorities for visits/missions to countries and 73% for informing the United Nations Development Assistance Framework (UNDAF). The country cooperation strategy is reported by all 83 of these WHO country offices to be used for at least one of these purposes and a total of 43 WHO country offices reported using the country cooperation strategy for all six highlighted purposes. Figure 21. Key areas of use of CCS as reported by WHO country offices across regions 01/03/2019 Page 3 1/1 prioritization resources alignmentadvocacy planningfinancial support country partners human information align countries missions informingprovide UNDAF visits mobilization resource Country cooperation strategies are reviewed by WHO country offices in collaboration with government and partner organizations to ensure optimal support and to allow for priorities to be updated if needed. This is reported to occur primarily at mid-term (39%) or at the end of the country cooperation strategy period (28%) for the country cooperation strategies that are currently valid. Within regions, reviews are most frequency conducted mid-term in the African Region, Region of the Americas, European Region and Western Pacific Region, at the end of the country cooperation strategy period in the Eastern Mediterranean Region, with mid-term and biennial time frames used with equal frequency in the South-East Asia Region. Figure 22. Frequency of strategy review among currently valid country cooperation strategies (%) At least once per year Biennially Mid-term End of CCS period 32 Ι WHO presence in countries, territories and areas In comparison with the 2017 country presence report, there has been a slight shift towards the shorter annual (+3 percentage points) and biennial (+2 percentage points) review time frames, suggesting an increased review frequency. 2.3 Joint WHO and government monitoring mechanisms The number of WHO country offices reporting the existence of a joint WHO and government mechanism to enhance implementation, monitoring and reporting on WHO technical cooperation has risen steadily from 77% to 89% between the 2015 and 2019 country presence reports. Coverage is consistently high across regions, with between 84% and 94% of countries within the six regions currently reporting a monitoring mechanism. Figure 23. Proportion of WHO country offices reporting the existence of a joint WHO and government monitoring mechanism (%) 05/03/2019 Extra 1/1 80 85 90 Country presence report year 2015 2017 2019 77 83 89 The majority of monitoring reviews are reported to be conducted either every six months (37%) or annually (33%) with these also being the most commonly used time frames within each region with the exception of the Western Pacific Region where reviews are most frequently carried out on a quarterly basis. AFR AMR EMR EUR SEAR WPR Figure 24. Number of WHO country offices reporting conducting a monitoring review at different time intervals 2. What we do Ι 33 2.4 Supporting implementation of the Sustainable Development Goals Following the adoption of the 2030 Agenda for Sustainable Development, WHO has supported governments and partners in developing the necessary technical tools, guidance and country and regional implementation plans. WHO has also been instrumental in establishing advisory groups to coordinate these activities in an effective and evidence-based manner. Of the 17 Sustainable Development Goals, SDG 3 is the main Goal with an explicit focus on health, although most other goals are also related to health. In total, more than 50 Sustainable Development Goal indicators have been agreed upon internationally to measure status and progress on health outcomes, determinants of health or health-service provision. In over three quarters of countries, territories and areas where WHO is physically present (149), Governments have established a national SDG coordination mechanism as a means to further implementation and monitoring of the SDGs. Two thirds of them reported that the government periodically monitors the progress of national SDG implementation plans or plans for mainstreaming SDGs in existing plans and programmes, while just under half reported annually to the United Nations High-Level Political Forum. With the Global Action Plan on the SDGs which has been approved by 12 UN and non-UN agencies, WHO country offices will be provided with a framework within which to coordinate the work of partners and governments and accelerate the implementation of SDG 3 in countries. Figure 25. Number of WHO country offices reporting priority actions being taken by governments to accelerate implementation of the SDGs Periodic monitoring of the progress of national implementation plans for SDGs, mainstreaming in existing plans Established national SDG coordination mechanism Annual reporting to the UN High Level Political Forum Other 34 Ι WHO presence in countries, territories and areas Worldwide, 93% of WHO country offices reported being active in advocacy for mainstreaming the SDGs into national plans, also accounting for over 80% of WHO country offices in every region and 100% of countries in the European Region where WHO is physically present. A high proportion of WHO country offices reported being also engaged in technical support for the mainstreaming of SDGs into national plans, policies and programmes (89%) as well as providing advice, facilitation and/or coordination on setting national targets and/or indicators (87%), the latter including all countries in the South-East Asia Region. Advice, facilitation and coordination on setting national targets and indicators Advocacy for mainstreaming SDGs in national plans Technical support for mainstreaming SDGs into national plans Support for measuring and reporting Promoting the establishment of alliances and a multisectoral approach Support for resource mobilization Capacity building for multisectoral approach Other Figure 26. Proportion of WHO country offices by region supporting the implementation of Sustainable Development Goals through various approaches (%) WHO country offices are further engaged in promoting the establishment of alliances and the use of a multisectoral approach (74%), providing support for measuring and reporting (70%), mobilizing resources (51%), and building capacity for a multisectoral approach (50%). Additional supportive roles played by individual WHO country offices include raising funds to operationalize SDG 3 and setting up a subnational coordination system. WHO country teams in 43 (29%) countries reported being engaged in all seven highlighted roles relating to the implementation of the Sustainable Development Goals while 89% are active in at least four of these roles. 2. What we do Ι 35 2.5 WHO support in health emergencies One of the three pillars of GPW 13 is about addressing health emergencies – 1 billion more people better protected from health emergencies. WHO has an essential role in building and sustaining resilient national capacities required to keep the world safe from epidemics and other health emergencies; and in ensuring that populations affected by acute and protracted emergencies have rapid access to essential life-saving health services including health promotion and disease prevention. Accordingly, WHO country offices are playing an important role in supporting Member States to prepare for, respond to and recover from emergencies with public health consequences. The WHO Health Emergencies Programme brings together outbreak and emergency resources across the three levels of the Organization to ensure greater speed, flexibility and rapid impact. In 2017–2018 a total of 901 new health emergency events were documented on the WHE Event Management System (EMS); they occurred in 162 countries and areas as listed in Table 9. WHO country offices in action: implementation of the SDGs in Bulgaria WHO facilitated policy dialogue to discuss implementation of the Bulgarian National Health Strategy 2020 geared towards achieving the WHO Policy Framework for Health and Wellbeing in support of the SDG Agenda. Stakeholders at the workshop developed a framework for achieving the SDGs in Bulgaria through multisectoral collaboration and active engagement. In the programme area of national health policies (NHP), the Bilateral Cooperation Agreement (2018-2019) sets out the key dimensions of WHO’s support for improved country governance capacity to formulate, implement and review national health policies; promote and strengthen health information and data analysis and information sharing; and strengthen national capacity in knowledge translation and use of evidence in policy- making. At the request of the Ministry of Health, the WHO Regional Office for Europe through the WHO Country Office in Bulgaria provided technical assistance aimed at increasing technical capacity for policy review through training on mapping of evidence that will inform the upcoming NHS2020 review. Beyond the developed and tailor-made methodology for mapping of evidence, an online tool in the national language was developed to improve outreach in the evidence gathering process. Support was also provided in the form of expert advice for the process of mapping evidence of NHS2020 implementation which is conducted by the national technical group. This advice was to ensure appropriate use of methodology and the usefulness of the mapping of evidence report. Global Action Plan for healthy lives and well-being for all Despite all the reported action on the SDGs, it is clear that three years since the launch of the SDGs, the pace of progress must be rapidly accelerated if the SDGs are to be achieved by 2030. Recognizing this challenge, in 2018 Germany’s Chancellor, Angela Merkel, Ghana’s President, Nana Akufo-Addo, and Norway’s Prime Minister, Erna Solberg, wrote a joint letter to the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, requesting that he leads the development of a Global Action Plan for health and well-being for all. In consultation with 12 other global health organizations, WHO took up this challenge. A framework for the Global Action Plan was presented by Dr Tedros at the World Health Summit in Berlin in October 2018. The final Action Plan will be launched at the UN General Assembly in September 2019. The action framework of the Plan sets out three strategic approaches for all relevant actors at the global, regional, national and local levels to give expression to the historic commitment to unite for the health and well-being of all. They are: 1. Align – coordinating work better to reduce duplication and inefficiencies. 2. Accelerate – using seven cross-cutting areas of innovation to accelerate progress: (1) sustainable financing; (2) frontline health systems; (3) community and civil society engagement; (4) determinants of health; (5) research and development, innovation and access; (6) data and digital health; (7) innovative programming in fragile and vulnerable states and for disease outbreak response. 3. Account – assessing results and linking investments more closely to results. 36 Ι WHO presence in countries, territories and areas Region Number of new health emergency events African Region 283 Region of the Americas 249 Eastern Mediterranean Region 100 European Region 96 South-East Asia Region 73 Western Pacific Region 100 Table 9. Number of new health emergency events which occurred globally in 2017–2018 Of the 901 events, 676 (75%) were of an infectious nature (including zoonoses); 86 (10%) were disasters; 47 (5%) were related to food safety; 2.4% were of an undetermined nature; and the remaining 70 (8%) were radiological and nuclear, product, chemical, societal or nutrition deficiency-related events. Over the same period, a total of 191 Rapid Risk Assessments (RRA) were conducted, 124 were posted on the IHR Event Information Site (EIS) and 189 editions of Disease Outbreak News (DON) were published on the WHO website. The likelihood and causes of health emergencies vary globally and WHO country offices must adapt and respond to contextual factors. The joint external evaluation is a voluntary, collaborative, multisectoral process to assess country capacity to prevent, detect and rapidly respond to public health risks occurring naturally or due to deliberate or accidental events, with the purpose of assessing country-specific status and promoting progress in effective implementation of IHR. The IHR is an international legal instrument which aims to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. 2. What we do Ι 37 International Health Regulations (IHR 2005) Core Capacities Since 2010, all 196 States Parties have reported at least once to the Secretariat using the State Party Annual Reporting (SPAR) questionnaire. In 2018, a new version of the SPAR questionnaire was introduced. As at 28 January 2019, one hundred and fifty-four (79%) of the 196 States Parties had submitted the questionnaire sent out in June 2018; by region, 47 (100%) States Parties from the African Region, 26 (74%) from the Region of the Americas, 14 (67%) from the Eastern Mediterranean Region, 40 (73%) from the European Region, 11 (100%) from the South-East Asia Region, and 16 (59%) from the Western Pacific Region have done so. Detailed information on the 2018 annual reporting by States Parties is published on the WHO Global Health Observatory website.3 Globally, progress has been reported across the 13 core capacities, particularly in respect of surveillance, laboratory and IHR coordination, but the overall average scores suggest that further and sustained efforts are urgently needed in the areas of chemical events, capacities at points of entry and radiation emergencies.4 Joint External Evaluation (JEE) of IHR Throughout 2016-2018, joint external evaluations of IHR (2005) core capacities were completed in a total of 91 countries (AFR–39; AMR–4; EMR–16; EUR–13; SEAR–8; WPR–11). 3 http://apps.who.int/gho/data/node.main.IHR00ALLN?lang=en 4 Based on the analysis of information received from 129 States Parties as at 21 January 2019. Figure 27. Number of countries by region which have completed a JEE 2016 2017 2018 JEE Reports can be found at: http://www.who.int/ihr/procedures/mission-reports/en/. 38 Ι WHO presence in countries, territories and areas Development of National Action Plan A total of 74% of the countries that have conducted joint external evaluations have either developed or are developing a National Action Plan for Health Security (NAPHS). The NAPHS is a country-owned, multi-year, planning process that can accelerate the implementation of IHR core capacities and is based on the ‘one health’ and ‘whole-of-government’ approach for all hazards. It captures national priorities for health security, brings sectors together, identifies partners and allocates resources for health security capacity development. The NAPHS also provides an overarching process to capture all ongoing preparedness initiatives in a country along with a country governance mechanism for emergency and disaster risk management. Since 2016, WHO has been working closely with many countries and partners to support the development and implementation of NAPHS. Consequently, the number of countries with an NAPHS increased from two in 2016, to 16 in 2017, and 27 in 2018. As of February 2019, a further 24 countries are developing plans. WHO country office action: Responding to health emergencies in Cuba Hurricane Irma was one of the most devastating hurricanes in the history of the Atlantic, hitting Cuba as a Category 5 storm in September 2017. For over 900 kilometres, Hurricane Irma destroyed almost everything in its path, including infrastructure in most provinces and in Havana, Cuba’s capital. Authorities required assistance in responding to the population’s health needs, which included rehabilitating over 1000 affected health institutions, ensuring continuity of health services and preventing outbreaks of water-borne as well as vector- transmitted diseases. The WHO country office worked in close collaboration with the Ministry of Health (MoH) to ensure an effective response with substantial resource mobilization by AMRO/PAHO. Daily meetings with the national authorities contributed to produce timely information to support the health sector response. Additionally, AMRO/PAHO coordinated the health efforts from the United Nations Population Fund and other partners. Over US$ 3.5 million was mobilized to replenish stocks of medicines, anti-vector materials, and medical supplies. Due to this intervention and the timely support provided by WHO to the MoH, no outbreaks were reported in the areas affected by Hurricane Irma and provision of quality health care was maintained to the affected Cuban population. Figure 28. Status of National Action Plan for Health Security (NAPHS) Number of countries that developed a NAPHS in 2016–2018 Number of additional countries developing an NAPHS in 2019 Completed NAPHS are available at: https://extranet.who.int/sph/publications. 2. What we do Ι 39 Between 2017 and 2018, all WHO country offices provided support to governments on emergency preparedness, prevention, detection and response (see Fig. 29). The most common form of support provided during this period was for strengthening minimum core Figure 29. Number of WHO country offices by region reporting the provision of different types of support for emergency preparedness, prevention, detection and response Assessment and reporting of all hazards emergency preparedness (including IHR annual reporting JEEs, AARs Detection, verification and risk assessment of potential health emergencies Development of innovative tools, products and interventions for high threat infectious hazards Implementation of prevention strategies for priority pandemic/epidemic-prone diseases (including cholera, yellow fever, influenza) Mitigation and reduction of the risk of the emergence/re-emergence of high threat-infectious pathogens Provision of essential health services and system strengthening in fragile, conflict and vulnerable settings Response to acute health emergencies leveraging national and international capacities Strengthening minimum core capacities for emergency preparedness and disaster risk management Support for operational readiness to manage identified risks and vulnerabilities 40 Ι WHO presence in countries, territories and areas capacities for emergency preparedness and disaster risk management (87%). This was also the most frequent form of support in the African Region, Region of the Americas, European Region and Western Pacific Region, and 100% of WHO country offices in the Region of the Americas reported being engaged in this activity. All WHO country offices in the South-East Asia Region reported providing support to the country through assessment and reporting of all-hazards emergency preparedness, implementation of prevention strategies for priority pandemic/ epidemic-prone diseases and giving support for operational readiness to manage identified risks and vulnerabilities. All WHO country offices in the Eastern Mediterranean Region reported providing assistance through detection, verification and risk assessment of potential health emergencies. Over one third (36%) of WHO country offices reported being engaged in at least eight of the nine highlighted emergency preparedness, detection and response activities between July 2017 and August 2018, including 55% of WHO country offices in the South-East Asia Region and over 40% in the African Region, Region of the Americas and Western Pacific Region. 2.6 Supporting health sector coordination An important role of WHO country-level support is to act as a convener/neutral broker among partners and to support the government in effectively coordinating the health sector. As Article 33 of the WHO Constitution provides for direct access of the Director-General and his or her representative (the HWO) to the various departments and ministries of the government, this ensures a whole-of-government approach with HWOs advised to keep the health ministry informed of their engagement with other government departments. The existence of a government-led health sector coordination mechanism was reported by WHO country offices in 106 (71%) countries, territories and areas where WHO is physically present. In countries where a government-led health sector coordination mechanism exists, 57% of WHO country offices reported playing at least one role related to leadership and coordination, most frequently as a co-chair with the Ministry of Health or other partners. Figure 30. Proportion of WHO country offices reporting the existence of a government-led health sector coordination mechanism in each region (%) AFR AMR EMR EUR SEAR WPR 77% 67% 78% 58% 91% 67% 23% 33% 22% 42% 9% 33% Global 71% 29% 2. What we do Ι 41 Figure 31. Number of WHO country offices participating in government-led health sector coordination mechanisms Co-chair with the Ministry of Health or other partners Participant (but no leadership or coordination role) Other Secretariat for the coordination mechanism Chair or rotational chair 42 Ι WHO presence in countries, territories and areas How we do it 3. WHO addresses country needs through the provision of support in many ways, including backstopping missions and funding. One of the GPW 13 strategic shifts specifically focuses on driving public health impact in every country using a differentiated approach based on countries’ capacities and vulnerability. 3. How we do it This requires WHO to become more focused and effective in country-based operations, working closely with partners, engaging in policy dialogue, providing strategic support and technical assistance, and coordinating service delivery, depending on the country context. The following figure unpacks the various elements of this strategic shift. Figure 32. Driving impact in every country as a strategic shift Placing countries at the centre Ground the strategic vision at country level Ensure better impact Engage in upstream or downstream actions according to the context Build a platform for leadership and coordination Strengthen country office capacity WHO will place countries squarely at the centre of its work. This strategic shift is the epicentre of GPW 13 and will become the focus of all levels of the Organization. WHO will strengthen its work at country level in all settings to ensure better impact. In some settings such engagement will be more upstream – policy- related, strategic and normative – and in others more downstream with a focus on technical assistance and strengthening service delivery. Strengthening WHO’s work at the country level involves a combination of WHO country office leadership, a fit-for-purpose staffing structure, appropriate delegation of authority, and business processes that facilitate effectiveness and efficiency. WHO must ensure that a robust technical platform is in place and to act as a convenor and coordinator of many partners in support of national authorities. COUNTRIES AT THE CENTER Flexibility Health leadershipBottom-up planning COUNTRIES AT THE CENTRE Policy dialogue partner Strategic supporter Technical assistance partner Service delivery coordinator • Strengthen the normative function of WHO secretariat • Better tailor country expertise • Align with global priorities • Adapt policy dialogue to the maturity of the health system • Focus on country needs with a bottom-up approach • Solve bottlenecks • Attract financing • Build more robust institutions • Provide relevant support in weaker health systems and in vulnerable contexts • Guide and support countries experiencing protracted crises at the subnational level with appropriate presence on the ground • Provide strategic support to strengthen health systems • Help maximize performance in terms of results, equity and financial sustainability • Advise on Universal Health Coverage • Support the country with multilevel action (in-country, national, regional, and HQ level) • Strengthen service delivery in the most fragile settings • Coordinate the health cluster and the Humanitarian Response Plan • Operate through a combination of national and subnational presence This strategic shift is based on two of WHO’s core functions: articulating ethical and evidence-based policy options; and providing technical support, catalysing change, and building sustainable institutional capacity. The four approaches to WHO’s support at country level listed below provide a guiding framework. 44 Ι WHO presence in countries, territories and areas 3.1 Technical backstopping One of WHO’s core functions and comparative advantages is the provision of high-quality technical cooperation from across the three levels of the Organization in order to catalyse change and build sustainable institutional capacity at the country level to achieve health impact. WHO country offices do not always have the capacity to respond effectively to the range of support required by countries and their dynamic, changing set of needs. ‘Technical backstopping’ in the form of technical and normative support from regional offices and headquarters is a recognized and essential approach for flexibly supporting countries with the right skills and expertise at the right time. Staff members from all three levels engage in missions and other forms of technical support to collaborate with and between the countries, territories and areas where WHO works to implement national health policies, strategies and plans developed on the basis of the SDGs and GPW 13. Figure 33. The three interacting levels of WHO Regional officesCountry officesHeadquarters Over the reporting period, country offices received support from regional offices and headquarters in areas such as: policy dialogue; adaptation of global and regional policies, strategies, tools and guidelines to national contexts and on-the-ground support for developing national documents; organizing technical meetings/seminars; training and consultations; and emergency response. Between January 2017 and 31 July 2018, a total of 5870 backstopping missions were conducted to support WHO country offices in all six regions. A total of 68% of these missions were initiated by WHO country offices, which indicates an increasing trend of demand-driven backstopping. The proportion of backstopping missions initiated by WHO country offices increased steadily from 51% in 2013–2014 to 68% in 2017–2018. Figure 34. Trend of missions initiated by WHO country offices between 2013 and 2018 (%) 01/03/2019 Extra 1/1 50 55 60 65 70 2013-2014 2015-2016 2017-2018 51 68 63 3. How we do it Ι 45 As presented in Figure 35, there is an increased trend of backstopping missions supported by regional offices (57% in 2017–2018) compared to 49% in 2013–2014. Headquarters provided 19% of backstoping missions in 2017–2018, which represents a slight overall increase compared to 2013–2014 (18%), but a decrease compared to 2015–2016 (22%). Figure 35. Proportion of backstopping missions by organizational level 2013–2018 (%) Headquarters Regional office Subregional office (where applicable) Joint visit by HQ and regional office (and/or subregional office) 01/03/2019 Mission trend 1/1 10 20 30 40 50 60 2013-2014 2015-2016 2017-2018 18 19 22 13 10 8 49 57 52 20 14 19 For WHO country offices in all six regions, the majority of technical backstopping comes from the respective regional office (70% in the Region of the Americas, 60% in the Eastern Mediterranean Region, 79% in the European Region, 54% in the South-East Asia Region and 46% in the Western Pacific Region). In the African Region, while a large proportion of backstopping comes from the regional office (39%), subregional offices play the largest role in terms of missions compared to other subregional offices in other regions. The African Region also receives the greatest amount of support from joint missions compared to other regions. The relatively high number of backstopping missions to countries in the European Region is in accordance with a region-specific model by which regional staff members provide technical assistance to countries rather than having an expert in each technical area in each country office. Communicable diseases accounted for the highest proportion (33%) of backstopping missions overall. Health systems/UHC comprised the highest proportion (25%) of backstopping missions in the Eastern Mediterranean Region, and the second highest overall reason for conducting a country mission (21%). The number of backstopping missions pertaining to health emergencies has increased in every region except for the Western Pacific Region since the 2017 country presence report, with a 54% increase reported in the African Region. While the 2019 country presence report covers a slightly shorter survey period, an increased number of backstopping missions have been reported by WHO country offices in the Region of the Americas and South-East Asia Region. Categories of WHO’s backstopping missions to countries: already working towards the three Strategic Priorities of the GPW 13 Universal health coverage Strengthening health systems to move towards UHC, ensuring equitable access to affordable health services.Working to increase and sustain access to prevention, treatment and care for HIV, tuberculosis, malaria and neglected tropical diseases and to reduce vaccine-preventable diseases. Better protection from health emergencies Helping countries prepare for and respond to health emergencies including extreme weather events and disease outbreaks. Better health and well-being Supporting countries to prevent and treat noncommunicable diseases and look beyond the health sector for solutions. Addressing environmental risks and social determinants of health, as well as gender, equity and human rights. 46 Ι WHO presence in countries, territories and areas Figure 36. Number of backstopping missions received by WHO country offices in the six regions from different levels of the Organization Figure 37. Distribution of backstopping missions to WHO country offices by region and area of work 3. How we do it Ι 47 3.2 Funding WHO’s work at the country level WHO requires predictable, flexible funding to provide high-quality technical assistance to Member States and to achieve results for people at the country level. This subsection provides details on the funds available to support WHO programmes in countries, territories and areas as well as the sources, distribution and status of expenditure during the report period. 3.2.1 Availability of financial resources at the country level As of 31 December 2018, US$ 2.48 billion was available for WHO country-level work under the WHO programme budget, representing 79% of the total planned costs for the 2018–2019 biennium, and an increase of 20% from the 2016– 2017 biennium. Of this amount, 58% (US$ 1.44 billion) was allocated for polio, outbreak and crisis response and special programmes, and 42% (US$ 1.036 billion) for base programmes. Key terms Assessed contributions Funds from Member States and Associate Member States used to finance the programme budget. They are calculated based on each country’s population and wealth. Core voluntary contributions Fully flexible funds at the level of the programme budget, or highly flexible at category level. Voluntary contributions Contributions made by Member States (and other partners) in addition to the assessed contribution. Earmarked funding is the biggest portion of the budget. Base segment Budget segment where WHO has exclusive strategic and operational control over undertaking the associated activities. Planned costs Amount allocated in the budget. The African Region and Eastern Mediterranean Region received 75% of total funds (US$ 1.86 billion) and 88% of funds allocated for polio, outbreak and crisis response and special programmes. The Eastern Mediterranean Region received 57% of funds for polio, outbreak and crisis response and special programmes as this Region contains two polio-endemic countries and seven priority countries1 facing Grade 2 and 3 emergencies. Since 2017 the number of polio-endemic countries has decreased from three to two, with polio funding being instrumental in providing support towards the eradication of polio. The South-East Asia Region received 10% of the total programme budget, while the European Region and Western Pacific Region both received 7% and the Region of the Americas 2%. Figure 38. Proportion of available funding allocated by segment (%) Base Polio, outbreak and crisis response and special programmes AFR AMR EMR EUR SEAR WPR In terms of the total base programme allocation, country offices in the African Region received the highest share of funds (37%), followed by the Eastern Mediterranean Region (20%), South-East Asia Region (17%), Western Pacific Region (14%), European Region (8%) and the Region of the Americas (4%). Higher funding for the African Region is consistent with the previous biennium and reflects organizational commitment to address the higher burden of disease and challenges of fragile health systems in that region. 1 Iraq, Libya, occupied Palestinian territory, Somalia, Sudan, Syrian Arab Republic and Yemen. 48 Ι WHO presence in countries, territories and areas 3.2.2 Distribution of base funds by programmatic priorities and operations The largest share of base funds distributed by programmatic priorities and operations to country offices was for communicable diseases excluding polio (34%) followed by cooperate services and enabling functions (19%), health systems (16%), health emergencies (14%), promoting health through the life-course (10%) and noncommunicable diseases (8%). This is consistent with data on backstopping missions which show that communicable diseases and health systems are the most frequent categories of missions received by country offices. The share of funding distributed to country offices for communicable diseases increased from 29% to 34% and for health emergencies from 10% to 14% in comparison to the 2016–2017 biennium. 3.2.3 Sources of funding for WHO country- level work WHO’s programme budget is funded through a mix of assessed and voluntary contributions. Assessed contributions are dues Member States pay to be a member of WHO. Member States (and other partners) may make voluntary contributions in addition to the assessed contribution. These are fully flexible at the level of the programme budget or highly flexible at the category level. Specified voluntary contributions account for the greatest proportion of funding allocated for the work of WHO country offices (82%), including 37% from Member States (other than their assessed contribution), 11% from United Nations organizations, 10% from philanthropic foundations, 7% from partnerships, 6% from Figure 39. Comparison of the distribution of base programme funds by category (%) Communicable diseases Corporate services and enabling functions Health Emergencies Programme Health systems Noncommunicable diseases Promoting health through the life-course 2016-2017 2018-20192018–20192016–2017 3. How we do it Ι 49 nongovernmental organizations and 10% from other sources. Assessed contributions made up 14% of overall funds allocated for country activities, with the distribution between voluntary and assessed contributions as sources of funding for WHO having remained consistent over the last four bienniums. Programme support costs accounted for the other 4% of distributed funds at the mid-biennial point. The institutions which are reported by WHO Region Most frequent donor Second most frequent donor Third most frequent donor African Region Government of the United States (17) Gavi (14) Government of the United Kingdom (12) Region of the Americas Government of Canada (7) Government of the United Kingdom (6) European Union (5) Eastern Mediterranean Region Government of the United States (9) European Union (8) Gavi (3) Government of Japan (3) European Region European Union (9) Government of the United States (5) Gavi (4) Global Fund (4) Government of Japan (4) South-East Asia Region Gavi (6) Government of the United States (5) Global Fund (4) Western Pacific Region Government of the United States (9) Government of the Republic of Korea (7) Government of Australia (6) Table 10. Donors reported in the ‘top three’ by WHO country offices; (x) denotes number of WHO country offices in each region receiving funds from the donor country offices to be among the top three donors that provided financial support to WHO country offices in 2017–2018 are detailed in Table 10. The Government of the United States was reported to be the most frequently mentioned donor – and among the top three donors to WHO country offices overall and in the African Region, Eastern Mediterranean Region and The Government of the United States of America is reported to be among the top three donors to 49 out of 149 WHO country offices. The European Union is reported to be among the top three donors to 35 out of 149 WHO country offices. It is the most frequent donor in the European Region, the second most frequent in the Eastern Mediterranean Region, and the third most frequent in the Region of the Americas. Gavi, The Vaccine Alliance, is reported to be among the most frequent donors to 33 WHO country offices. It is the most frequent donor to country offices in the South-East Asia Region, the second most frequent in the African Region, and the third most frequent in the Region of the Americas and the European Region. The Government of the United Kingdom is reported to be among the top three donors to 25 WHO country offices, reportedly the second most frequent donor in the Region of the Americas and the third most frequent in the African Region. The Government of Japan is reported to be among the top three donors to 18 WHO country offices, being the third most frequent donor in Eastern Mediterranean Region and European Region. Figure 40. The top five institutions funding WHO’s work in countries globally 50 Ι WHO presence in countries, territories and areas Western Pacific Region. The United States is followed by the European Union which was reported to be among the top three donors to 35 WHO country offices and the most frequently reported top donor in the European Region and also among the top donors in all regions except the Western Pacific Region. Gavi, the Government of the United States, specifically USAID, and the Government of the United Kingdom, specifically the Department for International Development (DFID), were reported to be among the top three donors by at least one WHO country office in every region. 3.2.4 Distribution and spending of planned funds at the country level Considering the distribution of funds against the planned budget among regions at the mid-biennium point, the European Region had received 88%, the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region had received 80–85% of the planned budget and the African Region and the Region of the Americas had received 70–75%. This represents a slight decrease compared to the same point in the 2016–2017 biennium for the African Region, Eastern Mediterranean Region and European Region, an increase of 2–5 percentage points for the South-East Asia Figure 41. Planned, distributed and spent funding by region at mid-biennium point of 31 December 2018 (US$ billion) AFR AMR EMR EUR SEAR WPR Planned costs Distributed funds Expenditure 3. How we do it Ι 51 Region and Western Pacific Region, and an increase of 30 percentage points for the Region of the Americas. As of 31 December 2018, the mid-point of the 2018–2019 biennium, fifty-five per cent of funds distributed for the 2018–2019 biennium had been spent at the country level, in line with the previous biennium. 3.2.5 Mobilization of funds for Human Resource support In 2017–2018, eighty-one per cent of WHO country offices reported mobilizing financial resources for supporting human resource/ programmatic activities. The amount of mobilized resources reported by WHO country offices to support their human resources or programmatic activities Figure 42. Number and proportion of WHO country offices reporting mobilization of resources for human resource support 83% 89% 100% 100%48% 93% 52 Ι WHO presence in countries, territories and areas Figure 43. Number of WHO country offices which reported mobilizing varying amounts of resources Less than US$ 1 million Between US$ 1–5 million Between US$ 6–10 million Above US$ 10 million between January 2017 and 31 December 2018 was most frequently between US$ 1–5 million (33%), followed by less than US$ 1 million (28%). Variations between regions are evident, with a third of WHO country offices in the Eastern Mediterranean Region reporting mobilizing over US$ 10 million. WHO country offices in the South-East Asia Region reported mobilizing a varied amount of resources. Four WHO country offices reported mobilizing between US$ 1 and 5 million, while four others reported mobilizing over US$ 10 million, namely Bangladesh, India, Indonesia and Myanmar. 3. How we do it Ι 53

Who we work with 4. As outlined in the GPW 13 strategic shifts, WHO is promoting the vital role of health by fostering partnerships at all levels of government, within the United Nations system, and with a range of non-State actors, including civil society “If we are serious about serving humanity, we need collaboration and partnership.” dr tedros a. ghebreyesus who director-general 4. Who we work with and communities at country level. WHO recognizes that engaging with partners from all sectors is crucial for driving health impact in each country. Specifically, at the country level, the Global Action Plan for Healthy Lives and Well-Being for All1 provides an additional opportunity for WHO to work with different partners – including bilateral and multilateral agencies – the United Nations System, funds and foundations, nongovernmental organizations and civil society organizations with a view to leveraging available expertise and providing coherent support to the implementation of the 2030 Agenda. 1 The Global Action Plan for Healthy Lives and Well-Being for All is an initiative of 12 global health organizations, led by WHO to support countries to take action on the health-related SDGs. It will be launched in September 2019 at the UN General Assembly. https:// www.who.int/sdg/global-action-plan 56 Ι WHO presence in countries, territories and areas This partnership approach of WHO at the country level can be categorized into: • engagement with government; • engagement with the United Nations System; • engagement with non-State actors and global health initiatives; • engagement with bilateral agencies; and • South–South and triangular cooperation. WHO country offices also work and collaborate on health issues with other intergovernmental organizations and subregional partners. 4.1 Collaboration with the United Nations system WHO collaboration with the United Nations System has been further strengthened, especially in the context of the Sustainable Development Goals and the reform of the United Nations development system. Through various United Nations coordinating mechanisms across the three levels of the Organization, WHO continues to support its Member States in achieving national health priorities and promoting better health outcomes. This collaborative approach also reflects WHO’s efforts to increase coherence, effectiveness and efficiency in delivering results. In the GPW 13, WHO has clearly stated its commitment to supporting the United Nations Secretary- General’s proposal to work as “One UN” to improve the efficiency and effectiveness of operational activities at the country level to support countries towards achievement of the Sustainable Development Goals. Work at the country level is key to progress towards addressing priorities, and platforms such as UNDAF, One United Nations Programme and health clusters in emergencies provide avenues to position health as well as catalyse multisectoral approaches for improved health outcomes. Reforms in the United Nations development system The 2030 Agenda for Sustainable Development set new, ambitious goals for all people around the world and reshaped the way the UN will work together to deliver on a global blueprint of such unprecedented scale. WHO is committed to contributing to the success of this UN reform process as stated in the GPW 13 and considers it an opportunity to position health at the centre of the UN system’s work at country level for achieving the SDGs. To effectively engage in this reform process and deliver on its promise, WHO will strengthen mutual accountability among UNCT members and hold its HWOs and Resident Coordinators accountable for increased priority and a multisectoral, integrated approach to achieving the health-related SDGs in the UNDAFs. WHO support to its Member States, including through country presence, remains subject to the direct request of the host country. WHO country presence is determined on the basis of bilateral discussions with the host government and corresponds to agreed health priorities and an allocated budget, in accordance with discussions in the Governing Bodies and the Global Policy Group. It is believed that a stronger WHO role at country level will depend on focused and mutually supportive engagement across several areas. In terms of promoting the centrality of health to the development process and strengthening WHO’s contribution to improved health outcomes, United Nations Resident Coordinators can advance WHO’s work by advocating for multisectoral action in response to cross-cutting issues across the SDG agenda; by maximizing entry points for WHO in sectors that influence health outcomes; and by increasing UN coherence and accountability on health-related SDGs within the context of UNDAF. A repositioned UNDAF is expected to serve multiple purposes and help support effective implementation of the SDGs and realize national health goals. WHO is supportive of increasing efficiencies, reducing costs and partnering with other UN agencies where this makes sense financially. WHO already participates in some common services in most of its country offices. Key elements of WHO’s collaboration with the United Nations System include: • positioning health in the debates and decisions of United Nations intergovernmental bodies; • contributing to a coherent and effective United Nations System at the global, regional and country levels; • providing leadership in health-related humanitarian efforts, including as the health cluster lead; and • promoting alliances and interagency approaches to address health issues. 4. Who we work with Ι 57 4.1.1 Supporting the United Nations Resident Coordinators As a UN specialized agency, WHO is committed to working as part of the United Nations country team (UNCT) within the Resident Coordinator system in support of the implementation of the 2030 Agenda for Sustainable Development. The Resident Coordinator system aims to bring together the different UN agencies to improve the efficiency and effectiveness of operational activities at the country level. Resident Coordinators lead and strategically position the United Nations country team in support of national priorities, development strategies and plans, and that role is pivotal to the success of the United Nations in driving the 2030 Agenda for Sustainable Development in each of the countries it serves. WHO is engaged with Resident Coordinators to strengthen the health capacity of the United Nations country teams, while recognizing WHO’s constitutional mandate to act as the directing and coordinating authority on international health work. WHO country offices reported the presence of a Resident Coordinator in 85% of countries, territories and areas where the WHO is physically present. During the period from October 2016 to 31 October 2018, HWOs served as acting Resident Coordinators in 88 of the 149 countries, territories and areas where WHO is physically present, as reported by WHO country offices. In 86% (76) of these countries, that role was assumed for a period of less than three months, while it lasted for more than six months in 5% of the countries, showing an increase in both cases from the 2017 country presence report. In 26% of countries (24) with a Resident Coordinator, the WHO country offices reported contributing financially to the functioning of the Resident Coordinator office. Figure 44. Proportion of WHO country offices per region reporting that the HWO acted as the Resident Coordinator at some point during the survey period, and the average duration of the assignment 58 Ι WHO presence in countries, territories and areas 4.2 Engaging within the United Nations Country Teams WHO’s efforts count most when it works in countries as part of the United Nations system. Through its country offices, WHO actively participates in United Nations joint activities towards achievement of the SDGs within the context of national priorities. The United Nations country team is the platform through which WHO: • strengthens dialogue among UN funds, programmes and specialized agencies; • fosters a multisectoral response to health challenges; • mobilizes additional resources to achieve national health goals. There is a UNCT in 91% (135 of the 149) of countries, territories and areas where WHO is physically present. There is a UNCT in all countries, territories and areas in the African Region, Eastern Mediterranean Region and the South-East Asia Region, 93% of countries, territories and areas in the Region of the Americas, 74% in the European Region and 73% of countries, territories and areas in the Western Pacific Region. WHO is the only United Nations agency present in one country in the Region of the Americas and in eight countries in the European Region. 4.2.1 WHO participation in Joint National/ United Nations Steering Committees Joint National/United Nations Steering Committees are a mechanism for effective collaboration between the government and United Nations agencies towards the achievement of national development goals. These committees are established in 76 (51%) countries, territories and areas where WHO is physically present. WHO country offices in 68 countries, territories and areas reported participating in the Joint Steering Committee. 4.2.2 United Nations Development Assistance Framework The UNDAF is the planning and implementation instrument for United Nations development activities in each country, in support of the implementation of the 2030 Agenda for Sustainable Development. It describes the collective and coherent response of the United Nations to national development priorities. The UNDAF is sometimes referred to as a United Nations Development Plan or a One United Nations Plan. WHO actively engages in developing, implementing and monitoring the UNDAF, shapes its health dimension, and aligns its country cooperation strategy with UNDAF. The UNDAF or equivalent document is reported in 130 (87%) of the 149 countries, territories and areas where WHO is physically present, and in over 90% of countries, territories and areas in the African Region, Region of the Americas, South- East Asia Region and Western Pacific Region. Figure 45. Proportion of WHO country offices reporting the presence of and participation in different activities of UNCTs (%) United Nations country team Operations Management Team United Nations Resident Coordinator Thematic working groups/results groups UNDAF or equivalent Joint United Nations communications programme Joint resource mobilization Joint programmes Political/peacekeeping mission 01/03/2019 Q23 1/1 AMR 0 50 100 96 93 93 93 89 63 63 44 19 AFR 0 50 100 100 98 98 94 91 79 70 62 23 EMR 0 50 100 100 100 100 94 83 78 78 44 44 EUR 0 50 100 74 61 61 58 58 48 35 32 10 SEAR 0 50 100 100 100 100 100 100 73 73 36 9 WPR 0 50 100 87 87 73 73 67 67 47 33 4. Who we work with Ι 59 WHO country offices in 128 countries (98% of countries with an UNDAF) reported to have participated in the development of the UNDAF and to be contributing to its monitoring and evaluation. By aligning the WHO country cooperation strategy, biennial collaborative agreements and helping to shape the health dimension of the UNDAF, WHO aims to ensure a more coordinated and integrated support to countries in achieving the health-related goals of the 2030 Agenda for Sustainable Development. To respond in an integrated and coherent manner to national development priorities in a country, the United Nations country team identifies strategic priorities (sometimes called results, areas, pillars or clusters) in the UNDAF. These pillars, framed by the 2030 Agenda for Sustainable Development, reflect the country situation, and are in line with national priorities and needs. In some countries, the UNDAF has specific health pillars. To ensure better health outcomes in countries, the country cooperation strategy and the health dimension of UNDAF have been harmonized and are mutually reinforcing. Of the 130 countries, territories and areas with an UNDAF, 31 (24%) corresponding WHO country offices reported that it reflects all the priorities in the country cooperation strategy and 93 (72%) reported that it reflects some of the priorities. The UNDAF reflects some or all of the country cooperation strategy priorities in 100% of countries, territories and areas with the UNDAF in the Region of the Americas, Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region, 93% in the African Region and 83% in the European Region. WHO country offices reported that health is incorporated into the UNDAF at outcome level (107 countries) and output level (103 countries). Incorporation of health in UNDAF has increased in comparison to the 2017 country presence report at all four levels, with a 7% increase in incorporation at outcome level and a 22% increase in incorporation at output level. Overall, universal health coverage is the most frequently included health priority in UNDAF Figure 46. Total number of UNDAFs per region where the WHO country office was involved in its development, monitoring and evaluation and degree of alignment to CCS UNDAF reflects some CCS priorities UNDAF reflects all CCS priorities UNDAF does not include any CCS priority AFR AMR EMR EUR SEAR WPR 60 Ι WHO presence in countries, territories and areas (87%). From the regional perspective, universal health coverage was the most frequently included health priority in UNDAFs in the Region of the Americas, Eastern Mediterranean Region, European Region and Western Pacific Region. “Promoting health through the life course” is reflected in 82% of UNDAFs. Noncommunicable d i seases (NCDs) and communicable diseases were each included in UNDAFs in 78% of countries, territories and areas, 80% of which included both areas, highlighting the many settings facing a double burden of communicable and noncommunicable diseases. Inclusion of antimicrobial resistance as a health issue increased from 15% of UNDAFs in the 2017 country presence report to 24% in this reporting period. 4.2.3 WHO participation in the thematic groups of United Nations country teams To promote an integrated approach, the United Nations country teams establish thematic or results groups in which WHO actively participates. These groups function as a coordination mechanism at the operational level that contributes to the achievement of UNDAF outcomes and covers a variety of areas from health to human rights and the environment. WHO participates and assumes leadership roles across multiple thematic and results groups. The highest level of involvement reported by WHO country offices is in the health thematic group (91% of countries with a United Nations country team) followed by disaster risk reduction, gender, and Sustainable Development Goals implementation (79%) and monitoring and evaluation and nutrition/food safety (74%). Between 55% and 60% of WHO country offices in countries with a United Nations country team reported being involved in thematic groups dealing with access to social services/social protection, environment, human rights and water and sanitation. In 77% of countries, territories and areas, the health thematic group is reportedly chaired or co-chaired by WHO, an increase of 11 percentage points from the 2017 country presence report. Figure 47. The number of WHO country offices reporting inclusion of health at different levels in the UNDAF Joint work plan Outcome level Output level Results group 4. Who we work with Ι 61 Additionally, WHO chaired or co-chaired an increasing number of health-related thematic groups between the 2017 and 2019 country presence reports as reported by WHO country offices. Overall participation in five of the thematic or results groups has increased over this time frame, with the largest increases evident in the monitoring and evaluation group (+12 percentage points) and the Sustainable Development Goals implementation group (+10 percentage points). 4.2.4 WHO participation in United Nations common business operations and activities WHO country offices in 81% of countries, territories and areas reported participating in at least one of the United Nations common business operations and activities, an increase from 70% in the 2017 country presence report. This is most commonly security services (79% with 46% of WHO country offices contributing in-kind), followed by local procurement (39%), travel Table 11. Number of WHO country offices reporting participation in UN common business operations and activities Region Nu m be r o f W HO co un tr y of fic es Se cu rit y se rv ice s Lo ca l pr oc ur em en t Tr av el Ad m in ist ra tiv e se rv ice s In fo rm at io n te ch no lo gy Lo gi st ics an d tr an sp or t IC T Ba nk HR No ne Ot he r AFR 47 39 27 19 19 18 18 16 13 14 3 8 AMR 27 10 6 9 2 6 1 3 4 1 10 1 EMR 18 17 8 7 10 7 10 8 6 7 1 1 EUR 31 17 10 3 5 5 6 6 7 1 3 5 SEAR 11 9 3 3 3 1 0 2 1 1 1 1 WPR 15 9 4 3 4 2 3 2 1 3 2 0 Nutrition Disaster Risk Reduction  Monitoring and Evaluation Gender Access to services and social protection Water and sanitation Environment  Human RightsHealth SDG implementation Figure 48. Thematic/results groups of the United Nations country team in which WHO country offices reported participation 62 Ι WHO presence in countries, territories and areas (30%) and administrative services (29%). Eight WHO country offices (five in the African Region, two in the Eastern Mediterranean Region and one in the Western Pacific Region) reported partaking in at least nine of the ten activities. 4.2.5 WHO participation in joint activities of the United Nations resident coordinator office WHO’s commitment to work as “One UN” as part of the resident coordinator system, is also demonstrated by its participation in joint activities organized by the resident coordinator office in countries. A total of 132 WHO country offices reported participating in or contributing in-kind to joint activities organized by the United Nations resident coordinator office. This includes all countries, territories and areas in the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region, 98% in the African Region, 70% in the Region of the Americas 4. Who we work with Ι 63 Figure 49. Percentage of WHO country offices by region reporting participation in, and in-kind contribution to joint activities of the UN resident coordinator office Participating (%) Providing in-kind contribution (%) AFR SEAR WPR Common business operations UN Security UN Dispensary Committee Joint Resource mobilization strategy Joint Communication group Joint Assessments Functioning Resident Coordinator office (e.g. RC premises) and 74% in the European Region. Over 60% of WHO country offices reported participating in joint assessments, and joint communication groups. A participation level of over 75% was reported for joint communication groups and joint assessments in both the African Region and Eastern Mediterranean Region. Joint resource mobilization activities between the United Nations and WHO generate additional resources to fulfil United Nations commitments reflected in the UNDAF. Various mechanisms are in place to jointly mobilize resources at the country level. Joint resource mobilization is reported by WHO country offices in 46% of countries, territories and areas where WHO has a presence. Eleven WHO country off ices reported participating in all seven activities highlighted in Figure 49, with the highest proportion participating in security services (79%) or joint communication group (66%). 4.3 UN Multi-Partner Trust Funds The Multi-partner or Multi-Donor Trust Funds (MDTFs) are partnerships by which the United Nations system, national authorities and funding partners establish a joint fund that uses the “pass-through fund management” model. These funds can be established in a variety of ways and can have a thematic or geographic focus. These pooled funds have common guiding strategies:2 • involves a broad range of stakeholders in the decision-making process; • builds on existing structures (rather than creating parallel ones); • strengthens aid effectiveness through coordinated and harmonized interventions; • full transparency and accountability in funding, management and implementation; • focuses on effective and efficient delivery of results. 2 Drawn from the Multi-Partner Trust Fund Office Gateway (www.mptf. undp.org) MDTFs are generally established to support a country and/or global strategic priorities that are defined in national or strategic plans of the UNDAF, Delivering as One (DaO) and similar strategic frameworks. WHO, as a UN agency, participates in the development of UNDAFs at the country level and can apply for funds as relevant, where MDTFs exist in country programmes. WHO country offices in 24 countries, territories and areas received funds from United Nations Multi- Partner Trust Funds, such as the One Fund/MDTF and the Sustainable Development Goals fund. Figure 50. Number of WHO country offices reporting receiving funds from United Nations Multi-Partner Trust Funds AFR AMR EMR EUR SEAR WPR In May 2018, the International Labour Organization (ILO), the Organization for Economic Co-operation and Development (OECD) and WHO signed a memorandum of understanding operationalizing the Working for Health Multi-Partner Trust Fund (MPTF). The MPTF will enable partners to pool resources and drive implementation of the Working for Health five-year action plan, a collaborative partnership between ILO, OECD and WHO to support countries to invest in the health and social service workforce required to achieve universal health coverage and the Sustainable Development Goals. 64 Ι WHO presence in countries, territories and areas 4.4 WHO country-level engagement with global health initiatives Development partners play an increasingly important role in promoting and protecting the health of the population in a country. Global health initiatives are humanitarian initiatives that raise and disburse additional funds for infectious diseases such as AIDS, tuberculosis and malaria; for immunization; and for strengthening health systems in low and middle-income countries. WHO recognizes the significance of these contributors to health and development in a country and gives priority to closely collaborating with them. One objective of this collaboration is to support the health ministry and health sector in general, to raise adequate financial resources for health programmes. The existence of a donor coordination mechanism was reported by 89 (60%) WHO country offices overall, and between 39% and 77% of WHO country offices within each region. These coordination platforms include bilateral development partners, multilateral agencies, funds and philanthropic foundations, nongovernmental organizations and civil society, the private sector and academic institutions. WHO plays a leadership role as either chair, co-chair or rotational chair in 62 (70%) of the countries, territories and areas with a donor coordination mechanism for health, while it acts as the Secretariat in 31 (35%) and as a participant in a further 22 (25%) countries. 4.4.1 WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is one of the leading funders of the prevention and control of HIV, TB and malaria. WHO is the only technical partner of the Global Fund that has expertise in HIV, TB, malaria, health systems strengthening, reproductive, maternal and newborn, child and adolescent health. WHO has an office in every country with a Global Fund grant, this global reach being essential for making an impact in the prevention and control of the three diseases targeted by the Global Fund, as well as strengthening the systems needed to deliver critical services and reach vulnerable populations. Recognizing the critical role of funding from the Global Fund Figure 51. Proportion of WHO country offices reporting the existence of a donor coordination mechanism and number of WHO country offices playing various roles in the coordination mechanism Chair or rotational chair Secretariat for the coordination mechanism Co-chair with other partners Participant but no leadership or coordination role Other 4. Who we work with Ι 65 in preventing and controlling diseases and strengthening systems, WHO country offices work in close partnership and collaboration with governments and partners to avail and use Global Fund financial resources. Countries consider WHO as their first port of call for information and technical support. In 113 countries, territories and areas with a WHO office and eligibility for Global Fund grants, WHO has provided technical support and/or capacity building for accessing, implementing and reporting on Global Fund grants. WHO country offices are most frequently engaged in being active members of the Country Coordination Mechanism (89%) and in updating disease control strategic plans (88%), with over 80% also facilitating comprehensive Strategic Framework for Collaboration between WHO and the Global Fund WHO and the Global Fund share a common commitment to universal health coverage and the SDGs. In 2018, to further strengthen and optimize the partnership between the two organizations, a Strategic Framework for Collaboration was signed. The Framework is designed to improve collaboration and communication between WHO and the Global Fund on a wide spectrum of policy, technical and programmatic areas to combat HIV, TB and malaria and efforts to support countries in building health systems, improving reproductive, maternal, newborn, child and adolescent health and addressing wider determinants of health. The agreed principles for this partnership have been defined and include country focus and partnership; gender and human rights; respect for each other’s mandate; evidence-based implementation; alignment between and within agencies; transparency and accountability. While the heads of both organizations are expected to meet annually, a joint steering committee and working groups will be meeting periodically to review progress and support implementation. Figure 52. Percentage of Global Fund-eligible countries where WHO has an office and supports the government to access and implement grants Active Member of the Country Coordination Mechanism Updating disease control strategic plans Facilitating comprehensive country dialogue across HIV, tuberculosis, malaria and health systems strengthening to determine cross-cutting elements in the Global Fund allocation envelope Funding request Concept note or proposal development Updating disease epidemiology and key intervention coverage trends Reporting on monitoring and evaluation of grant progress and performance Grant negotiation and implementation for service delivery Procurement of medical and public health supplies and equipment Managing WHO technical staff funded by Global Fund Implementing activities funded by the Global Fund for WHO country offices 66 Ι WHO presence in countries, territories and areas country dialogue across HIV, tuberculosis, malaria and health system strengthening (HSS) to determine cross-cutting elements in the Global Fund allocation envelope. WHO also supports the development of funding proposals and updating of epidemiological data and intervention coverage trends. Fifteen WHO country offices reported being engaged in all 10 roles highlighted in Figure 52. WHO country offices across 52 countries, territories and areas reported acting as subrecipients of at least one Global Fund grant with 29 of these receiving a grant for more than one programme. Tuberculosis is the primary programme through which the WHO country offices act as subrecipients (63%) followed by HIV/AIDS (60%), malaria (42%), health systems strengthening (23%) and RMNCH (6%). The proportion of WHO country offices in each region acting as subrecipients of Global Fund grants was 80% in the Western Pacific Region, 64% in the South-East Asia Region, 44% in the Eastern Mediterranean Region, 26% in the African Region and European Region, and 19% in the Region of the Americas. WHO and the Global Fund have developed a long-term, sustainable partnership to promote prevention and control to end the epidemics of HIV, tuberculosis and malaria. Under this partnership, significant financial resources have been mobilized and spent to strengthen countries’ ability to develop strategic, results-oriented grant proposals and effectively implement the approved grants. This collaboration is executed through the following key elements: • in-country technical assistance; • building the capacity of technical assistance providers through regional offices; and • assuring the quality of the technical assistance provided. WHO staff members at the country, regional and headquarters levels provide invaluable support to help attract critical financial resources from the Global Fund for government and civil society organizations. More than 400 WHO staff members directly and indirectly contribute meaningfully Figure 53. Global and regional distribution of Global Fund programmes for which the WHO country office has received a sub-grant 4. Who we work with Ι 67 to Global Fund processes and support health ministries in effectively implementing grants. 4.4.2 WHO and Gavi, the Vaccine Alliance Gavi, the Vaccine Alliance (Gavi), is an international alliance that was created in 2000 to improve access to new and underused vaccines for children living in the world’s poorest countries. WHO is a key policy influencer and implementing partner of Gavi. Vaccines contribute to healthier populations and universal health coverage through the life course, and WHO has developed a strategic approach to immunization to be aligned with GPW 13, with one focus area devoted to driving immunization impact in countries. The ultimate goal is to fully align the WHO GPW 13 implementation with the bottom-up approach of the Gavi Partners’ Engagement Framework. Gavi aims to focus its support on the world’s poorest countries, with national incomes determining eligibility. WHO country offices in 73 (49%) countries, territories and areas reported contributing to accessing and implementing Gavi grants, the same number as in the 2017 country presence report. Over 90% of these WHO country offices were engaged in supporting programming, planning and implementation or supporting reporting and monitoring. The majority (84%) of WHO country offices involved in supporting Gavi grants reported being engaged in at least five of the roles highlighted in Figure 54. In the field, Gavi relies significantly on collaboration with WHO’s six regional offices and country offices in countries that receive Gavi support. This support is provided through: • regional working groups that coordinate support for country programmes working through a core group of partners usually led by WHO and UNICEF; • WHO country offices working closely with national health authorities and their partner organizations in identifying national health priorities, formulating policy and supporting immunization and health system development; and Figure 54. WHO country offices which reported providing support to Member States in accessing and implementing Gavi grants, showing (a) % of country offices in each region participating, and (b) % of country offices which reported providing different types of support Support for programming, planning and implementation Reporting and monitoring Application for new vaccine introduction Member of the Inter-Agency Coordinating Committee (ICC) and/or Health Sector Coordination Committee (HSCC) or equivalent Preparation and reporting of Joint Appraisals Proposal Development Support for transitioning out of Gavi support Channelling funding for cash grants Other 68 Ι WHO presence in countries, territories and areas • WHO offices also assisting country health authorities in drafting applications for Gavi support and drawing up a plan of action for introducing vaccines. In addition, WHO staff members provide technical support for implementing immunization programmes, including storage and logistics, and monitoring and evaluating vaccines and equipment after they are introduced. 4.4.3 South-South and triangular cooperation The 2030 Agenda reaffirms the need to enhance South-South and t r iangular (SSTC) as well as regional and international cooperation on access to science, technology and innovation for the achievement of the Sustainable Development Goals. South-South and triangular cooperation is also recognized as one of the means to strengthen international support for implementing capacity-building in developing countries to support national plans to implement all the Sustainable Development Goals. The Thirteenth General Programme of Work emphasizes that WHO will help develop and scale up innovative solutions using such approaches as South−South cooperation. Globally, half of the WHO offices in countries, territories and areas in the six regions reported supporting a total of 241 South-South and/or triangular cooperation initiatives. The highest proportion of country office support for SSTC initiatives was reported in the Region of the Americas (78%), followed by the South-East Asia Region (64%), the Western Pacific Region (60%), the African Region (55%), the Eastern Mediterranean Region (28%) and the European Region (19%). Figure 55. Number of WHO country offices in each region which reported supporting SSTC initiatives AFR AMR EMR EUR SEAR WPR WHO country offices not involved in supporting SSTC Figure 56. Proportion of WHO country offices which reported support of SSTC initiatives and number of initiatives per region AFR AMR EMR EUR SEAR WPR 4. Who we work with Ι 69 Of the countries, territories and areas that supported SSTC initiatives, 50 WHO country offices (68%) reported supporting initiatives related to communicable diseases, followed by health systems strengthening and universal health coverage by 35 WHO country offices (47%). Health emergencies and International Health Regulations (IHR) initiatives were supported by 28 country offices (38%), followed by noncommunicable disease in 23 countries (31%), and promoting health through the life- course in 22 countries (30%). Timor-Leste, Sri Lanka: Strengthening immunization programme management The health system in Timor-Leste is relatively underdeveloped due to several years of conflict. A wide geographical spread of demographics poses a challenge to implementing a responsive immunization programme. Coupled with constrained capacity of the health system and an understaffed immunization (EPI) unit, transitioning from Gavi support at the end of 2019 is considered a big challenge. To cushion the transition from Gavi support, there was an urgent need to develop capacities within the EPI unit and the Ministry of Health. Sri Lanka, which had also suffered the impact of internal conflict, transitioned out from Gavi support in 2016 and took control of its own EPI with full government funding. In June 2017, at the sidelines of the WHO SEAR ITAG Meeting, Gavi, WHO, Sri Lanka and Timor-Leste officials met and had a preliminary discussion on how the two nations could build a partnership to strengthen the immunization programmes in both countries. South-South collaboration became the proposed solution. WHO, UNICEF and Gavi are supporting both nations in their twinning partnership. Under this programme, Timor-Leste’s health professionals are learning directly from their peers from Sri Lanka. For Sri Lanka, this programme provided an opportunity to showcase the strengths of its immunization programme both globally and regionally. It also enhanced its capacities in EPI mentoring and coaching with the potential for future twinning arrangements with other countries. Through this mutual partnership, both nations are on the fast track to achieving good health and well-being for women and children. Timor- Leste is now the third country to eliminate rubella and measles in South Asia. Upon completion of this twinning programme, a horizontal collaboration especially between South-South nations will be recognized as an effective solution for other countries challenged by capacity building and health systems development. Figure 57. Number of WHO country offices by region supporting SSTC initiatives in various technical areas Communicable diseases Health Emergencies and International Health Regulations (2005) Health systems and universal health coverage Noncommunicable diseases Promoting health through the life course Other Global Global Global 70 Ι WHO presence in countries, territories and areas The major focus of the initiatives varies among regions. Countries in the Region of the Americas were most likely to have reported supporting initiatives which were related to health systems and universal health coverage along with communicable diseases. The African Region also reported that the most common type of initiative supported by countries pertained to communicable diseases along with health emergencies/IHR. The top focus on initiatives in the Eastern Mediterranean Region, South-East Asia Region and Western Pacific Region was also on communicable diseases, while it shifted to noncommunicable diseases in the European Region. Over three quarters of WHO country offices reported the existence of SSTC initiatives including support through technical backstopping, while 74% provided support through training and capacity building, 47% by establishing information sharing platforms and networks, 32% provided financial and equipment support and 18% provided other services. South-South and triangular cooperation has been mainstreamed into the policies and programmes of the Organization and has become a means of implementation for achieving the health-related Sustainable Development Goals. However, keeping in mind the significance and contribution of SSTC to the protection and promotion of health in developing countries, this form of cooperation must be further strengthened and WHO country offices enabled to promote it. Figure 58. Number of WHO country offices supporting SSTC initiatives by type of support provided 11/03/2019 Q18c 1/1 AFR 10 6 6 19 18 21 AMR 12 8 3 18 17 6 EMR 3 3 3 4 13 EUR 4 3 4 4 25 SEAR 4 2 1 7 5 4 WPR 2 2 1 5 7 6 35 24 13 56 55 Global Training and capacity building Technical support Other types of support Financial and equipment support Establishment of information sharing platforms and networks 4. Who we work with Ι 71

Our work and its results 5. 5. Our work and its results Reflecting the overarching objective set out in WHO’s Constitution1 of enjoyment by all peoples of “the highest attainable standard of health”, GPW 13 places countries at the centre of WHO’s work. The foundation of WHO’s work is Sustainable Development Goal 3: ensuring healthy lives and promoting well-being for all at all ages. To ensure its achievement, GPW 13 has set the ambitious ‘triple billion’ goal on: • Universal health coverage – 1 billion more people benefitting from universal health coverage; • Health emergencies – 1 billion more people better protected from health emergencies; • Healthier populations – 1 billion more people enjoying better health and well-being. Placing the focus on the most vulnerable people, the GPW 13 also strives to ‘leave no one behind’. To deliver on the ambitious GPW 13, WHO is undergoing a number of strategic shifts to become more focused and effective in driving progress/impact in its country-based operations, working closely with partners, engaging in policy dialogue, providing strategic support and technical assistance, 1 WHO constitution, entered into force 7 April 1946, available at https:// www.who.int/governance/eb/who_constitution_en.pdf (accessed 2.7.2019). and coordinating service delivery, depending on the country context. Across 149 offices in countries, territories and areas, WHO staff, backed by six regional offices and headquarters, provide ministries of health with policy advice and technical assistance in many areas, including scaling up essential prevention, treatment and care services to achieve better health outcomes for populations. To showcase the result of the work of WHO offices in countries, territories and areas, more than 200 country experiences and success stories on the role of WHO teams in the field were compiled from its field offices. These stories highlight progress in a range of SDGs such as those relating to: communicable diseases, noncommunicable diseases, promoting health through the life-course (including sexual and reproductive, maternal, newborn, child and adolescent health; social determinants of health; and health and environment), health systems and universal health coverage, health emergencies and the International Health Regulations (all country stories will soon be made available on the country presence portal). For illustrative purposes, selected country stories from across all WHO regions covering the three strategic priorities of the GPW 13 are included below. Figure 59. GPW 13 strategic priority outcomes – promoting health, keeping the world safe, serving the vulnerable PROTECTION FROM HEALTH EMERGENCIES • Countries prepared for health emergencies • Epidemics and pandemics prevented • Health emergencies rapidly detected and responded to BETTER HEALTH AND WELL-BEING • Determinants of health addressed • Risk factors reduced through multisectoral action • Healthy settings and Health-in-All- Policies promoted UNIVERSAL HEALTH COVERAGE • Improved access to quality essential health services • Reduced number of people suffering financial hardship • Improved access to essential medicines, vaccines, diagnostics and devices for primary health care 74 Ι WHO presence in countries, territories and areas Fi gu re 60 . E xa m pl es of W HO co un tr y o ffi ce ac tiv iti es w or ld w id e 5. Our work and its results Ι 75 The essence of universal health coverage is a strong and resilient people-centred health system with primary care as its foundation. WHO provides support to countries to progress towards universal health coverage and the goal of ensuring that all people and communities Expanding universal health coverage have access to, and can use the promotive, preventive, curative, rehabil itative and palliative health services that are appropriate to their needs, and that are of sufficient quality to be effective, while not exposing the user to financial hardship. SERVICE ACCESS AND QUALITY HEALTH WORKFORCE ACCESS TO MEDICINES, VACCINE AND HEALTH PRODUCTS GOVERNANCE AND FINANCE HEALTH INFORMATION SYSTEMS POLICY DIALOGUE 76 Ι WHO presence in countries, territories and areas SOLOMON ISLANDS Western Pacific Region The Ministry of Health & Medical Services (MHMS) established the National Health Strategic Plan 2016-2020 (NHSP) and the Solomon Islands Government (SIG) have since identified that the Role Delineation Policy (RDP) is the key implementation mechanism to operationalize the NHSP and move towards universal health coverage. Traditionally, service delivery has not been integrated, especially as 80% of the population lives in rural and remote areas. RDP promotes integrated and patient centered care through service delivery packages provided in each of six levels of service and facilities, with referral pathways as well. Packages include considerations of staffing, equipment, essential medicines, guidelines, clinical support services at each level. WHO responded to country needs and helped in building strong partnerships in health and mobilizing and coordinating all available resources. The WHO country office has a program of ongoing support for the MHMS as it embarks on the implementation of RDP in the years ahead. After consultations conducted by the RDP national and provincial health planners, local staff and communities now have a common reference to identify what range and quality of services they can expect and deliver. RDP provides a roadmap for the realization of universal health coverage for the country. Challenge: implementing the NHSP to move towards universal health coverage Action: promote decentralized service delivery packages Outcome: common reference on range and quality of health services SERVICE ACCESS AND QUALITY 5. Our work and its results Ι 77 ARGENTINA Region of the Americas The Argentine Public Health Virtual Campus of the Pan American Health Organization/World Health Organization (PAHO/WHO) plays a strategic role for professionals and health workers. With a total of 79 296 persons enrolled, the platform offers a wide range of courses, resources, services and educational activities, as well as information and knowledge management in health. This Virtual Campus is comprised of a network of committed people, institutions and organizations that collaborate with a shared objective of strengthening capacity in public health. It is an important tool resulting from the joint effort of the Ministry of Health and Social Development (MOHSD) and PAHO/WHO to train public health professionals. The MOHSD’s National Observatory on Human Resources for Health supports the management of the Virtual Campus and designs and promotes courses according to its needs in coordination with PAHO/WHO. As a result, in 2017 alone, more than 30 courses were provided through the Argentine node of the PAHO/WHO virtual campus including courses on primary care management, establishing electronic health records, environmental health practice, surveillance of non-communicable diseases, vaccines in medical practices and key aspects of essential medicines. In 2017, more than 19 000 people participated in courses through self-learning or with tutoring in the country. Most of these courses were developed with contributions from the government. As a result, the PAHO/WHO Virtual Campus has evolved into a key resource for learning and collaboration in Argentina and has served to strengthen the steering and governance role of the national health authorities. Challenge: providing a platform for training public health professionals Action: creation of Virtual Campus to deliver courses Outcome: strengthening the human resources for health HEALTH WORKFORCE 78 Ι WHO presence in countries, territories and areas INDIA South-East Asia Region In India, an estimated 40 million people are infected with hepatitis B and approximately 6 million people are infected with hepatitis C with 184 000 deaths annually due to complications, twice the number of HIV and malaria deaths combined. In 2017, the Government of India responded to this public health crisis by providing free nation-wide treatment for hepatitis C using generic direct acting antiviral (DAA) drugs. This decision was made based on the results of a hepatitis C treatment programme that was piloted in Punjab state and from two economic analyses that were conducted with WHO’s technical support, including a cost-effectiveness analysis of DAA treatment and a treatment cost analysis of the whole course of drugs based on the pilot project. The results showed that a 12-week course using DAAs would cost $300 and that this plan would continue to be cost-effective over time. From June 2016 to September 2018, over 50 000 hepatitis C patients started the free treatment in Punjab and there was a cure rate of more than 92%. Generic drugs are now being manufactured in India making them affordable by bringing the cost down from $300 to $70 for a 12-week course. The generic drug programme used a decentralized service delivery model called ECHO in which doctors in tertiary hospitals provide oversight and monitoring via WhatsApp to doctors in district hospitals. Patients are monitored and those with viral suppression are given a certificate to prove they are disease free. Challenge: hepatitis B and C are a public health crisis Action: providing evidence on cost-effectiveness of pilot Outcome: piloting the project in Punjab with a 92% cure rate ACCESS TO MEDICINES, VACCINE AND HEALTH PRODUCTS 5. Our work and its results Ι 79 RWANDA African Region Over 80% of the population in Rwanda had financial barriers in accessing health care. Rwanda introduced community-based health insurance (CBHI) to address this issue, but faced some challenges along the way. Collecting premiums, attaining optimal recovery levels, a regressive flat fee premium, and significant financial deficit in covering reimbursement costs to CBHI providers were all challenges. WHO worked with partners to support and develop national health financing and CBHI policy documents and laws, to promote institutional capacity building, and to categorize people and health financing systems by socio-economic health financing system reviews. The WHO country office also advocated for equitable health care access, financial protection, policy support to move CBHI from the Ministry of Health/Districts to Rwanda Social Security Board (RSSB), and resource mobilization through the United Nations Development Assistance Plan. Since CBHI transferred to RSSB, coverage increased from 76% to 81% and utilization rose from 0.9 to 1.72 visits per person per year. The financial risk protection situation has improved, with a decrease of households who faced catastrophic health expenditure by more than 1.5% and a decrease in inequities between poorer and wealthier and/or urban and rural households. Challenge: financial barriers to accessing healthcare Action: supporting the development of a community based health insurance Outcome: improvements in coverage, visit rates, and financial protection GOVERNANCE AND FINANCE 80 Ι WHO presence in countries, territories and areas TAJIKISTAN European Region Recognizing that the collection of accurate and up-to-date data is crucial for evidence-based policy-making to achieve universal health coverage, WHO provided support to the Agency for Statistics under the President of the Republic of Tajikistan to gather reliable data on key areas such as health services utilization, unmet need and financial burden. The work was focused on updating a health module of the Household Budget Survey (HBS) and providing in-depth training for over 100 survey interviewers from the Agency for Statistics. The training series was in July 2018 and focused on building the capacity of interviewers, at both national and regional levels, to collect data on health services utilization and household expenditures within the scope of the routinely conducted HBS. During the training, interviewers were given guidance on processing data from the questionnaires and on fieldwork using the computer-assisted personal interviewing (CAPI) application. Including the revised health module questionnaire with the regular HBS makes it possible to link utilization and health expenditure data to detailed information on household consumption, including costs associated with disability. This data helped in strengthening analysis on equity and poverty dimensions, and the relevant financial protection aspects per household. It has also allowed for the calculation of the burden of health-care expenditures and the estimation of the impact of catastrophic health expenditures. Challenge: improving evidence-based policy making Action: training 100 employees of the Agency of Statistics in health services data collection Outcome: building capacity to investigate equity and poverty dimensions in health HEALTH INFORMATION SYSTEMS 5. Our work and its results Ι 81 TUNISIA Eastern Mediterranean Region Absence of coherent health sector vision has been an important challenge to the achievement of universal health coverage in Tunisia. One of the aims of the Tunisian Jasmine Revolution was to create better conditions of life, including better access to quality public services, more accountability, and a more open society where people influence policymaking more directly. The WHO country office has been helping establish an innovative citizen participation mechanism called “Dialogue Sociétal en santé” to define a common vision in policy making for universal health coverage and will monitor implementation mid-2018. Seven thematic strategic documents had been developed through Dialogue which cover the following themes: people centered-care, health determinants and multisectoral action, health financing, drugs and medical devices, digital health, health research and health sector governance. Debates around these strategic documents have been organized with support from the WHO country office. The participatory process of the Dialogue Sociétal and its ownership by the different stakeholders, including civil society, is an example of health democracy that can inspire other countries. Tunisia is also rapidly moving towards having a technically sound and coherent vision as well as policy documents which will guide the health sector for many years to come. Challenge: enhancing participative policy making towards universal health coverage Action: helping to establish a citizen participation mechanism Outcome: producing strategic documents leading to a coherent vision POLICY DIALOGUE 82 Ι WHO presence in countries, territories and areas The threat of epidemics and emergencies is universal, and every country is vulnerable to one or more types of health emergencies. WHO works with Member States and partners using an ‘all-hazards’ approach to health emergency preparedness, prevention, detection and risk management, response and recovery. This is done through the implementation of the International Health Regulations (IHR 2005) and the Sendai Framework for Disaster Risk Reduction. In responding to emergencies, WHO plays a central role at the country level as the Addressing health emergencies humanitarian health cluster lead. Meanwhile, WHO’s work in the area of emergencies also intersects with the other two strategic priorities of the GPW 13. For instance, under the health and well-being strategic priority, mitigating and addressing climate change and climate sensitive diseases are essential in preventing emergencies. Similarly, in fragile and conflict- affected countries, WHO focuses on preventing health system collapse, maintaining critical services and rebuilding health systems after crises. ACCESS TO LIFE- SAVING TREATMENTS IN HUMANITARIAN CRISES MITIGATE RISKS FROM INFECTIOUS HAZARDS ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 5. Our work and its results Ι 83 YEMEN Eastern Mediterranean Region Nearly 16.4 million people lack access to basic healthcare in Yemen. To respond to this massive need, WHO, Health Cluster partners and other health sector actors are delivering health services despite the critical security situation, logistical difficulties and the collapsing health system. WHO and Health Cluster partners have scaled-up their presence to meet rising health needs, reaching 9.5 million beneficiaries out of the targeted 10.4 million people. This has been done through preventive and curative interventions in 1708 health facilities and with 239 emergency medical mobile teams (EMMTs). WHO and other health partners scaled up the overall operational response to infectious disease outbreaks. At the peak of the cholera outbreak, there were 229 Diarrhoea Treatment Centres (DTCs) with in-patient capacities, and 1095 Oral Rehydration Corners (ORCs) for early detection, treatment and referral of severe cholera cases. Rapid response teams (RRTs) were established across all 333 districts in Yemen. WHO supported the technical and operational work of the response to contain outbreaks and build local capacity at governorate and district level health facilities and at community levels. Despite all challenges such as accessibility to the conflict affected areas, with WHO support, it was possible to save or improve the lives of at least 9.5 million people in 2017. Challenge: health needs amid a humanitarian crisis Action: coordinating and supporting the Health Cluster Outcome: containing outbreaks and delivering essential services, reaching 9.5 million people in need ACCESS TO LIFE-SAVING TREATMENTS IN HUMANITARIAN CRISES 84 Ι WHO presence in countries, territories and areas UGANDA African Region Uganda faced outbreaks of newly emerging or re-emerging diseases that constitutes public health threats, such as Marburg virus disease, yellow fever, meningitis, hepatitis B, E and cholera. These outbreaks are due to poor disease detection, drug stock outs, non-adherence to treatments, inadequate training, lack of necessary equipment, weak health system functionality and poor service delivery. The WHO country office helped address these problems by building core capacities to prevent, detect, report, assess and respond to public health emergencies. The Ministry of Health has increased emergency preparedness and integrated disease surveillance. There is now an Emergency Operation Center and improved laboratory infrastructure. However, despite these improvements, a joint external evaluation (JEE) showed that Uganda had a demonstrated capacity of 20%, a developed capacity of 40% and limited capacity of 30% of JEE core indicators. This strengthened system capacity allowed for the quick detection and response to the Marburg virus disease, which was contained in 42 days. Cholera guidelines also prevented outbreak. Health system strengthening in Uganda has also helped to contain Congo Crimean haemorrhagic-fever (CCHF) with no deaths. All these measures have strengthened the health system, decreased morbidity, and reduced associated mortality. Challenge: containing re-emerging outbreaks Action: building capacity to monitor and respond to outbreaks Outcome: faster containments with fewer or no deaths MITIGATE RISKS FROM INFRECTIOUS HAZARDS 5. Our work and its results Ι 85 ROMANIA European Region The ongoing measles outbreak in Romania started in January 2016. Since then, WHO, in close collaboration with UNICEF, has been providing extensive support to the country to interrupt the outbreak that represents a serious public health threat not only for the country but also to the region. Technical assistance has been provided by WHO, in close collaboration with Regional Office and Headquarters in developing the communication plan to ensure protection among the individuals identified as being most susceptible, including those at the highest risk of infection. As part of the outbreak response, a survey was conducted to identify the main reasons for parents not vaccinating their children. WHO and UNICEF assisted the Ministry of Health in preparing supplemental immunization activities in the country to interrupt the measles outbreak. With WHO’s support and as part of preparation for the measles campaign, a communication plan was developed using the survey data. Through training activities, more nationals are now able to strengthen their risk communication response capacity during outbreaks. The draft outbreak response plan was developed in collaboration with the European Centre for Disease Control and applied WHO’s After Action Review (AAR) methodology. The vaccine supply shortage review was performed, and areas for improvement were identified aiming at strengthening the Ministry of Health’s vaccine procurement capacity. The Immunization Law provision was reviewed before the planned public debate. Challenge: responding to measles outbreak Action: providing technical assistance to develop communication plan Outcome: risk communication response capacity strengthened RESPONDING TO DISEASE OUTBREAK 86 Ι WHO presence in countries, territories and areas MYANMAR South-East Asia Region In Myanmar, the WHO country office was notified of 13 H1N1 cases by the Ministry of Health and Sports (MoHS) on 24 July 2017. WHO provided significant support to the MoHS in the form of influenza A(H1N1) pdm09 response activities. By 5 January 2018, MoHS reported 406 H1N1 lab confirmed cases, including 60 deaths, 38 of which were likely due to Influenza and 22 due to influenza with co-morbidities. The WHO country office supported national authorities in overcoming the H1N1 outbreak by providing influenza event management and clinical case management technical experts from SEARO, the WHO country office, and the National University of Singapore. WHO’s technical support was essential for the coordination of influenza immunizations, viral characterization, data management and coordination with partners to ensure a comprehensive response. WHO also provided essential preventive and diagnostic tools, such as influenza vaccines, laboratory reagents and personal protective equipment. Risk communication capacity building for public health professionals was implemented in close collaboration with MoHS. The collaboration between MoHS, WHO, and development partners resulted in a significant decrease in laboratory confirmed Influenza A (H1N1) pdm09 cases and deaths since mid-August 2017. This decreasing trend in diagnoses show that Myanmar has successfully controlled the situation within a short duration of time. Challenge: responding to H1N1 influenza outbreak Action: providing management expertise, technical support and essential tools Outcome: situation under control within a short time duration RESPONDING TO DISEASE OUTBREAK 5. Our work and its results Ι 87 BAHAMAS Region of the Americas The WHO country office collaborates with the national health authorities and National Emergency Management Agency in both The Bahamas (BHS) and Turks and Caicos Islands (TCA) to prepare for and respond to disasters and emergencies. Technical assistance has been provided to both countries to prepare All Hazards Emergency preparedness and response plans. Both BHS and TCA are highly vulnerable to weather related disasters because of their geographical location, small land masses, low elevations and vulnerable coastal areas. The islands were adversely impacted by hurricanes Irma and Maria in 2017, which caused damage to infrastructure and economic losses. The WHO country office provided water purification and vector control supplies post-hurricanes and donated funds for construction materials to repair a health clinic on Ragged Island in The Bahamas. Human resources were provided to support Emergency Operating Centres (EOCs) in both countries and for evaluating damage to health facilities. Training was provided for emergency responders and coordinators on “Psychological first aid” and “Incident Command Management Systems” in TCA. Equipment was procured to improve communication and EOC operational capacities in both countries. In BHS consultants were assigned to assist with health risk assessment and air pollution testing equipment was donated to the Ministry of the Environment in response to another emergency caused by a fire at the landfill in New Providence in 2017. Challenge: improve preparedness for extreme weather events Action: providing human, in-kind and monetary resources Outcome: improved infrastructure and human capital to respond to emergencies ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 88 Ι WHO presence in countries, territories and areas VANUATU Western Pacific Region Malaria used to be a main cause of morbidity and mortality in Vanuatu. The WHO Vanuatu country office is the major long term technical partner for malaria control and the office helps in resource mobilization, strategic planning, field assessments such as vector surveillance and case finding; monitoring and evaluation; supervision; and bed-net distribution. As a result, malaria incidence has decreased by 95% in the last 10 years. A major milestone was that TAFEA province was declared malaria free in 2017. Several other provinces are on track, but the main challenge is the decreasing availability of funding. Vanuatu is ranked by the UN as the country most at risk of being severely impacted by natural disasters. The WHO country office, as co-chair of the health cluster has helped with the health sector’s responses to the many disasters in Vanuatu, including Tropical Cyclone Pam in 2015, Cyclone Donna in 2017, earthquakes, and, most recently, a serious volcanic eruption that required the removal of 10 000 people from the affected island. Among other activities, the WHO country office assisted in the completion of impact assessments and nutritional surveys and helped with training health workers and setting up syndromic surveillance for detection of outbreaks among affected and displaced populations. Other support consisted of health cluster coordination, creating emergency medical teams, and data management. WHO country office support significantly strengthened the health sector’s response to these emergencies. Challenge: malaria control and emergency response Action: technical partner for malaria and co-chairing health cluster Outcome: 95% decrease in malaria incidence over the last 10 years and health sector emergency response strengthened ADDRESS CRITICAL GAPS IN EMERGENCY PREPAREDNESS 5. Our work and its results Ι 89 WHO will contribute to better health and well- being for people through five interconnected platforms (left). Each of them presents considerable 21st Century challenges to people’s health and calls for multisectoral action to address health determinants. Using Promoting better health and well-being an integrated approach across technical units and levels of the Organization, WHO has a unique comparative advantage to work with governments and partners to address these five areas. ACCELERATING ACTION ON PREVENTING NONCOMMUNICABLE DISEASES AND PROMOTING MENTAL HEALTH IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE HEALTH EFFECTS OF CLIMATE CHANGE ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES TACKLING ANTIMICROBIAL RESISTANCE 90 Ι WHO presence in countries, territories and areas BURUNDI African Region Cervical cancer is the leading cause of cancer deaths among women in Burundi. Cancer screening services are still very poor, and the detection and treatment of pre-cancerous lesions is quasi inexistent. Cancer registries are yet to be institutionalized. The human papillomavirus (HPV) vaccine has proven to be effective in preventing cervical cancer. In 2016, WHO Burundi advocated and successfully mobilized US$ 161 882 through the GAVI Alliance to conduct a demonstration project to introduce the vaccine in two pilot districts. This step was very useful to generate evidence on feasibility of vaccine introduction, to galvanize political support and mobilize additional resources to scale up the intervention nationwide. WHO conducted high level advocacy, leading to the engagement of the Burundi’s First Lady in the introduction of the HPV vaccine in 2016. The preparation and technical organization of this activity was entrusted to the EPI Program. WHO provided technical support for planning, implementation, monitoring and evaluation, documentation of the results of the campaign and facilitated resource disbursement. A total of 91% of girls aged between 9 and 13 years throughout schools and surrounding communities were protected after receiving the first and second doses in 2016 and 2017. Following this successful intervention, national authorities are now engaged and GAVI has expressed willingness to consider an application from Burundi to apply for funding to extend HPV vaccination to the entire country as from 2019. Challenge: reducing cervical cancer deaths Action: advocacy, resource mobilization and technical support Outcome: 91% of girls aged 9–13 received the two rounds HPV vaccination IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE 5. Our work and its results Ι 91 PARAGUAY Region of the Americas Paraguay faces high levels of maternal and newborn mortality and aims to reduce the number of women who die during childbirth each year. The current registered maternal mortality ratio (MMR) in Paraguay is 81.8 per hundred thousand live births (as measured in 2016). Paraguay promoted the “National Mobilization for the reduction of maternal and newborn mortality 2014-2018”. Within this framework, PAHO’s technical cooperation focused on improving components such as strengthening the integrated health services network; maternal and neonatal health surveillance; development of human resources competencies and capacities in the mother-child area of the three levels of care; and strengthening of the strategic information system in health. This program has resulted in important advances, such as the strengthening of Family Health Units with basic equipment, supplies and materials, improving the mortality information system and reinforced analysis capabilities. The program also strengthened capacity of human resources for comprehensive health care, which made technical and financial cooperation possible in hospitals and primary care units in hard to reach communities. A total of 6663 health professionals and technicians have been trained to date. As a result, there has been a 10% reduction in the number of maternal deaths recorded during the last three years, showing that the national mobilization for the reduction of maternal and newborn mortality 2014– 2018 has been effective in saving the lives of women and newborns in Paraguay. Challenge: reducing maternal mortality Action: strengthening surveillance and capacity and integrating services Outcome: 10% reduction in the number maternal deaths over the last three years IMPROVE HUMAN CAPITAL ACROSS THE LIFE COURSE 92 Ι WHO presence in countries, territories and areas LITHUANIA European Region Lithuania has a high rate of alcohol consumption, binge-drinking patterns and high levels of alcohol-attributable mortality and burden of disease. In the latest comparative risk assessments, Lithuania ranked highest among all European Union countries, and sixth among all the WHO European Region countries in alcohol-attributable mortality, and highest in alcohol-attributable disability-adjusted life years. “Best buys” are a WHO created concept describing evidence-based, highly cost- effective and feasible interventions to reduce the impact of NCD risk factors. Currently, Lithuania is implementing all three best buy alcohol related policy options, namely increased taxation, restricting availability and banning marketing and advertising along with other policy changes with major changes being implemented between 2016 and 2018. The WHO country office in Lithuania contributed to this process by continuously prioritising the topic of alcohol consumption and related harm within the biennium cooperation agreements and providing on-going policy advice and technical support in raising awareness and sharing evidence and good practices. In 2017/2018, with new political leadership in the country and renewed commitment for introducing relevant alcohol control measures, WHO used this window of opportunity to support the Government and the Parliament in introducing alcohol control policies. With technical and political support from regional and headquarter levels, the WHO country office has actively engaged in policy dialogue and strategic communication with national stakeholders. It has clarified WHO’s approach on alcohol consumption estimates and highlighted the harm and burden of high alcohol use on health, despite opposition from the alcohol industry and related groups. It was considered key to monitor and evaluate the alcohol control policy situation and its impact on healthy. Currently the WHO country office is supporting the set-up of a study to rigorously evaluate these policies. Challenge: reducing alcohol abuse Action: advocacy, policy dialogue and evaluation on policies on alcohol-attributable health issues Outcome: the government prioritized alcohol control policies ACCELERATING ACTION ON PREVENTING NONCOMMUNICABLE DISEASES AND PROMOTING MENTAL HEALTH 5. Our work and its results Ι 93 SAMOA Western Pacific Region World Health Assembly Resolution 50.29 called on Member States to eliminate lymphatic filariasis as a public health problem. In response, WHO launched its Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000 with the aims of eliminating transmission and alleviating the suffering caused by lymphatic filariasis by 2020. In 1999, PacELF baseline surveys in Samoa revealed an antigenemia prevalence rate of 4.52%. The mass drug administration (MDA) strategy for the interruption of lymphatic filariasis transmission is 5-6 annual rounds of large-scale treatment of all eligible people in areas where infection is present. In efforts to accelerate elimination of lymphatic filariasis in Samoa, the Ministry of Health adopted the new treatment strategy recommended by the WHO in 2017 to implement MDA with triple drug therapy nationwide from 14 to 26 August 2018. WHO provided technical advice and financial assistance at each stage of the MDA campaign in Samoa. The rationale and purpose of WHO assistance is three-fold: stop transmission of lymphatic filariasis and prevent new infections by 2020; ensure the provision of basic care for people living with disability due to lymphatic filariasis; enhance Post-Mass Drug Administration Surveillance towards validation by 2024. The preliminary results based on Savaii Island demonstrate a high coverage of more than 90% of the entire eligible population. The results for Upolu Island and Apia are expected to be within a similar range. The MDA will be repeated in 2019 and if the rounds of MDA in 2018 and 2019 are successful then Samoa will be declared free of lymphatic filariasis by WHO. Challenge: eliminating lymphatic filariasis Action: providing technical and financial assistance Outcome: provision of basic care reached 90% of the eligible population ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES 94 Ι WHO presence in countries, territories and areas DJIBOUTI Eastern Mediterranean Region In 2017, Djibouti experienced a malaria epidemic, as confirmed by the WHO country office. The WHO country office supported the malaria control program to reduce the incidence of malaria by assisting in training 170 health workers regarding malaria diagnosis, case management, and community mobilization. To bolster malaria prevention, a total of 203 000 long lasting insecticide treated bed nets were distributed in the most affected areas. The malaria caseload reduced to below the epidemic threshold because of this WHO country office intervention. Of all confirmed malaria cases in Djibouti, 87% received the first line of treatment and 20 000 cases were effectively treated. A total of 91 788 rapid tests were provided and used. Additionally, WHO country office involvement led to strengthening of the national vector control capacity for malaria in terms of necessary equipment and support for the workforce. Challenge: responding to malaria epidemic Action: assisting in training and provision of bed nets Outcome: reduction of caseload to below epidemic threshold ACCELERATING ELIMINATION AND ERADICATION OF HIGH IMPACT COMMUNICABLE DISEASES 5. Our work and its results Ι 95 MALDIVES South-East Asia Region As part of the Joint UN program on Low Emission Climate Resilient Development (LeCRED), the WHO country office has collaborated with six other UN agencies to address issues related to climate change and health. Waste management and vector control activities were among some of the most challenging areas where opportunities to build on each agency’s comparative advantages were evident. Following the mapping of activities, the WHO country office prioritized focus on developing health care waste management activities which remained a neglected area in overall waste management approach. After agreeing to implement vector control activities with agency partners, the WHO country office provided technical assistance to develop health care waste management technology. As the work progressed it was noted that country did not have a Health Care Waste Management Policy, Strategic Plan and Operational Plan, subsequently the WR led development discussions at the highest level with the Health Minister. The WHO country office team then mobilized high quality technical assistance from the regional office which supported identification of a suitable expert to further the plan’s development and established sites for appropriate health care waste management with an autoclave at the regional hospital and a desktop autoclave in each of 11 island health centres as an example of policy implementation. Utilizing the opportunity, the WHO country office brought different agencies together to participate in elements of the campaign such as communication activities, facilitating participation of the women groups from islands and mobilizing local councils while the WHO country office mobilized the hospital and health centre staff for participation in the campaign which was launched by Health Minister, State Minister of Environment and Energy and attended by local council chief, members of atoll and island councils and several community representatives. Given the limited staff numbers at the WHO country office, the joint working with UN agencies made it possible to mobilize different partners, stakeholders and importantly ensured engagement of the community as well. Challenge: developing resilience to climate change Action: mobilizing high quality technical assistance and bringing other UN agencies to work together Outcome: achieving both community and high level engagement HEALTH EFFECTS OF CLIMATE CHANGE 96 Ι WHO presence in countries, territories and areas Annexes Annex 1 List of WHO Member States and Associate Member States Puerto Rico Tokelau A S S O C I AT E M E M B E R S TAT E S Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic Chad Chile China Colombia Comoros Congo (the) Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Democratic People’s Republic of Korea Democratic Republic of the Congo Denmark M E M B E R S TAT E S Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People’s Democratic Republic Latvia Lebanon Lesotho Liberia Libya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Republic of North Macedonia Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Syrian Arab Republic Tajikistan Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Yemen Zambia Zimbabwe 98 Ι WHO presence in countries, territories and areas Annex 2 WHO offices and suboffices in countries, territories and areas A F R I C A N R E G I O N Country, territory, area Location Country, territory, area Location Algeria Algiers Lesotho Maseru Angola Luanda Liberia Monrovia Benin Cotonou Madagascar Antananarivo Botswana Gaborone Malawi Lilongwe Burkina Faso Ouagadougou Mali Bamako Burundi Bujumbura Mauritania Nouakchott Cabo Verde Praia Mauritius Port Louis Cameroon Yaoundé Mozambique Maputo Central African Republic Bangui Namibia Windhoek Chad N’Djamena Niger Niamey Comoros Moroni Nigeria Abuja Congo (the) Brazzaville Rwanda Kigali Côte d’Ivoire Abidjan São Tomé and Príncipe São Tomé Democratic Republic of the Congo Kinshasa Senegal Dakar Equatorial Guinea Malabo Seychelles Victoria, Mahé Eritrea Asmara Sierra Leone Freetown Eswatini Mbabane South Africa Pretoria Ethiopia Addis-Ababa South Sudan Juba Gabon Libreville Togo Lomé Gambia Banjul Uganda Kampala Ghana Accra United Republic of Tanzania (the) Dar es Salaam Guinea Conakry Zambia Lusaka Guinea-Bissau Bissau Zimbabwe Harare Kenya Nairobi W H O O F F I C E S Annexes Ι 99 Annex 2, continued R E G I O N O F T H E A M E R I C A S Country, territory, area Location Argentina Buenos Aires Bahamas Nassau, New Providence Barbados Bridgetown Belize Belize City Bolivia (Plurinational State of) La Paz Brazil Brasilia Chile Santiago Colombia Bogotá Costa Rica San Jose Cuba Havana Dominican Republic Santo Domingo Ecuador Quito El Salvador San Salvador Guatemala Guatemala City Guyana Georgetown Haiti Port-au-Prince Honduras Tegucigalpa Jamaica Kingston Mexico Mexico City Nicaragua Managua Panama Panama City Paraguay Asunción Peru Lima Suriname Paramaribo Trinidad and Tobago Port-of-Spain Uruguay Montevideo Venezuela (Bolivarian Republic of) Caracas E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Location Afghanistan Kabul Djibouti Djibouti Egypt Cairo Iran (Islamic Republic of) Tehran Iraq Baghdad Jordan Amman Lebanon Beirut Libya Tripoli Morocco Rabat Oman Muscat Pakistan Islamabad Saudi Arabia Riyadh Somalia Mogadishu Sudan Khartoum Syrian Arab Republic Damascus Tunisia Tunis West Bank & Gaza Strip Jerusalem Yemen Sana’a W H O O F F I C E S 100 Ι WHO presence in countries, territories and areas Annex 2, continued E U R O P E A N R E G I O N Country, territory, area Location Albania Tirana Armenia Yerevan Azerbaijan Baku Belarus Minsk Bosnia and Herzegovina Sarajevo Bulgaria Sofia Croatia Zagreb Czech Republic Prague Estonia Tallinn Georgia Tbilisi Greece Athens Hungary Budapest Kazakhstan Astana Kyrgyzstan Bishkek Latvia Riga Lithuania Vilnius Montenegro Podgorica Poland Warsaw Pristina Pristina Republic of Moldova Chisinau Republic of North Macedonia Skopje Romania Bucharest Russian Federation Moscow Serbia Belgrade Slovakia Bratislava Slovenia Ljubljana Tajikistan Dushanbe Turkey Ankara Turkmenistan Ashgabat Ukraine Kyiv Uzbekistan Tashkent S O U T H - E A S T A S I A R E G I O N Country, territory, area Location Bangladesh Dhaka Bhutan Thimphu Democratic People’s Republic of Korea Pyongyang India New Delhi Indonesia Jakarta Maldives Male Myanmar Yangon Nepal Kathmandu Sri Lanka Colombo Thailand Nonthaburi Timor-Leste Dili W E S T E R N PA C I F I C R E G I O N Country, territory, area Location Cambodia Phnom Penh China Beijing Kiribati Tarawa Lao People’s Democratic Republic (the) Vientiane Malaysia Kuala Lumpur Micronesia (Federated States of) Palikir Mongolia Ulaanbaatar Papua New Guinea Port Moresby Philippines Manila Samoa Apia Solomon Islands Honiara South Pacific Suva Tonga Nuku’alofa Vanuatu Port Villa Viet Nam Hanoi W H O O F F I C E S Annexes Ι 101 Annex 2, continued A F R I C A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Angola Luanda 0 Angola does not have suboffices, but does have an office in each of the 18 provinces, located within each of the provincial health directorates. The offices have all required equipment to function, including a vehicle, a driver, and technical staff with an epidemiological/surveillance background Central African Republic Bangui 3 Bambari, Kagabandoro and Bouar Chad N’Djamena 6 Abeche, Sarh, Moundou, Mongo, Mao and N’Djamena Democratic Republic of the Congo Kinshasa 11 Kinshaha, Matadi, Bandundu ville, Kananga, Mbuji Mayi, Lubumbashi, Bukavu, Goma, Kindu, Kinsagani and Mbandaka Ethiopia Addis-Ababa 1 Somali Region Ghana Accra 1 Tamale Guinea Conakry 2 Nzérékoré and Guéckédou Kenya Nairobi 4 Garissa (serving the North Eastern Province), Embu, Eldoret, Nakuru Nigeria Abuja 37 In each of the 37 states, including the Federal Capital Territory in Abuja South Sudan Juba 10 In all the capitals of the 10 States that constitute the country Uganda Kampala 1 Moroto United Republic of Tanzania (the) Dar es Salaam 5 Zanzibar, Tanga, Dodoma, Mwanza and Iringa W H O S U B O F F I C E S R E G I O N O F T H E A M E R I C A S Country, territory, area Location Number of suboffices Location of WHO suboffices Barbados Bridgetown 7 Anguilla, Antigua, Dominica, Grenada, Saint Kitts, Saint Lucia and Saint Vincent Guatemala Guatemala City 1 San Marcos Mexico Mexico City 1 Tuxtla Gutiérrez Chiapas Paraguay Asunción 1 Boqueron, Filadelfia in El Chaco Paraguayo 102 Ι WHO presence in countries, territories and areas Annex 2, continued E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Afghanistan Kabul 8 Jalalabad, Gardez, Herat, Kandahar, Bamyan, Kunduz, Balkh and Badakhshan Iraq Baghdad 5 Erbil, Dohuk, Sulaimaniyah, Basrah and Baghdad (within the Ministry of Health) Jordan Amman 0 EMRO Regional Centre for Environmental Action (CEHA) EMRO Regional Centre for Polio Eradication and Emergency Libya Tripoli 2 Benghazi , Sabah Pakistan Islamabad 4 Lahore, Karachi, Peshawar and Quetta Somalia Mogadishu 4 Nairobi (Liaison Office), Hargeisa (serving Somaliland), Garowe (serving Puntland), and Baidoa (serving southwestern State) Sudan Khartoum 6 El-Fasher, Nyala, Geneina, Kassala, Kadugli and Damazine Syrian Arab Republic Damascus 4 Qamishly, Aleppo, Homs and Latakia West Bank & Gaza Strip Jerusalem 2 Ramallah, Gaza Yemen Sana’a 4 Aden, Al Hodeida, Ibb (serving Ibb and Taiz) and Sadaa W H O S U B O F F I C E S E U R O P E A N R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Bosnia and Herzegovina Sarajevo 1 Banja Luka Turkey Ankara 1 Gaziantep Ukraine Kyiv 4 Donetsk, Kramatorsk, Luhansk and Severodonetsk S O U T H - E A S T A S I A R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices India New Delhi 7 In all seven regional hubs in the country Indonesia Jakarta 2 Jakarta W E S T E R N PA C I F I C R E G I O N Country, territory, area Location Number of suboffices Location of WHO suboffices Philippines Manila 1 Davao City Viet Nam Hanoi 1 Ho Chi Minh City Annexes Ι 103 Annex 3 Number and categories of staff members working in WHO offices in countries, territories and areas A F R I C A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Algeria 15 2 7 6 Angola 53 12 15 26 Benin 25 1 9 15 Botswana 15 1 7 7 Burkina Faso 32 3 9 20 Burundi 25 3 7 15 Cameroon 28 1 11 16 Cabo Verde 8 1 3 4 Central African Republic 36 8 10 18 Chad 58 13 10 35 Comoros 16 0 5 11 Congo (the) 23 0 9 14 Côte d’Ivoire 34 3 11 20 Democratic Republic of the Congo 90 12 35 43 Equatorial Guinea 8 0 3 5 Eritrea 19 1 6 12 Eswatini 16 1 5 10 Ethiopia 131 15 59 57 Gabon 17 1 5 11 Gambia 16 1 5 10 Ghana 29 1 10 18 Guinea 34 3 9 22 Guinea-Bissau 11 2 2 7 Kenya 47 5 20 22 Lesotho 14 2 4 8 Liberia 32 5 5 22 Madagascar 27 3 9 15 Malawi 24 0 12 12 Mali 26 4 8 14 Mauritania 22 3 8 11 Mauritius 9 1 2 6 Mozambique 29 3 13 13 Namibia 18 3 4 11 Niger 40 4 15 21 Nigeria 403 34 144 225 Rwanda 21 2 10 9 São Tomé and Príncipe 7 0 3 4 Senegal 16 1 6 9 104 Ι WHO presence in countries, territories and areas Annex 3, continued R E G I O N O F T H E A M E R I C A S Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Argentina 11 4 2 5 Bahamas 3 2 1 0 Barbados 24 17 1 6 Belize 3 1 1 1 Bolivia (Plurinational State of) 14 7 1 6 Brazil 63 24 24 15 Chile 7 1 2 4 Colombia 15 6 3 6 Costa Rica 6 3 1 2 Cuba 1 1 — — Dominican Republic 11 7 1 3 Ecuador 14 5 4 5 El Salvador 12 8 0 4 Guatemala 15 7 1 7 Guyana 10 3 4 3 Haiti 17 10 0 7 Honduras 16 8 3 5 Jamaica 10 6 1 3 Mexico 15 9 2 4 Nicaragua 11 3 3 5 Panama 11 8 1 2 Paraguay 12 8 1 3 Peru 22 14 2 6 Suriname 5 3 1 1 Trinidad and Tobago 10 7 0 3 Uruguay 12 6 3 3 Venezuela (Bolivarian Republic of) 13 5 2 6 Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Seychelles 6 1 2 3 Sierra Leone 56 18 14 24 South Africa 36 7 9 20 South Sudan 73 23 19 31 Togo 17 2 3 12 Uganda 46 3 20 23 United Republic of Tanzania (the) 42 4 17 21 Zambia 32 2 16 14 Zimbabwe 40 2 12 26 A F R I C A N R E G I O N Annexes Ι 105 E A S T E R N M E D I T E R R A N E A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Afghanistan 105 23 19 63 Djibouti 10 3 0 9 Egypt 17 1 7 9 Iran (Islamic Republic of) 18 1 4 13 Iraq 66 21 16 29 Jordan 16 4 3 9 Lebanon 9 1 2 6 Libya 23 11 4 8 Morocco 10 1 3 6 Oman 9 1 0 8 Pakistan 127 38 31 58 Saudi Arabia 8 3 1 4 Somalia 56 25 13 18 Sudan 57 7 11 39 Syrian Arab Republic 61 5 22 34 Tunisia 14 2 1 11 West Bank & Gaza Strip 25 4 8 13 Yemen 123 29 29 65 Annex 3, continued 106 Ι WHO presence in countries, territories and areas E U R O P E A N R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Albania 6 1 3 2 Armenia 8 1 3 4 Azerbaijan 6 1 2 3 Belarus 5 1 2 2 Bosnia and Herzegovina 7 2 1 4 Bulgaria 3 1 1 1 Croatia 2 0 1 1 Czech Republic 2 1 0 1 Estonia 2 0 1 1 Georgia 9 1 5 3 Greece 1 1 0 0 Hungary 3 1 1 1 Kazakhstan 5 1 2 2 Kyrgyzstan 17 2 9 6 Latvia 1 0 1 0 Lithuania 2 0 1 1 Montenegro 2 0 1 1 Poland 3 1 0 2 Pristina 0 1 3 4 Republic of Moldova 7 0 5 2 Republic of North Macedonia 6 1 2 3 Romania 3 1 1 1 Russian Federation 9 1 4 4 Serbia 9 2 3 4 Slovakia 2 1 0 1 Slovenia 3 1 0 2 Tajikistan 17 2 8 7 Turkey 37 13 11 13 Turkmenistan 7 1 2 4 Ukraine 35 10 14 11 Uzbekistan 18 2 9 7 Annex 3, continued Annexes Ι 107 S O U T H - E A S T A S I A R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Bangladesh 63 13 19 31 Bhutan 15 2 3 10 Democratic People’s Republic of Korea 7 7 0 0 India 88 10 48 30 Indonesia 52 10 16 26 Maldives 21 3 4 14 Myanmar 54 12 8 34 Nepal 50 7 15 28 Sri Lanka 28 3 8 17 Thailand 28 7 5 16 Timor-Leste 22 7 4 11 Annex 3, continued W E S T E R N PA C I F I C R E G I O N Country, territory, area Total workforce International professional staff members National professional staff members General service staff members Cambodia 46 13 11 22 China 31 5 14 12 Kiribati 2 0 0 2 Lao People’s Democratic Republic (the) 51 12 17 22 Malaysia 7 1 1 5 Micronesia (Federated States of) 2 1 0 1 Mongolia 16 1 6 9 Papua New Guinea 37 14 4 19 Philippines 28 7 8 13 Samoa 9 1 2 6 Solomon Islands 12 6 0 6 South Pacific 44 14 9 21 Tonga 4 1 0 3 Vanuatu 11 5 1 5 Viet Nam 45 9 13 23 108 Ι WHO presence in countries, territories and areas Annex 4 Global fund grants of which WHO is a subrecipient Region Country HIV/AIDS TB Malaria RMNCH Health systems strengthening African Region Democratic Republic of the Congo Madagascar Malawi Nigeria Senegal South Sudan Eastern Mediterranean Region Afghanistan Iran (Islamic Republic of) Iraq Lebanon Somalia Sudan Syrian Arab Republic Tunisia European Region Ukraine South-East Asia Region Bangladesh Democratic People's Republic of Korea India Indonesia Nepal Myanmar Sri Lanka Thailand Timor-Leste Western Pacific Region Cambodia Kiribati Lao People's Democratic Republic Micronesia (Federated States of) Mongolia Papua New Guinea Solomon Islands South Pacific (Fiji) Tonga Viet Nam Annexes Ι 109 Annex 5 Countries (with WHO presence) eligible for Gavi new vaccines support in 2018 Region Country African Region Benin Burkina Faso Burundi Cameroon Central African Republic Chad Comoros Côte d'Ivoire Democratic Republic of the Congo Eritrea Ethiopia Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mozambique Niger Rwanda São Tomé and Príncipe (grace year) Senegal Sierra Leone South Sudan Togo Uganda United Republic of Tanzania Zambia Zimbabwe Region Country Region of the Americas Haiti Eastern Mediterranean Region Afghanistan Djibouti Pakistan Somalia Sudan Yemen European Region Kyrgyzstan Tajikistan South-East Asia Region Bangladesh Democratic People’s Republic of Korea Myanmar Nepal Western Pacific Region Cambodia 110 Ι WHO presence in countries, territories and areas Annex 6 Planned costs and available funds for WHO work in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Algeria 3 354 850 2 979 382 89 Angola 24 299 010 17 693 432 73 Benin 8 200 207 5 351 466 65 Botswana 3 445 319 3 037 354 88 Burkina Faso 11 273 270 8 124 304 72 Burundi 6 660 682 5 587 156 84 Cameroon 17 577 558 13 326 433 76 Cabo Verde 4 730 065 3 448 769 73 Central African Republic 18 572 844 15 069 549 81 Chad 30 803 324 21 304 288 69 Comoros 3 414 705 2 176 013 64 Congo (the) 26 769 904 5 693 820 21 Côte d’Ivoire 12 252 284 7 286 136 59 Democratic Republic of the Congo 181 951 333 143 081 603 79 Equatorial Guinea 4 484 128 3 454 689 77 Eritrea 7 355 205 4 484 026 61 Eswatini 4 780 486 3 561 213 74 Ethiopia 53 761 403 43 172 305 80 Gabon 4 692 818 4 085 179 87 Gambia 3 751 184 2 170 860 58 Ghana 12 116 486 8 969 669 74 Guinea 16 349 029 10 726 905 66 Guinea-Bissau 5 535 346 4 182 410 76 Kenya 32 290 476 21 948 090 68 Lesotho 3 734 509 2 811 489 75 Liberia 14 428 682 11 661 850 81 Madagascar 16 366 539 14 370 110 88 Malawi 8 916 737 6 177 910 69 Mali 14 870 265 11 481 693 77 Mauritania 8 798 427 6 406 695 73 Mauritius 2 283 500 2 216 480 97 Mozambique 21 562 163 21 558 333 100 Namibia 9 235 202 4 011 953 43 Niger 24 563 396 16 650 933 68 Nigeria 274 225 293 230 135 696 84 Rwanda 8 145 971 6 429 951 79 Reunion 137 635 — — A F R I C A N R E G I O N Annexes Ι 111 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Saint Helena 27 000 — — São Tomé and Príncipe 2 538 691 1 950 664 77 Senegal 9 342 428 4 497 119 92 Seychelles 1 897 998 1 453 667 77 Sierra Leone 24 530 437 22 524 940 92 South Africa 11 132 639 9 286 472 83 South Sudan 53 479 013 41 280 367 77 Togo 5 774 562 4 302 253 75 Uganda 32 264 856 17 162 892 53 United Republic of Tanzania (the) 24 230 131 11 608 319 48 Zambia 14 482 869 11 815 824 82 Zimbabwe 18 242 013 14 258 706 78 Annex 6, continued A F R I C A N R E G I O N 112 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Antigua and Barbuda 11 033 129 090 1170 Argentina 1 366 845 1 124 521 82 Bahamas 522 520 320 000 61 Barbados — — — Belize 552 109 268 000 49 Bolivia (Plurinational State of) 4 206 424 2 148 605 51 Brazil 7 222 510 5 304 093 73 Chile 1 814 720 883 100 49 Colombia 5 469 985 3 676 606 67 Costa Rica 528 520 638 200 121 Cuba 1 680 281 1 274 856 76 Dominica 180 555 292 533 162 Dominican Republic 4 240 384 2 705 569 162 Ecuador 4 099 095 2 368 657 58 El Salvador 1 159 984 532 800 46 Guatemala 5 013 879 3 148 302 63 Guyana 1 699 937 946 642 56 Haiti 10 699 476 6 478 422 61 Honduras 3 181 013 2 149 729 68 Jamaica 1 953 417 1 162 255 59 Mexico 3 419 410 2 375 101 69 Nicaragua 1 995 827 1 080 370 54 Panama 521 229 579 600 111 Paraguay 820 959 924 635 113 Peru 3 001 846 2 349 296 78 Saint Kitts and Nevis — 112 600 — Saint Lucia 22 288 115 050 516 Saint Vincent and the Grenadines 121 622 72 900 60 Suriname 1 256 805 584 385 46 Trinidad and Tobago 819 424 811 100 99 Uruguay 169 640 276 000 163 Venezuela (Bolivarian Republic of) 5 925 824 7 340 856 124 R E G I O N O F T H E A M E R I C A S Annex 6, continued Annexes Ι 113 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Afghanistan 157 135 700 119 155 728 76 Bahrain 155 200 81 819 53 Djibouti 6 392 200 3 651 229 57 Egypt 11 798 300 8 509 450 72 Iran (Islamic Republic of) 7 988 500 3 867 272 48 Iraq 110 262 700 94 300 408 86 Jordan 10 154 800 5 713 004 56 Kuwait 172 000 60 331 35 Lebanon 21 098 700 14 236 270 67 Libya 26 599 700 19 313 886 73 Morocco 5 176 085 4 287 802 83 Oman 2 836 700 2 147 231 76 Pakistan 257 405 000 191 394 534 74 Qatar 432 800 321 881 74 Saudi Arabia 4 298 800 3 047 146 71 Somalia 62 832 300 42 188 661 67 Sudan 62 733 100 43 565 790 69 Syrian Arab Republic 105 299 661 76 488 688 73 Tunisia 4 123 500 2 706 712 66 United Arab Emirates 326 900 174 838 53 West Bank & Gaza Strip 27 218 000 22 310 493 82 Yemen 373 507 300 369 137 766 99 Annex 6, continued E A S T E R N M E D I T E R R A N E A N R E G I O N 114 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Albania 1 831 260 1 457 596 80 Armenia 3 145 420 2 320 690 74 Azerbaijan 1 207 745 887 159 73 Belarus 3 199 699 2 569 017 80 Bosnia and Herzegovina 3 416 290 2 609 555 76 Bulgaria 1 043 872 824 894 79 Croatia 968 792 675 620 70 Czech Republic 972 651 691 455 71 Estonia 784 164 434 453 55 Georgia 3 964 069 3 070 140 77 Greece 2 373 327 2 138 895 90 Hungary 1 148 856 939 293 82 Kazakhstan 3 752 448 2 591 150 69 Kyrgyzstan 9 416 911 8 125 086 86 Latvia 552 689 332 185 60 Lithuania 1 423 195 1 114 997 78 Malta 70 894 60 108 85 Montenegro 864 005 460 531 53 Poland 844 397 651 686 77 Portugal 67619 — — Pristina 3 143 169 2 357 184 75 Republic of Moldova 6 276 964 4 756 292 76 Republic of North Macedonia 1 701 757 1 326 068 78 Romania 2 519 260 1 624 509 64 Russian Federation 5 970 404 4 597 918 77 Serbia 5 901 876 4 806 787 81 Slovakia 960 705 795 682 83 Slovenia 1 046 199 606 170 58 Tajikistan 7 676 342 5 559 447 72 Turkey 83 390 473 85 718 788 103 Turkmenistan 3 890 947 2 664 082 68 Ukraine 19 590 756 13 983 726 71 Uzbekistan 6 389 891 6 602 945 103 E U R O P E A N R E G I O N Annex 6, continued Annexes Ι 115 Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) Bangladesh 49 640 875 43 834 788 88 Bhutan 4 861 688 4 016 623 83 Democratic People’s Republic of Korea 17 377 145 15 462 803 89 India 93 858 328 81 296 126 87 Indonesia 28 943 767 25 001 023 86 Maldives 4 553 397 4 179 797 92 Myanmar 30 521 648 23 331 055 76 Nepal 19 131 618 13 459 360 70 Sri Lanka 7 662 773 6 776 800 88 Thailand 12 136 200 9 861 971 81 Timor-Leste 10 900 823 9 625 720 88 Annex 6, continued S O U T H - E A S T A S I A R E G I O N 116 Ι WHO presence in countries, territories and areas Country, territory, area 2018–2019 Planned costs Distribution (as at 31 December 2018) Proportion of planned costs received (%) American Samoa 69 000 69 000 100 Brunei Darussalam 36 000 36 000 100 Cambodia 18 823 279 13 752 325 73 China 20 350 734 15 822 108 78 Commonwealth of the Northern Mariana Islands 37 000 37 000 100 Cook Islands 363 660 413 994 114 Fiji 4 714 772 4 232 239 90 French Polynesia 53 628 36 000 67 Guam 36 000 36 000 100 Kiribati 1261 550 965 027 76 Lao People’s Democratic Republic (the) 17 868 331 14 625 881 82 Malaysia 1 964 802 1 935 218 98 Marshall Islands 348 925 282 951 81 Micronesia (Federated States of) 2 026 031 1 949 584 96 Mongolia 6 385 632 5 224 683 82 Nauru 126 000 101 000 80 Niue 94 000 94 080 100 Pacific Island Countries 19 260 182 17 580 263 91 Palau 181 000 124 000 69 Papua New Guinea 35 398 591 34 000 257 96 Philippines 14 608 471 12 730 708 87 Samoa 3 385 657 3 321 791 98 Singapore 37 000 37 000 100 Solomon Islands 11 685 543 12 021 731 103 Tokelau 92 941 95 973 103 Tonga 1 000 414 1 167 082 117 Tuvalu 125 976 107 360 85 Vanuatu 4 470 244 4 279 321 96 Viet Nam 22 382 432 17 256 130 77 W E S T E R N PA C I F I C R E G I O N Annex 6, continued Annexes Ι 117 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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