Forty-ninth Regional Committee for Europe: Florence, 13 - 17 September 1999: strengthened partnership with European countries: towards a renewed country strategy

Provisional agenda item 3(e) EUR/RC49/8 + EUR/RC49/Conf.Doc ./8 5 July 1999 09319 ORIGINAL: EN GLISH S t r e n g t h e n e d P a r t n e r s h i p w i t h t h e E u r o p e a n C o u n t r i e s - T o w a r d s a r e n e w e d c o u n t r y s t r a t e g y As a follow-up of the discussions at the forty-eighth session of the Regional Committee for Europe on the work of the Regional Office for Europe in the countries, the Regional Director proposed to put the country strategy specific to the Regional Office on the agenda of the forty-ninth session of the Regional Committee. A first discussion in the Standing Committee of the Regional Committee (SCRC) took place in December 1998 during which the SCRC recommended that a) the Regional Committee discuss a detailed paper at its fiftieth session on the European country strategy together with the findings of the EUROHEALTH evaluation; b) the Regional Committee, at its forty-ninth session, discuss a new form of presenting the programme budget and Regional Director's report so that the Regional Office's work to support countries is better reflected; and c) proposals for a new allocation formula for the country budget also be presented to the Regional Committee at its forty-ninth session. This document includes a number of general issues to guide the Regional Office's work towards elaborating an updated country strategy and deals in detail with the issues identified under items b) and c) above. REGIONAL COMMITTEE FOR EUROPE F orty -n in th session, Florence, 1 3 – 1 7 September 1 9 9 9 WORLD HEALTH ORGANIZATION R e g i o n a l O f f i c e f o r E u r o p e C o p e n h a g e n C O N T E N T S Page Background.............................................................................................................................................................................1 Historical perspective - the evolutionary approach .................................................................................................... 1 Towards a renewed European country s tra tegy ............................................................................................................2 Objective, scope and principles.............................................................................................................................2 Policy issues................................................................................................................................................................3 M anagem en t...............................................................................................................................................................3 O rganization ...............................................................................................................................................................4 The totality of the Regional Office’s support to countries........................................................................................ 4 Country budget allocation....................................................................................................................................... 4 General considerations............................................................................................................................................. 5 Allocation model for 2002-2003 and b e y o n d ..................................................................................................5 Current level of WHO support to countries.......................................................................................................6 Possible a c t io n .......................................................................................................................................................................8 Action at the level of WHO headquarters and the global governing bodies.............................................8 Action at the level of the European R eg ion .......................................................................................................8 C onclus ion ..............................................................................................................................................................................9 Annex 1. Country budget allocations proposed for 2002-2003 and 2010-201 1 .......................................... 10 Annex 2. EURO country support funds 1990-1991 and 1998-1999................................................................11 EUR/RC49/8 page 1 B a c k g r o u n d 1. During the programme budget discussions for 2000-2001 at the forty-eighth session of the Regional Committee, some delegations suggested using more objective criteria in allocating the budget as a whole, whereas others expressed concern that only 10% o f the budget was included in the country allocations. 2. The Regional Director, in his reply, pointed out that the specific strategies developed by the Regional Office meant that the bulk of the Regional Office’s work was in fact practical cooperation with countries, although for the purposes of budget presentation it figured as intercountry or regional activities. As a result, the country allocation was far more than 10% of the budget in reality. The Regional Director proposed to put the country strategy specific to the Regional Office on the agenda of the forty-ninth session of the Regional Committee. 3. Following a broad-ranging discussion in the Standing Committee of the Regional Committee (SCRC) on this subject in Eilat in December 1998 and in Copenhagen in April 1999. it was agreed to discuss this item during the forthcoming two sessions of the Regional Committee. 4. A two-step approach was agreed upon: • the Regional Committee will renew the key strategic issues at its forty-ninth session, including new ways of presenting the regional programme budget and the Regional Director's report and a new formula for country budget allocation together w ith the principles, management and organization of a renewed country strategy emerging from the new European scene as well as from global developments; • the Regional Committee would discuss the findi.igs o f the EUROHEALTF1 evaluation at its fiftieth session as well as a proposal for a icnewed country strategy for the Region. H i s t o r i c a l p e r s p e c t i v e - t h e e v o l u t i o n a r y a p p r o a c h 5. The Regional Office for Europe has always had a country programme, but over the decades there has beer, continuous and steady evolution towards a more strategic approach. 6. Already during the 1950s, 1960s and 1970s. Algeria. Morocco and Turkey received considerable support from the Regional Office in technical areas such as communicable diseases, maternal and child health, water and sanitation, whereas other countries profited from the very active fellowship programme. The 1970s saw increasingly close collaboration between the Regional Office and other Member States. The first family planning programmes were set up; programmes such as aging, accident prevention and training of health personnel facilitated intersectoral collaboration among other agencies and the Regional Office. Many of these programmes were supported by the United Nations, United Nations Development Programme, United Nations Fund for Population Activities and other sources. 7. In the 1980s, the adoption of the European health for all policy and its 38 targets was the beginning of a new era of public health in Europe. The Regional Office encouraged and supported the formulation of national health policies, in line with health for all, which made the work with the countries more strategic, involving a number o f new partners. During the 1980s, country programmes oriented towards health for all were set up in southern Europe and some of the socialist countries. 8. A very important new approach was introduced during the 1980s, when collaborative networks were established to reach out to and actively involve different sectors and groups at national and local levels. Thus a combined approach of developing national health policy based on health for all and these horizontal links to reach out to a wide range of partners in today’s complex societies resulted in the creation of a powerful movement. Four different types of collaborative network were set up: EIJR/RC49/8 p;ige 2 • fora of professional nongovernmental organizations (national medical, nursing and pharmacist associations); • settings (Healthy Cities, Regions for Health, Health Promoting Schools and others); • health problem-specific networks (such as the St Vincent Diabetes Network); and in the 1990s - geographical networks (CARNET, EASTNET, M1DNET and SOUTHNET). 9. In about 1990, a political earthquake changed the entire European scene. The number of countries in the European Region increased from 31 to 51, with major health problems in 26 of them. All these countries needed and requested support from the Regional Office at a time when its working budget was decreasing. Suddenly the Regional Office was faced with high demand for advice and material support from these countries, ten of which were going through devastating armed conflicts. 10. To respond to these challenges, the EUROHEALTH Programme for intensified collaboration with the countries of central and eastern Europe and the newly independent states was set up in 1991, and updated in 1995 with six priorities. In 1992 the Country Health Development Department was established to ensure adequate and coordinated support to the countries and to create and maintain the country presence of the Regional Office. 11. Thus the country work during the 1980s and 1990s resulted in a new way of working with the countries: a more focused and integrated concept, oriented towards policy, strategy and programmes. During the coming years further development is required, given the new challenges, which also provide new opportunities, such as United Nations reform, W H O reform, increased regional allocation, a growing number of new partners in countries and others. T o w a r d s a r e n e w e d E u r o p e a n c o u n t r y s t r a t e g y 12. A renewed country strategy will therefore have to be developed for the next ten years. It will build on the strength of the present approach specific to the Regional Office but will go further in a number of areas, as outlined below. This strategy will take into account the outcomes of the forthcoming EUROHEALTH evaluation, and it will be presented to the Regional Committee at its fiftieth session in September 2000. To guide the Regional Office’s work to produce that strategy, this chapter outlines a number of key issues. O bjective, scope and principles 13. Since 1991, when the EUROHEALTH framework was adopted, there have been significant developments in Europe. The Regional Office is now working in a complex and competitive environment with countries and groups of countries in very different stages of socioeconomic development, and therefore need different responses from WHO. A key concern is to match W H O ’s agenda with that of the countries and their expectations from WHO. The first challenge of the renewed country strategy is therefore how to reconcile the expectations of Member States with the capacity available. The second challenge is how to respond to the new developments inside and outside WHO. In this respect the most significant developments are the new global thinking of partnership with countries, the ongoing United Nations reform and the increased partnership with other international agencies. 14. The objective of the country programme is to support countries in their overall health development. In so doing, the Regional Office will give high priority to supporting countries in developing their long­ term national health policies and implementation plans in line with HEALTH21. 15. The scope of the country programmes should extend to all 51 European countries with well specified needs and responses. WHO needs to serve and be relevant to all countries in the Region. EUR/RC49/8 page 3 16. The principles will be fully in line with the global thinking that everything we do in WHO is work in, with and for countries. The totality of W H O 's work therefore has to be made available to Member States in a well organized way. The principles will therefore be: • improved coherence and relevance to countries' needs; • a more strategic approach, through a joint needs assessment by WHO and each country that can identify opportunities for making a real difference; • a broad multisectoral approach with links, alliances with other sectors and development partners (national and international); • a single, unified WHO cooperation strategy with contribution from all parts o f the Organization; • clarity on W H O ’s role: policy, advocacy and technical advice; and • an enhanced WHO country presence. Policy issues 17. The renewed country strategy will be guided by the following considerations: • Country health development in Europe should extend to the whole of the Region following the EUROHEALTH Programme evaluation in 2000. It will be recommended to move away from the EUROHEALTH name but not from the concept of giving intensified support to countries most in need, as having one programme framework to cover 26 countries in such very different stages of socioeconomic development is no longer justifiable politically. This will be replaced by an integrated approach to developing health in countries for the whole Region, linked to subregional political processes. During the next year, work will be done to identify strategic issues in the subregional political processes on which W H O ’s involvement would make a difference. At the same time, efforts will be made to further clarify the needs and expectations of all groups of countries as well as W H O ’s response to them, and this will feed into the detailed country strategy to be presented to the Regional Committee at its fiftieth session in September 2000. • To achieve major impact in countries, the WHO country programme must be strategic and relevant to the most important development objective of the government, as reflected by the main public health problems of the population. WHO country programmes therefore must be involved in the major health development issues of the countiy with a broad-based multisectoral and multiagency mechanism. • The approach specific to the Regional Office of working with countries in two ways should be retained, as this has proved to be an asset in the Regional Office (they would also seem to be relevant to other parts of WHO). This includes keeping the key role of the Regional Office’s technical departments and units in active delivery of country programme activities (see paragraphs 39-47). In working with individual countries, the large collaborative networks o f the Regional Office (such as Healthy Cities, Health Promoting Schools and CARNET) should be used to stimulate HFA-oriented developments. • The Regional Office’s country presence should be strengthened in two ways. The existing system o f liaison offices should be enhanced by further strengthening their role, clarifying relations with technical units and other partners and providing training. In addition, when needed and when resources permit - public health advice should be provided through international experts on a country and multicountry (area office) basis, based either in Copenhagen or in the field. • A comprehensive system for evaluating country programmes should be developed - in line with the forthcoming global mechanism for evaluating country work. M anagem ent 18. The strategic country programmes will be based on a rolling planning horizon developed for a longer time span (4 -6 years) and will incorporate input from any level of W HO that may contribute. The country-specific support in the European Region should remain the prime responsibility of the Regional HI1R/RC 49/S page 4 Office, which will draw on the knowledge, experience and expertise of WHO headquarters and other regions (as applicable). 19. The planning of the country programme will be further improved, parallel to the increased regional allocation. Joint planning will be earned out by W HO and each country, identifying areas where a difference and impact can be expected, with a WHO team visiting the country and linking up with other relevant agencies. 20. Clearer guidelines for using country funds and ground rules for preparing, implementing and following up country visits will be developed. 21. An improved evaluation mechanism will be developed as a regular feature of the country work. Organization 22. The Country Health Development Department (with its subregional desks and liaison offices) will work very closely with the Regional Office’s technical departments and with their national counterparts at the country level. To increase the capacity of the Regional Office to implement the country programme, further use of European centres, WHO collaborating centres and European collaborative networks will be made. 23. To strengthen the country presence of the Regional Office in the functions for which a combination of national and international staff is advisable (such as policy dialogue, coordination with international agencies and capacity-building), the possibility of establishing subregional area offices may be tested out in one or two areas in the next biennium with a strong evaluation mechanism attached to it. The latter is crucial, as such an innovation may have positive as well as negative aspects. T h e t o t a l i t y o f t h e R e g i o n a l O f f i c e ’s s u p p o r t t o c o u n t r i e s Country budget allocation 24. World Health Assembly resolution WHA51.31 recommended that the regional, intercountry and country allocation in W H O ’s future global programme budgets approved by the Health Assembly should for the most part be guided by a model that draws on the Human Development Index of the United Nations Development Programme, possibly adjusted for immunization coverage, incorporating population statistics w'ith logarithmic smoothing. 25. The same resolution also stipulates two additional issues that are relevant and important for allocating the country budget. • The additional funds resulting from the reallocation should flow to the country level. • The regions themselves should determine the partition between country, intercountry and regional office budgets. 26. There will be regular reporting back to the Executive Board and World Health Assembly, starting already in January 2000, on details of the model and on the regional, intercountry and country allocation applied in the 2000-2001 biennium. 27. In response to WHA5 1.31, resolution EUR/RC48/R9 (operative paragraph 5) states: INVITES the SCRC and the Regional Director to review, paying particular attention to resolution WHA51.31, the principles related to and criteria used in the determination of all country allocations in the European Region, with a view to developing an allocation model based on objective criteria, and to report back to the Regional Committee at its forty-ninth session. EUR/RC49/8 page 5 28. In close collaboration with WHO headquarters, the Regional Office has accordingly developed options for country budget allocations for consideration by SCRC and thereafter the Regional Committee for Europe. General considerations 29. The principles to be followed for the 2000-2001 programme budget have already been laid down by resolution EUR/RC48/R9. to the effect that the first increase of allocation in biennium 2000-2001 (US $2.2 million, out of which 2 million to country operations and 0.2 million to staff support) will be equally divided among six countries qualifying as “ Iow-income” countries according to the World Bank’s definition (Armenia, Azerbai jan, Bosnia and Herzegovina, Kyrgyzstan, Republic of Moldova and Tajikistan). 30. With regard to the proposed 2002-2003 programme budget, the total allocation for distribution among countries is expected to consist of the following three parts:1 Current country allocation in regular budget US $2.9 million Supplement released in 2000-20011 US $2.2 million Supplement released in 2002-20032 US $2.2 million 31. W HO's global allocation formula stipulates that, in any case, country budgets will be allocated only to countries with a gross national product per person below the World Bank definition of “high- income countries” (currently US $9636, comprising 29 countries in the Region), and it will be reviewed every two years when budgets are drawn up. The allocation of the country budget will favour countries “ in greatest need” , in the spirit of the World Health Assembly and Regional Committee resolutions. 32. The country budget for liaison offices would be maintained at a minimum of US $2.3 million; however, strengthening the country presence may be necessary (see paragraphs 17-23). in which case this amount would be increased further. Allocation model for 2002-2003 and beyond 33. While the Regional Committee took a decision at its forty-eighth session to allocate the increased budget for 2000-2001 - US $2.2 million - by giving an equal amount to the six most needy countries in the Region, it also asked for a formula for the future. In approaching such an analysis, it might be useful to first keep in mind what will be the final situation desired when the present system of transfers from other regions to the African and European Regions is over. According to the present assumptions, this situation would be reached in the 2010-2011 biennium, at which time there would be a total of US $14 million for country programmes (excluding country presence funds) for distribution among the beneficiary countries in the European region. Which formula should be used at that time? In the view of the SCRC, the most practical and most fair would be to use only the Human Development Index. There are two reasons for this. 34. On the one hand, it is an internationally used and widely recognized index that is fairly simple and that includes key elements of development (gross national product per person, literacy rate) as well as one composite health indicator that reflects well the totality of a country’s health experience (life expectancy at birth). The second argument supporting the use of the Human Development Index is that it will be in line with resolution WHA51.31. It should be noted, however, that immunization coverage has not been included, on purpose, as it is felt to be a parameter that is subject to very rapid change and could furthermore act as a disincentive to good public health work by the countries concerned. 35. When the Human Development Index is applied to the 29 countries in the Region below “high- income" status (but giving no allocations to Yugoslavia since its membership status is not clarified at this stage), the result would be as indicated in Annex 1. 1 According to the proposed programme budget. 2 Assumption only; no planning guidance available yet (June 1999). EUR/RC49/S page 6 36. If this, then, should be the ultimate goal for allocation of country programme funds to the countries in the European Region, how should one proceed from 2002-2003 until the final goal is reached in 2010-2011? The SCRC in April 1999 spent considerable time discussing a wide range of alternatives for this and agreed on the following principles. • Every country should gain and none should lose: until the final stage of the transition period, no country’s allocation should be reduced from its 2000-2001 level. Thus, none of the six countries identified by the Regional Committee at its forty-eighth session (see resolution EUR/RC48/R9) as being in greatest need would go below their allocation of 2000-2001 until they reach their final allocation in 2010-2011. • The Human Development Index should be introduced gradually until countries reach their final allocation in 2010-2011. • Any country (other than the six) that reaches its 2010-2011 allocation before that biennium remains at that level until 2010-2011. 37. The SCRC therefore proposes the following model. • For 2002-2003, the six countries in greatest need keep will their 2000-2001 allocation. Yugoslavia would get no allocation, unless the problem of its membership status has been solved by then. The additional US $2 million of 2002-2003 is distributed to each of the remaining 22 countries according to the Human Development Index and then added to the 2000-2001 allocation of each of these countries. • In subsequent biennia, the same model would be applied: any new increased allocation would be distributed according to the Human Development Index and added to the allocation the country had during the previous biennium - until the country reaches its 2010—2011 allocation. • As from 2010-2011, only the Human Development Index should be used for the total country funds. 38. Annex 1 gives a country by country presentation of the allocations for 1998-1999. 2000-2001. 2002-2003 and 2010-2011. Current level of W HO support to countries 39. During the programme budget discussions for 2000-2001 at the forty-eighth session of the Regional Committee, the Regional Director promised the Regional Committee that better ways would be found to present a true picture of the Regional Office’s total support to countries, without the constraint of conforming to global definitions. 40. In fact, despite the cuts in its regular budget, the Regional Office has responded rather forcefully to the changes in the political, economic, social and health situation in the European Region in the 1990s. Even during the substantial budget cuts the Region had during the 1990s, the country programme was always given highest priority. As a result, the percentage of the total regular budget that went to the country level almost doubled, as can be seen by comparing the figures in Annex 2: Regional Office for Europe Country Support Funds 1990-1991 and 1998-1999. Furthermore, the strength gained in the Region through the strong interaction between intercountry and country programmes, as well as the new innovative collaborative networks, was perhaps even more important. 41. There is a great problem, however, with the current form of presentation of the budget. The difficulty is that the global definitions used in the programme budget do not enable the above specificity of the Regional Office’s modality of work to be properly and accurately reflected. Currently, the Regional Office component of the budget comprises governing bodies, administration, finance, building maintenance and senior management. The country budget is described as the portion of the budget (10%) that is either exclusively for programme activities in a particular country according to “the country allocation” or for maintaining W H O ’s country presence. Although much of the budget for intercountry programmes is used to directly support the development of national programmes in technical areas in HUR/RC49/8 page 7 countries, this part is not classified as "country support". Likewise, the Regional Office's collaborative networks (such as Healthy Cities) - which act as the interface between intercountry and country programmes, are based entirely in countries and create a horizontal, multidimensional, and societal movement to reach out to a multitude of national partners - are today not classified as "country support" at all. 42. Staffing - a major part of the Regional Office’s budget allocation - is not visible in its true contribution to country work. This is a particular problem in the European Region, where the Copenhagen-based programme managers implement country and intercountry programmes and run the collaborative networks. The activity of the Country Health Development Department - in particular, the Emergency Assistance and EUROHEALTH programmes - are directed exclusively towards the countries and yet they are not classified under the country budget! Technical programme staff spend much of their time directly supporting country operations, and many spend more than half of their time on this. Since staff costs account for 66% of the total regular budget and their location is mostly at the Regional Office, the current way of presenting the WHO programme budget inevitably gives a misleading picture - low Regional Office support to countries - while the reality is quite different. 43. A breakdown of the non-staff (that is, programme) costs gives a somewhat more accurate picture of the reality and shows a clear and increasing share for the country programme element between the 1990-1991 biennium and the 1998-1999 biennium. There is also a difficulty here in the programme budget presentation, as the full costs of the following types of activity (selected examples) are not classified as country programmes: • duty travel of staff to countries, including advising on policy development, implementing country medium-term programmes or supporting the country in its effort to implement specific national initiatives; • developing and supporting the collaborative networks and other multicountry (Europe-wide) projects and activities implemented at the country level; and • activities that benefit every Member State by making existing knowledge better known and enabling individual countries to readily share and learn from their own successes and failures (such as the continued maintenance, updating and dissemination of the HFA database). 44. In order to provide a quantified estimate of the problem, the Regional Office chose a number of technical programme areas such as Poliomyelitis Eradication, Health Services Management and Pharmaceuticals to carry out an ad hoc analysis o f the above issues. Based on estimates of staff time devoted to country work in these units, it has been calculated that some 50% of intercountry programmes and Regional Office costs are in reality direct country support. The revised breakdown of staff and non­ staff costs between regional, intercountry and country programmes uses the estimates specified below: • 50% of non-staff intercountry programmes (including duty travel costs) are estimated as directly beneficial to countries; • 100% of the staff of EUROHEALTH. the Emergency Assistance Programme and some technical programme areas (such as Health Care Policies and Systems), 75% of some other programmes (Pharmaceuticals, etc.) and about 50% of other programmes should be classified as country support; • 100% of country programme funds are (naturally) listed as country activities and include two elements: programme activities specified in the country medium-term programme, and maintenance of liaison offices, communications, etc. 45. Annex 2 compares the programme budget approved for the Regional Office for 1990-1991 and for 1998-1999 and what the presentation would be, if the above estimates had been used. The figures for 1998-1999 reveal that, whereas the programme budget shows 11% for country programmes, the reality should be 52% (34% plus 18%). Similarly, the intercountry programmes should be not 49% as shown in the programme budget, but rather 23%. Last, but certainly not least, the Regional Office element in the EUR/RC49/8 page 8 programme budget, shown as 30%, should probably be only 25%. The figure also shows the strong increase in country support from 1990-1991 to 1998-1999: the programme budget figure rose from 6% to 1 1%, and the estimate rose from 38% to 52%. 46. Thus, in conclusion, the present classification shows quite a distorted picture of the true extent of the support the Regional Office (and probably WHO overall) provides to countries. Such support is likely to be very much higher than should be inferred from the official documents - possibly representing over 50% of the overall Regional Office budget. 47. Although the analysis in this section at this stage only represents a rough estimate, based on a sample of programmes, there is little doubt that the main conclusion is correct. The way W H O ’s programme budget is presented today gives an inaccurate picture of the reality of the work done by the Organization and invites unjustified attacks from people who want to portray WHO as a bureaucracy that does not use its resources to support countries. How can this be changed? P o s s i b l e a c t i o n Action at the level of W HO headquarters and the global governing bodies 48. The fundamental problem lies in the way that WHO classifies its staff and activities. The logical solution to the problem is therefore to change those classifications. This can be done if the Director- General takes this issue up with the Executive Board, and the Regional Committee may therefore wish to encourage the Director-General to do so. Action at the level o f the European Region 49. Even if change is not undertaken at the global level of the organization, the Regional Committee can decide, if it so u'ants, to take action specific to the European Region. Two official documents would seem important in this context. 50. The first is the Regional Director’s report on the work of the Regional Office. At the moment, no data collection system can give the information required to present a reliable picture of the type sampled on an experimental basis in the study referred to earlier in this section. However, as of January 2000, it is expected that the Regional Office will have introduced W H O ’s new Activity Management System (AMS), and it is expected that this system will enable reports to be made that can provide the information required. Thus, the Regional Director’s report for the 2000-2001 biennium could be structured so as to give this information. However, it would be of advantage to have some experience with the functioning of that system before drawing firm conclusions with regard to its validity. It is therefore proposed that the SCRC at its meeting in April 2001 discusses that experience and endorses a framework for the Regional Director’s report for the 2000-2001 biennium that specifies how the country support information is to be presented. 5 1. The second possibility is the document on the European Regional programme budget. Although the Region will have to follow whatever general structure is decided by headquarters at any one time for the regional programme budgets of the Organization, there would be no problem in including additional elements in the document to be discussed by the Regional Committee, should the Regional Committee so wish. This can be done either as additional columns in tables, as additional and specified text elements in different chapters or, perhaps most easily, by a special annex that deals comprehensively with the issue. Such additional elements specific to the European Region would then not be included in the European Region’s part of the global programme budget document that goes to the World Health Assembly but remain only in the version presented to the Regional Committee. Nevertheless, it will be of considerable advantage to have such a presentation, as it would give the M ember States of the Region a better understanding of the work of the Regional Office. It would also provide a source of information that could be officially referred to in the public debate. EUR/RC49/S page 9 52. Should the Regional Committee endorse such a proposal, it could probably not be included until the programme budget 2004-2005. as it should rely on the experience mentioned above in introducing the new AMS, and this experience will not be available in time for the preparation of the 2002-2003 programme budget. C o n c l u s i o n 53. The Regional Office for Europe has strengthened its emphasis on country support in recent years through preferential allocation of its budgets, through the creation of country offices and a country health department and through the rapid growth of collaborative networks - the latter representing a new strategy in applying intercountry policies and tools at the local level. The European developments will be further enhanced by the new emphasis given to country support by the reform processes started at WHO headquarters during the last 12 months. 54. The increased allocations for country programmes that will flow to the European Region (and the African Region) through interregional transfers over the coming decade will further enhance the possibility for strengthening country programmes. The Regional Committee is presented with a proposal to change the regional allocation principle so as to base it on the Human Development Index and a logarithmically stretched population figure, with a “phasing in” over the next four or five biennia. 55. W H O 's current classification system gives a distorted view of the effort that the Organization currently undertakes - at least in the European Region - in supporting countries. The Regional Committee is presented with proposals for correcting this situation, either by encouraging the Director- General to take steps to modify the current classification system and/or to undertake changes in the Regional Director's report and the regional programme budget for 2000-2001 and 2004-2005, respectively. 56. The Regional Committee is also asked to endorse a number of the principles and policy issues regarding management and organization that will subsequently guide the Regional Office's work in producing an updated country strategy to be decided at the fiftieth session of the Regional Committee. EURVRC'49/8 page 10 Annex I Country budget allocations proposed for 2002-2003 and 2010-2011 C o u n try 1 9 9 8 - 1 9 9 9 A p p ro v e d 2 0 0 0 - 2 0 0 1 P r o p o s a l s fo r 2 0 0 2 - 2 0 0 3 P r o p o s a l s fo r 2 0 1 0 - 2 0 1 1a A lb a n ia 1 3 0 0 0 0 1 3 0 0 0 0 1 9 8 2 0 0 3 8 3 9 0 0 A r m e n ia 1 3 0 0 0 0 4 6 3 3 3 3 4 6 3 3 3 3 3 6 9 4 0 0 A z e r b a i ja n 1 3 0 0 0 0 4 6 3 3 3 3 4 6 3 3 3 3 5 5 7 2 0 0 B e la r u s 1 3 0 0 0 0 1 3 0 0 0 0 1 9 3 5 0 0 3 5 7 6 0 0 B o s n ia a n d H e r z e g o v in a 1 3 0 0 0 0 4 6 3 3 3 3 4 6 3 3 3 3 2 8 8 7 0 0 B u lg a r ia 5 0 0 0 0 5 0 0 0 0 1 0 6 7 0 0 3 1 9 1 0 0 C r o a t ia 1 3 0 0 0 0 1 3 0 0 0 0 181 9 0 0 2 9 2 0 0 0 C z e c h R e p u b lic 5 0 0 0 0 5 0 0 0 0 8 3 8 0 0 1 9 0 4 0 0 E s to n ia 5 0 0 0 0 5 0 0 0 0 8 6 2 0 0 2 0 3 8 0 0 G e o r g ia 1 3 0 0 0 0 1 3 0 0 0 0 2 1 4 3 0 0 4 7 4 3 0 0 H u n g a r y 5 0 0 0 0 5 0 0 0 0 91 0 0 0 2 3 1 1 0 0 K a z a k h s t a n 1 3 0 0 0 0 1 3 0 0 0 0 2 4 1 9 0 0 6 3 0 2 0 0 K y rg y z s ta n 1 3 0 0 0 0 4 6 3 3 3 3 4 6 3 3 3 3 4 4 6 6 0 0 L a tv ia 5 0 0 0 0 5 0 0 0 0 1 0 2 1 0 0 2 9 3 2 0 0 L ith u a n ia 5 0 0 0 0 5 0 0 0 0 1 0 0 4 0 0 2 8 4 0 0 0 M a lta 5 0 0 0 0 5 0 0 0 0 5 5 5 0 0 5 5 5 0 0 P o la n d 5 0 0 0 0 5 0 0 0 0 1 3 8 5 0 0 4 9 8 1 0 0 R e p u b l ic o f M o ld o v a 1 3 0 0 0 0 4 6 3 3 3 3 4 6 3 3 3 3 4 7 1 5 0 0 R o m a n ia 5 0 0 0 0 5 0 0 0 0 1 4 9 3 0 0 5 5 8 8 0 0 R u s s i a n F e d e r a t io n 2 0 0 0 0 0 2 0 0 0 0 0 6 0 7 3 0 0 2 2 9 3 0 0 0 S lo v a k ia 5 0 0 0 0 5 0 0 0 0 7 8 6 0 0 161 1 0 0 S lo v e n ia 5 0 0 0 0 5 0 0 0 0 6 8 5 0 0 1 0 4 4 0 0 T a j ik is ta n 1 3 0 0 0 0 4 6 3 3 3 3 4 6 3 3 3 3 5 8 2 7 0 0 T h e F o r m e r Y u g o s la v R e p u b lic of M a c e d o n ia 1 3 0 0 0 0 1 3 0 0 0 0 1 7 3 2 0 0 2 4 3 2 0 0 T u rk e y 2 0 0 0 0 0 2 0 0 0 0 0 3 9 0 9 0 0 1 0 7 4 8 0 0 T u rk m e n is ta n 1 3 0 0 0 0 1 3 0 0 0 0 2 0 3 1 0 0 411 7 0 0 U k ra in e 1 3 0 0 0 0 1 3 0 0 0 0 3 7 0 9 0 0 1 3 5 5 9 0 0 U z b e k is ta n 1 3 0 0 0 0 1 3 0 0 0 0 2 8 4 2 0 0 8 6 8 1 0 0 Y u g o s la v ia 5 0 0 0 0 5 0 0 0 0 0 0 T o ta l 2 9 5 0 0 0 0 4 9 4 9 9 9 8 6 8 9 9 9 9 8 14 0 0 0 3 0 0 a D is tr ib u te d a c c o r d in g to th e H u m a n D e v e lo p m e n t In d e x o n ly . EUR/RC4‘)/8 page 11 Annex 2 WHO Regional Office for Europe Country Support Funds, 1990-1991 and 1998-1999 1990-1991 1 999 estim ate As sho w n in 19 9 0 -1 9 9 1 p rog ra m m e b u dge t 1998-1999 1999 estimate As shown in 1998-1999 programme budget Country support: staff non-sta ff In tercountry: sta ff □ non-s ta ff □ R egional O ffice : staff non-sta ff