WHO Reform Progress and Implications for the European Region
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Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, on 14 September 2015, at the 65th session of the WHO Regional Committee for Europe (Vilnius, Lithuania, 14–17 September 2015)
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WHO Reform Progress and Implications for the European Region
- 1. WHO Reform Progress and Implications for the European Region Dr Zsuzsanna Jakab Regional Director
- 2. WHO reform: progress and implications • Fifth consecutive report to Regional Committee (RC) • Annual rolling plan on implications of reform for Europe • Document EUR/RC65/15 gives broad overview of progress • Five key areas covered in 2015 by global governing bodies: – strategic budget space allocation – framework for engagement with non-State actors – reform implementation, with emphasis on governance reform – strengthening WHO accountability framework – global staff mobility, as part of human resources reform.
- 3. Related reform issues to be discussed In addition to an overall review of progress on WHO reform, agenda item 5 (h) includes separate presentations on: • WHO work in outbreaks and emergencies, with health and humanitarian implications • overview of global governance reform • accountability and compliance.
- 4. Strategic budget space allocation • Key issue of reform: how to find a rational, fair and equitable methodology for allocating the budget among HQ and the six regions; • Two major exercises undertaken in the past – both since discontinued; • This time, Member State-driven through Programme, Budget and Administration Committee (PBAC) Working Group (WG); • After long and difficult negotiations, consensus at 137th session of Executive Board (EB) only on technical cooperation with countries (segment 1); • Tribute to the active involvement of European Member States, and to Chair of PBAC WG (Dr Dirk Cuypers, Belgium).
- 5. Strategic budget space allocation: implications • Broad agreement reached at EB136 (January 2015) on general principles to be applied for budget segments 2, 3 and 4; • Consensus decision EB137(7) relates only to segment 1 – technical cooperation at country level, amounting to US$ 933 million; • WHO Regional Office for Europe share of segment 1 to gradually increase from 5% to 6.4% over next three bienniums; • Due to 8% overall budget increase, no net reduction to any Region in 2016–2017; • Regional Office pilots application of methodology for allocation of assessed contributions among biennial collaborative agreement countries for 2016–2017.
- 6. WHO engagement with non-State actors • Of key importance to the overall governance of global health; • Has been discussed repeatedly – and inconclusively – over four years; • Main impediments continue to include: – conflict of interest – transparency – resources – role of the Engagement Coordination Group – feasibility of the implementation. • World Health Assembly adopted resolution WHA68.9 on the way forward.
- 7. Non-State actors: next steps • Consensus reached through WHA68.9 that process must be concluded by Sixty-ninth Health Assembly in 2016, following final review by EB138; • Following Sixty-eighth Health Assembly, open-ended intergovernmental meeting convened 8–10 July 2015, with good progress; • Further informal session before next formal meeting scheduled for 7–10 December 2015; • Implications for European Region: Standing Committee of the Regional Committee (SCRC) to review Regional Office partnership strategy following global agreement.
- 8. Overview of reform implementation • Important lessons learned from unprecedented complexity and scale of Ebola outbreak; • Separate discussion on this issue scheduled later this afternoon; • In addition, weaknesses in progress and coherence of governance reform identified by EB136 and Chair of Independent Expert Oversight Advisory Committee; • Member State consultative process on governance reform established: Estonia and Russian Federation represent European Region in WG; • Separate discussion also on this issue later today.
- 9. Governance reform: European perspective • European Member States proactive on governance reform since 2010, with successive subgroups set up by SCRC • Summary of European governance reform initiatives posted on Headquarters website, covering: – procedures for nomination of Regional Director – strengthening governance oversight by RC and SCRC – management of RC agendas – management of resolutions and amendments – transparency of and criteria for nomination of members to the EB and the SCRC.
- 10. Accountability and compliance: regional perspective • 2011: Compliance team formally established • 2012: Financial certification introduced for contracts exceeding US$15 000 • All 36 country offices and geographically dispersed offices routinely reviewed for financial compliance according to a risk assessment • Sharp decrease in single source contracts • No long-outstanding open audit recommendations for Regional Office • SCRC is regularly informed through extensive oversight reports • Separate presentation to be provided by I. Hollo, Division Director, Administration and Finance.
- 11. Human Resources reform: global mobility scheme • Consequences of Ebola outbreak: difficulties in managing rapid deployment of 700 staff – later revised upwards to 1000 positions; • New mobility scheme: gradual implementation from early 2016; • Initially on voluntary basis – after 2018, mandatory for all staff holding rotational posts in P and D categories; • Best guess: to probably involve 300–400 staff movements per year; • Overall cost: between US$ 8–9 million per biennium.
- 12. Reform of WHO work in outbreaks and emergencies with health and humanitarian consequences • An active process overseen by WHO Director-General – the Advisory Group on Reform of WHO’s Work in Outbreaks and Emergencies with Health and Humanitarian Consequences – a Project Secretariat • With a six-step roadmap: – a unified WHO programme for health emergencies – clear performance metrics for the programme, built on partnerships with other responders – a global health emergency workforce – a new business processes to facilitate a rapid and effective response – a contingency fund – accelerated research and development in epidemics or health emergencies.
- 13. Thank you
Notas do Editor
- This is my 5th report to the RC on progress in implementing the WHO Reform Agenda, including the implications for the European Region. The document in front of you gives an overview of development during the last 12 months since we last met, indicating progress under each of the 5 key reform areas you see listed on this slide: Strategic budget space allocation; Framework for engagement with non-State actors; Overview of reform implementation, with particular emphasis on governance reform; Strengthening the Organization’s accountability framework; and Planning for the new global mobility scheme for staff, as part of overall HR reform. Issues of particular relevance to the European Region have been highlighted. And there is an Annex to the document, which provides a summary of reform initiatives undertaken in the European Region over the last 5 years.
- For this afternoon, and in addition to the overall presentation on progress of reform as set out in document EUR/RC65/15, we are planning to also discuss 3 important and related issues: Reform of category 5 on health emergencies and response,based on the lessons learned from the Ebola outbreak in West Africa, and we are fortunate to have Dr Guenael Rodier from HQ with us here today to brief you on this issue; Overview of global governance reform, which will be covered by the distinguished delegates from Estonia and the Russian Federation, acting as the European Region’s representatives on the global goverance Working Group; and finally Mr Imre Hollo, our Director of Administration and Finance will take you through what the European Regional Office is doing in the area of accountability and compliance with the Organization’s administrative processes.
- The issue of strategic budget space allocation has been a cornerstone of the WHO Reform process ever since it started in February 2010, with the discussions on the ’Future of Financing for the Organization.’ As many of you will recall, earlier attempts had been made in 1998, culminating with Resolution WHA51.31, but limited to the regular budget, and again in 2006, as a post facto internal validation mechanism for HQ and regional allocations. This time around, however, it was different, as it was initiated and driven by Member States from the beginning, through a PBAC Working Group, chaired most admirably by Dr Dirk Cuypers from Belgium. The Working Group was later expanded by the 136th session of the Board, and Dr Outi Kuivasniemi from Finland also joined as a European Representative. The work started with concentrating on guiding principles and defining criteria first, before diving into statistical models. In retrospect, this approach was key to the success of the undertaking and the SCRC has played a very important role in providing structured input with a global perspective to the PBAC Working Group. The PBAC Group also decided to concentrate only on Segment 1 – technical cooperation with countries – for the time being. Once the overarching principles were set and the relevant criteria were identified, the expanded PBAC Working Group met both in April in Geneva and again on the margins of the 68th Assembly, considering a number of models and algorithms. The fact that it managed to bring such difficult issues to a resolution by consensus by the 137th Board is truly remarkable and a tribute to both the active involvement of European Member States, and in particular to the chairmanship of Dr Dirk Cuypers of Belgium. Thanks to this work, today we have a more solid foundation of budget allocation among major offices for Segment 1.
- As you will see on this slide, there were early and broad agreement on the general principles to apply to budget segment 2 (Provision of global and regional public goods), segment 3 (Administration and managment) and segment 4 (response to emergency events, such as outbreak and crisis response). Nearly all of the PBAC Working Group’s discussions and deliberations therefore concerned budget Segment 1: Technical cooperation at country level, amounting to $ 933 million globally. In an extensive report to EB137 in May this year the Working Group outlined step-by-step the process it had followed to arrive at a scientifically–based model that took the different needs and development status of all WHO regions into account. While EURO’s increased share of segment 1 was in the final analysis smaller than earlier models had predicted, there were fully justifiable reasons for this, based on revised criteria and thresholds. The final outcome, pointing to a gradual increase for the European Region from 5% to 6,4% for category 1 was therefore supported by all Member States as well as by the Secretariat. It is also worth noting that, at least for 2016-2017, there will be no net reduction in the overall budget allocation for any of the 6 regions, as decreases in Category 1 for WPRO, SEARO and EMRO will be offset by the overall budget increase of 8% endorsed by the Assembly. In order to bring this work further in EURO, we have started to use this methodology for distributing assessed contributions among BCA countries for 2016-17. The initial figures and relative allocations underscore the robustness of the SBSA methodology.
- As far as a Framework for engagement with non-State actors is concerned, this is not only of key importance for the Organization’s interaction with other stakeholders in international health, but it has unfortunately also developed into the most complex issue of the entire reform process. In spite of the tireless and unwavering stewardship of the Argentine Chair during 9 consecutive meetings held on the sidelines of the 68th Assembly, several sticking points still exist notably as concerns conflict of interest; transparency; resources, the role of the Engagement Coordination Group; and feasibility of the implementation. Many Member States have requested WHO to look at the feasibility to implement the framework and we are currently working on a paper that will be presented prior to the next meeting. On the last day of the Assembly, Resolution WHA68.9 was however adopted, outlining the next steps and the way forward on this difficult issue. If a question arises on feasability of implementation: We are currently looking at this, and have, as a start, calculated how many ’engagements’ we have had over the first six months of this year. Including our coountry offices, the number of NSAs which we have had contact with is around 800, many times with multiple engagements. All these NSAs need to be in the register and for each NSA we need to go through a due diligence review.
- Following adoption of the way forward by Resolution WHA68.9, good progress was made in yet another intergovernmental meeting on the subject, held in Geneva on 8 – 10 July. Currently there are informal meetings to move forward specific topics and a new session of the intergovernmental meeting is scheduled for 7 – 10 December. Hopefully those discussions will lay the basis for an agreement to be tabled at EB138 in January 2016, with final adoption by the 69th Assembly in May 2016. The European Region will then revise its own Partnership Strategy through the SCRC, for presentation to RC66 in September 2016.
- As stated by the Director-General during her address to the 68th World health Assembly, the Ebola outbreak had pushed the process of WHO reform into high gear, and had shook the Organization to its core. The outbreak had also clearly pointed out the need to accelerate reform in areas such as the complementary roles and functions of the 3 levels of the Organization with regard to emergency situations; human resource reform and the capacity to rapidly mobilize human resources to meet urgent needs at the country level; and resource mobilization, providing quick access to adequate financing. You will hear more about these issues a bit later this afternoon through Dr Rodier’s presentation on Reform of Category 5. In addition, however, a view was expressed both by Member States attending the January session of the Board, as well as by the Chair of the Independent Expert Oversight Advisory Committee that there were general weaknesses in the progress of governance reform. An inclusive Member State consultative process was therefore established through Decision EB136(16). Estonia and the Russian Federation are Europe’s representatives on the Working Group, and they will brief us on progress also a bit later this afternoon.
- I need hardly remind any of you of the priority given by the RC and the SCRC ever since 2010 on the issue of governance reform in the European Region. A summary of those initiatives has been posted on the HQ reform webage, explaining action taken on the issues listed on this slide. In addition, the document in front of you (EUR/RC65/15) includes an Annex, which also gives a brief overview of all reform initiatives within the region, - for your information.
- As many of you will recall from the discussions at PBAC and the Assembly this year, questions were raised by Member States regarding a number of unsatisfactory internal audit reports, and whether or not this was indicative of a culture of tolerance of non-compliance with rules and policies. There remains, and always has been, zero tolerance in the Organization on non-copmpliance, and i wish to assure the Regional Committee on action taken over the last few years in the European Region to continuously strengthen our vigilance in this cruical area, as you will see from this slide. (Bullet points are self explanantory) The European Region already has a robust internal control framework in place as it is evidenced by the generally positive audit reports of the past years. Several of our country offices along with the Regional Office have been audited and they all found that the most important control mechanisms were in place. This does not mean, however, that there is no room for improvement. I would like to use the important initiatives from EMRO and AFRO and connect performance appraisal with compliance targets. In the interest of time, I do not wish to dwell further on these points, but would like to refer you to the presentation which will come a bit later later this afternoon by our Director of Administration and Finance, Mr Imre Hollo who will go through the main audit findings of the past 3 years, which in itself is a new initiatives and signals the importance EURO gives to audit recommendations.
- The Ebola outbreak was indeed a defining moment for the work of WHO, and the Organization’s ability to rapidly mobilize both financial and human resources to repond to the crisis. While we should not delude ourselves to believe that a global mobility scheme would be enough to resolve staff deployment in a new crisis, it is nevertheless clear that such a system will contribute to resolving at least some of the HR weaknesses identified by the Ebola Interim Assessment Panel in its report to this year’s Assembly. At present, as a first step of the process all Major Offices are in the process of identifying rotational and non-rotational posts. In the European Region, we expect a number of around 15 to 20 posts to emerge, which will represent just under 10% of the internationally recruited workforce. While mobility of staff is very important, we also have to ensure that Euro’s technical excellence in highly complex and context specific areas is preserved. This is the only way we can acertain that we remain relevant to our Member States. Globally, as you see on this slide, the current estimate is that the mobility scheme will involve some 3-400 staff movements per year, at a cost per biennium of around US $ 8 – 9 million. We will of course keep both the SCRC and future RC sessions fully informed on developments in this area, but at the present moment this is really work-in-progress, as the process has only recently started. Chair, - that concludes my presentation on the overall thrust and progress of reform in WHO, but there are, as mentioned, additional separate presentations related to this agenda item which i believe will be of interest to the Committee.. I thank you for your attention.
- The unprecedented Ebola outbreak in West Africa, which is not yet fully over, has led to many reviews on how to improve preparedness and response of WHO and the international community. The Report of the Ebola Interim Assessment Panel, the Executive Board Special Session on Ebola and the World Health Assembly have all underlined and requested WHO to reform its work in Outbreaks and Emergencies with Health and Humanitarian Consequences. The WHO Director General has initiated and is overseeing an active process. She is guided by a high-level Advisory Group specially set up to provide advice for WHO’s work in outbreaks and emergencies, and a project Secretariat. In addition other process feed into the internal effort, such an IHR Review Committed specially established to look at the role of the IHR(2005) in the Ebola Outbreak and Response. You will hear more on the what has been done so far and future planned actions, especially in relation to the six step approach as outlined by the Director General later during the session from Dr Rodier.